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COPYRIGHT DEPOSIT 






HOW TO 
KEEP WELL 



DR. EVANS' 
* HOW TO * 
KEEP WELL 

A HEALTH BOOK 
FOR THE HOME 



BY 

W. A. EVANS, M.S., M.D., LL.D., D.P.H. 

President of The American Public Health Association, 1916-1917, Former Commissioner of 
Health of the City of Chicago, Editor Health Department of the Chicago 
Tribune and Other Newspapers, Professor of Sanitary Science in the 
Northwestern University Medical School, Ex-President of the 
Chicago Medical Society, Ex-President of the Illinois 
Society for the Prevention of Tuberculosis, Mem- 
ber of: the American Medical Association, 
The National Society for the Study and 
Prevention of Tuberculosis, The 
National Safety Council, 
Chicago Infant Wel- 
fare Society, 
Etc. 




WITH COLORED PLATES AND OVER FIVE HUNDRED 
ILLUSTRATIONS IN THE TEXT 



PUBLISHED FOR 

SEARS, ROEBUCK AND CO. 
D. APPLETON AND COMPANY 

NEW YORK 

1917 






COPYRIGHT, 191 7, BY 

D. APPLETON AND COMPANY 



m 



JAN -4 1917 



Printed in the United States of America 



©CI.A455010 



TO MY WIFE 



WHO MAKES IT HER DUTY 
TO KEEP ME WELL 



"Why shouldest thou die before thy time?" 

— Eccl. 7:17. 



PREFACE 

While Health Commissioner of Chicago, I was invited by the Chicago 
Tribune to take charge of a Health Column ("How to Keep Well") which 
they proposed to establish. The proprietors of the Tribune said they believed 
that by joining them not only could I continue the good that I was doing 
for the people of Chicago as Health Commissioner, but that I could reach 
more people and make my work of much wider influence through such a column 
as they proposed to establish. 

There is a great reservoir of information on medicine which is sufficient 
to prevent most diseases and to cure most of the developed ailments. If there 
was to be an elevation of the standards of health, resulting in greater efficiency 
and lower sickness and death rates, it was necessary that this great reservoir 
of information be tapped and a means found for getting this information to 
the people. The Chicago Tribune believed that they possessed the means — a 
great daily newspaper, with a large circle of readers. That they were right 
and that my column "How to Keep Well" has been of real benefit to the people, 
has, I believe, been proven by the fact that there are now over four hundred 
newspapers following substantially the Tribune plan; and during the past six 
years, several million readers have had the opportunity to read "How to Keep 
Well" each day in the year. 

It is apparent to anyone who analyzes the known existing condition of 
public health that something is needed. People drift into incurable — in some 
instances fatal, in others disabling — conditions because of lack of knowledge 
about the human body, health and disease; because of lack of elementary knowl- 
edge of both curative and preventive medicine. A hundred or more health 
surveys have been made in various parts of the country; some in cities, some 
in small towns and some in rural communities. Some have been made in 
industrial plants, some in farming communities and some in business estab- 
lishments. The conclusions reached by all the investigators are practically 
the same. They are all in substance that : when it comes to knowledge of dis- 
eases, their causes, their manifestations and their cure, the average man or 
woman is uninformed. When it comes to perfect health and the means of 
achieving it, the average man or woman either does not know or else does not 
apply what he knows. A large percentage of people in need of medical 
service are not availing themselves of such service. The methods of preventing 
disease are being neglected by the people themselves. On top of all this, demon- 
strating both the proof of the conclusion and the need of some effort, the investi- 
gations show that more than half the people are in some measure incapacitated 
by disease most of which is preventable and nearly all of which is curable. 
This condition is all the more inexcusable when it is borne in mind that the 
majority of these people only needed counsel as to wrong habits of eating, 
sleeping, exercising, worrying and using alcohol or tobacco. 

This line of reasoning led me to the opinion that there was a need for 
such a column and that it could be made influential with the several million 
prospective readers. Then the question arose: Could I accomplish this end 
or any considerable part of it? 

I was reared in the country and in a small town. I had practiced medicine 

vii 



viii PEEFACE 

in this country place among my own people. I had moved to a large city 
and practiced medicine there. I had conducted a clinical laboratory. For 
sixteen years I had taught pathology in one large medical college. For nearly 
half as long I had taught hygiene and sanitation in another. I had been active 
in tuberculosis work, infant welfare work and other campaigns waged in behalf 
of preventive medicine. I had served as health commissioner of the second city 
in the Union. I might not be able, of course, to do all that "How to Keep Well" 
would demand of me but, I reasoned, whose experience had been broader, more 
varied or more preparing than mine ? It was up to me. 

The next question which arose was — how could I keep in touch with what 
the people wanted as well as with what they should have? Of course I could 
depend on "sensing" the demand. But a person is so apt to "sense" what he 
wants to "sense." There is no method for "sensing." I talk health to popular 
audiences a great many times during the year, I belong to all sorts of health and 
medical organizations and I attend them; but I could see where these, as 
methods of discovering what was wanted, were insufficient. The plan hit upon 
was questions and answers. By encouraging questions I would be informed 
daily as to the popular mind. 

And so I have found it. To change any of the habits or customs of a 
people it is necessary to know them just as they are and to appeal to them in 
terms of their daily experiences. The "Questions and Answers" department 
was founded with a view to keeping the column in touch with the people. Expe- 
rience demonstrated that it was the most effective part of my efforts. The 
questioner asked a direct question in which he stated specifically what he 
wanted to know. The answer was direct, stating specifically my reply to the 
question asked. The reader interprets the question and answer. He either 
sees a specific answer or he sees that the answer is not specific. If not specifically 
answered he can form an opinion as to why it is not. The largest element con- 
tributing to the success of "How to Keep Well" is the "Questions and An- 
swers." 

And lastly, I saw that if, making use of these approaches, I was to tap 
the great reservoir of medical information for the benefit of those who needed 
it I must keep "How to Keep Well" just as human as possible. 

Out of this work grew this book. The strong appeal of the "How to Keep 
Well" articles, as they appeared from day to day, resulted in a very large num- 
ber of requests that they be put in permanent form. During the past five 
years I have written a great deal, the result of much work, study, investigation 
and research; but I believe it has proved to be of real and permanent value. 
It is these articles, revised in the light of the latest discoveries in the science 
of medicine and surgery, together with much new matter, which has not 
appeared in the newspaper, that make up this book. This new material, I 
believe, will make this book especially helpful, as it covers a number of subjects 
which could not be discussed in a newspaper column. The questions and 
answers contain many hundreds of letters received by me and my answers to 
them. Some of these letters and their answers are now published here for the 
first time. Among the most helpful features in this book, that did not appear 
in the newspaper, are the illustrations. There are over five hundred of them 
and they have been collected from three sources: (1) new illustrations made 
especially for this book; (2) the most helpful illustrations, charts, diagrams 
and tables of the various state and municipal boards of health and national 
bureaus; and (3) illustrations selected from other medical works of established 
merit. 

For assistance in preparing this book I am grateful for the help given 



PREFACE ix 

by Doctor A. R. Reynolds and Mr. Wyatt Rushton as well as the publishers. 
As will be noted, for illustrations I have drawn freely upon various national, 
state and municipal boards of health and various other governmental agencies 
and various publications. I wish to thank them for the privilege of using these 
cuts and illustrations. 



CONTENTS 

CHAPTER PAGE" 

I.— INTRODUCTION 1 

The advent of preventive medicine — just a start. What is health? 
Health can be bought. Ending well. 



II.— THE NOSE 9 

Construction of the nose. A baby's nose. Adenoids and enlarged 
tonsils. 

Questions and Answers. — Chronic nose infection. Have your nose 
examined. Mouth breathing dangerous. Chronic nose trouble. 
Obstructed nostrils. Mouth breathing. Harm of mouth breathing. 
Cause of mouth breathing. 

III.— THE TONSILS 15 

Construction of the tonsils. Keeping the tonsils clean. 

Questions and Answers. — Has tonsil trouble. Keeping tonsils clean. 
Tonsillar crypts. Keeping crypts clean. Does not weaken lungs. 
Developing the lungs. Fresh air counts. 

IV.— ADENOIDS 20 

Construction of adenoids. Clean mouths and infection. 

Questions and Answers. — Cause, prevention and treatment of ade- 
noids. Dryness and adenoids. Removal of adenoids. See throat 
specialist. 

Snoring. 

Questions and Answers. — Cause of snoring. 

V.— COLDS— CATARRH— SORE THROAT 25 

Colds a luxury, not a necessity. What is a cold ? Cause of cold. The 
cost :>f colds. Drafts and colds. Suggestion for prevention of colds. 

Questions and Answers. — To get rid of cold. Toilet of the nose. 
Cold in the head. "Chronic cold in the head." Cause and cure 
of colds. To avoid taking cold. Treatment for cold. Cold con- 
tagious. Habits may be cause. Complains of colds. How to 
prevent colds. Take care of a cold. 

Catarrh. 

Questions and Answers. — Chronic catarrh. Catarrh. Catarrh a 
symptom. Vaccine for nasal catarrh. See a physician. Catarrh 
of the head. Treatment for catarrh. Offensive breath and catarrh. 

Sore Throat. 

Questions and Answers. — Hoarseness. Wash the throat daily. Trou- 
ble in throat. Sore throat. 

xi 



xii CONTENTS 

CHAPTER p AGE 

VI.— COUGH— ASTHMA 40 

Cough. Useless coughs. What to do for a cough. 

Questions and Answers. — Mild climate needed. Chronic cough. 

Asthma. 

Questions and Answers. — Incipient asthma. Curability of asthma. 
Find underlying cause. Bronchial asthma. May be asthma. Va- 
rious causes for asthma. 

VII.— BRONCHITIS— HAY FEVER 46 

Bronchitis. 

Questions and Answers. — Chronic bronchitis. 

Hay fever. Fighting hay fever. 

Questions and Answers. — Hay fever antitoxins good. Causes of hay 
fever. Hay fever cures. 

VIII.— PNEUMONIA— PLEURISY 55 

To avoid grip and pneumonia. Pneumonia. Pneumonia and drink- 
ers. Cold air and pneumonia. What to do after pneumonia. Pneu- 
mococci elsewhere than in the lungs. A possible pneumonia cure. 

Questions and Answers. — Pneumonia and air. 

Pleurisy. 

Questions and Answers. — Empyema of pleura. 

IX.— CONSUMPTION 70 

Facts about tuberculosis. The relation of inheritance to consump- 
tion. The relation of heart disease to tuberculosis. The relation of 
diabetes to tuberculosis. The relation of pregnancy to tuberculosis. 
The relation of alcohol to tuberculosis. The relation of chest develop- 
ment to consumption. The relation of age to consumption. The 
influence of race on consumption. Occupation in relation to consump- 
tion. War against consumption. Early diagnosis necessary. When 
to suspect consumption. What can the consumptive do to be safe 
to others ? What is the consumptive to do for himself ? Heading off 
consumption. How to have consumption. How is a consumptive to 
know? How can a consumptive judge of progress? What the con- 
sumptive should do. Chasing the cure in the clouds. Cure of tuber- 
culosis. Where shall the consumptive go ? Climate and consumption. 
Care of consumptives. Night camps for consumptives. Tubercu- 
losis day. Captain Raoul's example. The consumptive nurse. 

Questions and Answers. — Tuberculosis. Tuberculosis of the spine. 
Curvature of the spine. Curvature of spine causes. Curvature 
of the spine. Ill not transmissible. Consumption in diabetes. 
Tuberculosis in animals. Symptoms of consumption. Consump- 
tion and cough. Not tuberculosis cough. Looks like tuberculosis. 
Pains, sputum, and cure of tuberculosis. Preventing consump- 
tion. Needs medical advice. Enlargement of glands. Tubercu- 
losis of the knee. Tuberculous sores. Advice to a consumptive. 



CONTENTS xiii 

CHAPTER PAGE 

Menace to neighbors. Should protect girls. Night sweats. Con- 
sumption cures. Tuberculin as a cure for consumption. Treat- 
ment of tuberculosis. Tuberculin is of value. Sun better than 
sulphur. Medicines no use. Why consumptives go west. Advice 
on a cure for tuberculosis. Going away question. May be curable 
consumption. Reason for varying advice. Sanitaria about Den- 
ver. Breathing and consumption. Arizona better place. 

X.— THE EYE Ill 

Preventable blindness. The sight fails. Trachoma. Eye fatigue. 
Danger to the eyes. Smith cataract treatment. Squint. Pink eye. 

Questions and Answers. — Cannot dissolve cataract. Trachoma. 
Pings before the eyes. Causes of infant blindness. Eye drops for 
baby. To prevent blindness. May need glasses. Bloodshot eyes. 
Tears symptom of closed ducts. Glasses for astigmatism. Oper- 
ation for cataracts. Failing sight. Tears best eyewash. Cataract 
"ad" untrue. Treatment of styes. Infection causes styes. 
Strained eyes. 

XI.— THE EARS 133 

An early sign of deafness. Earache. Reeducation of hearing. What 
the mother of a deaf child ought to know. Lip reading. 

Questions and Answers. — Perforated ear drum. Cotton in ears 
harmless. Your physician will determine. Remedy for earache. 
Approach of deafness. See ear specialist. Partial deafness hered- 
itary. Running of the ear. To prevent deafness. Meniere's 
disease. Lip reading. Ringing in the ears. 

XII.— RHEUMATISM . 141 

Eorms of rheumatism. "Full of rheumatism." Growing pains. Ar- 
thritis germ infection. People with stiff legs. Hygiene versus rheu- 
matism. 

Questions and Answers. — Causes of rheumatism. Rheumatoid ar- 
thritis. Rheumatism and climate. Troubled with rheumatism. 
Rheumatoid arthritis treatment. Meat and rheumatism. Flan- 
nel no rheumatism cure. 

XIII.— GOUT 154 

The gouty diathesis. 

Questions and Answers. — Gout. Lumpy fingers show gout. Diet in 
gout. Rheumatism and gout. 

XIV.— DIABETES 158 

Causes of diabetes. Types of diabetes. Diabetics subject to infec- 
tions. Diet in diabetes. 

Questions and Answers. — Diabetes — cause and diet. Possibly dia- 
betes. Diabetes sometimes curable. Diabetes and Bacillus bul- 
garicus. Symptoms of diabetes. Examination of urine for dia- 



xiv CONTENTS 

CHAPTER PAGE 

betes. Stages of diabetes. Not diabetes symptom. Testing for 
sugar. Buttermilk in diabetes. Diabetes not hereditary. Diet 
and diabetes. Teeth in diabetes. 

XV.— PELLAGRA 165 

Causes of pellagra. Diet in pellagra. Diagnosis and treatment of 
pellagra. 

Questions and Answers. — Concerning pellagra. Symptoms of pel- 
lagra. Cause of pellagra. Warnings of pellagra. Reply to an 
old lady. Thousands of cases. 

XVI.— BERIBERI 172 

Spread of beriberi. Diet. Prevention. 

XVII.— SCURVY— SCROFULA— RICKETS 179 

Scurvy. Scurvy, how to know it and what to do about it. 

Questions and Answers. — May be scurvy. 

Scrofula. Causes of scrofula. Symptoms. Prevention. Pickets. 
How to know rickets and what to do for it. 

Questions and Answers. — Cause of rickets. Child has rickets. Not 
much difference. Treatment of rickets. Might be rickets. Curva- 
ture of the spine. 

XVIIL— CONTAGION— DISINFECTION 192 

Contagion and infection. On reporting contagious diseases. Control 
of contagion in small towns and country. Onset and incubation. 
Danger from pets. Easy to control contagion. 

Questions and Answers. — Destroying mold germs. How to fight 
epidemic. Danger from rooms where consumptives have lived. 
Contagious diseases. School and contagious diseases. Pule of 
quarantine. Danger of contagion. 

Fumigation. When to fumigate. Disinfection. 

Questions and Answers. — How to fumigate. The grip and fumiga- 
tion. How to fumigate room. Fumigate the book. Fumigation 
by gas. Fumigation method. Fumigation of cars. Fumigation 
after consumption. 

XIX.— CONTAGIOUS DISEASES 213 

Smallpox. How to control smallpox. Lesson of an epidemic. How 
punish the weak sister? The two Niagaras. Cost of protection. 
Varioloid. 

Questions and Answers. — Finsen method has failed. No smallpox 
danger. Mild form of smallpox. Two distinct diseases. 

Vaccination. Discovery of vaccination. Production of smallpox vac- 
cine. When to vaccinate. Where to vaccinate. How to vaccinate, 
Anti-vaccinationists. 



CONTENTS xv 

CHAPTER PAGE 

Questions and Answers. — How to vaccinate. Experts and theorizers. 
Blood test for vaccination. Smallpox and vaccination. Scarlet 
fever. How scarlet fever spreads. Development of scarlet fever. 
Scarlet fever and hot houses. Mystery of scarlet fever. Scarlet 
fever incubation. Definition of scarlatina. Keporting scarlet 
fever. Obey health board. Scarlet fever in school. Hot baths in 
scarlet fever. Scarlet fever danger. Scarlet fever contagion. Dis- 
infection after scarlet fever. Contagiousness of scales and disin- 
fection. Scarlet fever aftermath. 

Diphtheria. Development of diphtheria. Use of antitoxin. Almanac 
talk on diphtheria. 

Questions and Answers. — Carriers of diphtheria. What croup is. 
To get rid of bacilli. 

Croup in children. Treatment of croup. Measles. Development 
of measles. 

Questions and Answers. — Measles not universal. In cases of measles. 
Conveying measles. Susceptibility to measles. Time of contagion 
in measles. Open window no danger. German measles. 

Whooping cough. Discovery of the germ of whooping cough. Sus- 
ceptibility to whooping cough. Epidemiologic points to be noted. 

Questions and Answers. — Whooping cough contagious. Incubation 
period. Whooping cough danger. Shouldn't go to school yet. 
Whooping cough and quarantine. - Duration of whooping cough. 
Whooping cough treatment. City will fumigate. 

Mumps. Development of mumps. Treatment. Chicken pox. How 
chicken pox is spread. Period of incubation. Treatment of chicken 
pox. Infantile paralysis. The virus of infantile paralysis. The 
spread of the disease. Suggestions for its prevention. Infantile 
paralysis exercises. What the mother of a crippled child ought to 
know. 

Questions and Answers. — Infantile paralysis. Infantile paralysis 
infectious. Clothing and infantile paralysis. Spread of infantile 
paralysis. Care of infantile paralysis. 

Cerebrospinal meningitis. How cerebral meningitis is spread. Epi- 
demic meningitis. Cerebrospinal fever. Symptoms of cerebrospinal 
fever. Causes and precautions. Erysipelas. What, the ancients 
thought of erysipelas. What others have said of erysipelas. What is 
known of the disease at the present time. Chances of infection. 
Chances of recovery from erysipelas. Yellow fever. Last yellow 
fever region. Diagnosis of yellow fever. 

Questions and Answers. — Cause of yellow fever. 

Malaria. Causes of malaria. Day-biting mosquitoes. To control 
mosquitoes. How to kill the mosquito breed. Mosquitoes. How 
malaria spreads. How to end malaria. How to control malaria. 
Eradicating malaria. Cure your malaria. Half cured malaria. The 
cost of malaria on a plantation. Use of quinin. Outline of mosquito 
work. A mosquito campaign. Oiling to prevent malaria. 



xvi CONTENTS 

CHAPTER PAGE 

Questions and Answers. — Weeds and malaria. Malaria easy to cure. 
Daily allowance of quinin. Effect of quinin. Mosquitoes. Mos- 
quitoes from cisterns. Malaria in Lexington. 

Anthrax. Anthrax of the lungs. Anthrax in the blood. Anthrax and 
furs. Plague. The present pandemic of plague. Diseases of rats. 
Plague and the canal. Spread of plague. The cost of rats. 

Questions and Answers. — Symptoms of bubonic plague. 

Leprosy. Danger of leprosy. 

Questions and Answers. — Causes of leprosy. 

Hydrophobia. Dog days. Hydrophobia prevention. 

Questions and Answers. — Hydrophobia and milk. Dog bites. 

Lockjaw. Symptoms of lockjaw. Treatment and cure of lockjaw. 
Typhoid fever. Typhoid a preventable disease. The typhoid bacillus. 
Course of typhoid fever. Tests. Walking typhoid. Foods that cause 
typhoid. Contact or finger typhoid fever. Activity of typhoid fever. 
How winter typhoid is spread. 

Questions and Answers. — Preventing typhoid. Milk and typhoid. 
Typhoid vaccination. Cesspools and typhoid. Developing typhoid 
fever. Avoiding typhoid germs. Protection of typhoid vaccina- 
tion. Filters. Winter cholera. Cause of typhoid. 

Foot and mouth disease. Fighting foot and mouth disease. Foot and 
mouth disease easily avoided by people. 

Questions and Answers. — Human foot and mouth disease. Prev- 
alence of human foot and mouth disease. 

Rocky Mountain fever. Its importance from an epidemic standpoint. 
Preventive measures. Typhus. The history of typhus. Typhus in 
Mexico. 

XX.— HABIT-FORMING DRUGS 327 

Dope fiends of one city. Dope law weaknesses. What is the drug 
fiend to do? Morphin cure. Sceleth drug treatment. 

Questions and Answers. — Do not take morphin. Drug habit danger. 
Morphin habit. Must give up morphin. Bars morphin users. 
Sleep caused by drugs. See doctor first. Don't take soporific. 
Don't take bracers. Heroin derived from opium. An opium fiend. 
When to use codein. Starts drug habit. Drug habit effects. 

Cocain fiends. 

Questions and Answers. — Cocain habit. Do not use cocain. 

The alcohol habit. Whisky and heat. Rules for getting drunk. 

Questions and Answers. — Periodic drinkers. Whisky and alcohol. 
Drink habit. Cures for liquor habit. 

Smoking. 

Questions and Answers. — Tobacco and capacity. Not justified in 
smoking. Giving up tobacco. Woman and tobacco. Should stop 
smoking. Quit smoking. Tobacco stunts growth. Cigarettes 



CONTEXTS xvii 

CHAPTER PAGE 

of no benefit. Inhaling smoke. Smoking harms sight. Will alone 
suffices. Chewing tobacco. Tobacco and weak heart. Tobacco 
heart. Tobacco and hearing. Craving that persists. Danger from 
cigars. Cigarette habit cnre. Use of snuff. 

Coffee. Ingredients of coffee. Coffee effects. Coffee making. The 
coffee or tea habit. Tea and war. 

Questions and Answers. — Coffee and sleep. Avoid tea and coffee. 
Harm from coffee. Coffee and tobacco. Coffee and caffein. Cof- 
fee story false. No food value in coffee. No "weed" ; no tea ; 
no coffee. To make tea. Too much tea. The coca cola habit. 

XXI.— THE MIND 3G2 

"The Human Machine." Human betterment advice. 

XXII.— SYMPATHETIC NERVOUS SYSTEM . . . . . .370 

Disturbance areas. To prevent nervousness. Influence of the mind 
on digestion. The influence of mind on nutrition. The mind and the 
heart and circulation. Influence of the body on the mind. The mind 
in mental disorders. Persisting neuralgias. Neuralgia. Sciatica. 

Questions and Answers. — Neuritis — Neuralgia. Adjust your mind. 
Thinking disease. Has poor memory. Nervous indigestion. May 
imagine illness. Nervous and run down. Should go to sanitarium. 
Have him examined. Boy needs control. Has sudden fears. 
Needs mental treatment. Relaxing body and mind. But little 
danger. Stop worrying. Don't worry about it. Quit worrying. 

XXIII.— NEURASTHENIA— THE PHYSICIAN AND NEURASTHENICS . 393 
Symptoms of Neurasthenia. Treatment of Neurasthenia. 

Questions axd Answers. — Neurasthenia. Medicine in neurasthenia. 
Marriage and neurasthenia. Neurasthenic. Mild neurasthenia. 
Try reading these books. Better read Du Bois. Cures self of 
neurasthenia. Should learn control. Case for psychotherapy. 
Temper in the morning. Victim of neurasthenia. Neurotic and 
nervous. 

Neurasthenia and hysteria. 

Questions and Answers. — Treatment of neurasthenia. 

Insomnia. 

Questions and Answers. — Insomnia. Cause of sleeplessness. Sleep 
mental condition. Needs more sleep. Cause of dreams. Wants 
more sleep. Insomnia not disease. Mental training for dreams. 
Afflicted with nightmare. Causes of nightmare. 

XXIV.— INSANITY— TO PREVENT INSANITY . . . . . .413 

Erysipelas in the insane. 

Questions and Answers. — Insanity. Melancholia. Mysophobia. 
Sign of nervousness. Biting the fingernails. 

Dementia precox. — Plea for the child. 
Questions and Answers. — Dementia precox. 



xviii CONTENTS 

CHAPTEE j, AGl2 

XXV.— DISEASES OF THE NERVES— CONVULSIVE DISORDERS . . 418 

St. Vitus' dance. Epilepsy. 

Questions and Answers. — Treatment for epilepsy. Care may cure 
epilepsy. Looks like epilepsy. Epilepsy rarely curable. Value 
not proved. Mild epilepsy. No epileptic colony. One chance 
in ten. No institution for epilepsy. 

Paralysis Agitans. 

Questions and Answers. — Causes remain mystery. Marry him. 

Huntington's chorea. 

XXVI.— STAMMERING AND STUTTERING — STUTTERING SCHOOL 

CHILDREN 435 

Stammering. 

Questions and Answers. — Stammering. Stammering a nervous con- 
dition. To prevent stuttering. Cure matter of training. How 
to cure stuttering. May help yourself. Suggestion for stam- 
merers. Child stammers. 

Phrenology. Head noises. 



XX VII.— HEADACHES 443 

Four kinds of headaches. Headache prevention method. Headache 
medicines. 

Questions and Answers. — Sick headache. Cause of sick headache. 
Headaches from stomach. Migraine. Suffers from migraine. 
Treatment for migraine. Not a headache preventive. Has harm- 
ful effect. Forbidden by law. Dizziness. Paraffin and headache. 
Too much aspirin harmful. 



XX V1IL— FOODS 450 

Bread. Meat. Frozen chickens. Fish as food. Oysters. Eggs. 
Cheese. Mushrooms. Fruit as food. Cottonseed food. Pasteurized 
butter. Milk. Food economics. Digestibility of foods. Preserve 
fruits for winter use. Toxins in foods. Quantity of food. Over- 
eating at dinner. Food values. 

Questions and Answers. — No brain foods. Not blood builders. Food 
value of grapes. How to tell butterine. Evaporated milk. Mixed 
diet most helpful. No reason for it. May eat too much. Bulk 
of food. Bran and agar for human food. Buttermilk tablets. 
Fresh buttermilk better. Buttermilk. Colored butter. Bran gems. 
Baked beans good food. Dried fruits. Value of oysters. Candy 
concentrated food. Cottonseed meal. Cottonseed oil nutritive. 
Foodstuffs. Water at meals. Tomatoes not harmful. Fruit acids 
weak. 

Food preservation. Refrigeration. Cold storage. Control of cold 
storage. Ice box odors. 

Questions and Answers. — Eefrigeration. To cleanse refrigerator. 



C0XTEXT3 xix 

CHAPTER PAGE 

XXIX.— MILK— COWS MILK 513 

Age of milk. An infant diet. Milk production. Milk transporta- 
tion. City delivery of milk. Indorsed milk report. Milk store score 
card. How bad milk does harm. Certified milk. Clean milk. A 
flyless, odorless dairy. La Salle milk. Milk of Eichmond, Ya. Milk 
at summer resorts. Keeping- milk cold. Warm and dirty milk. The 
government's position on milk. Another milk epidemic. Milk sold 
in small cities. 'Tlain talk to Chicago milk producers." Treating 
tainted milk. Ice cream. 

Questions and Answers. — What constitutes fresh milk. Flesh made 
by milk. Use of milk diet. Effects of milk diet. Milk disagrees 
with her. Milk as food. Be careful of milk. Care of milk. Grape 
fruit with milk. Thermos-kept milk. Is centrifuged milk safe? 
How to get safe milk. Do not drink raw milk. Questions on milk 
answered. Good milk proposal. Milk safety. Certified milk safer. 
Is boiled milk nutritious ? Eefers to boiled milk. Heating water 
and milk. Very warm and cold milk. Condensed milk safe. Try 
cheese and milk. Ice cream poisoning. Pasteurized milk. Pas- 
teurization enough. Pasteurized milk constipating. Pasteurize 
the milk. Sour milk. Sweet milk and buttermilk. Buttermilk 
safer. Buttermilk. Buttermilk as beverage. Kind of buttermilk. 
Gives buttermilk formula. Culture buttermilk better. Yalue of 
buttermilk. When buttermilk disagrees. 

XXX.— LYMPHATIC GLANDS 547 

Hodgkin's disease. 

Questions and Answers. — Lumps on neck. Hodgkin's disease symp- 
toms. Consult family physician. May need draining. Are easily 
cured. Swollen lymph gland. Enlarged lymph glands. 

XXXI.— DUCTLESS GLANDS 555 

Acromegaly. Thyroid maladies. 

Questions and Answers. — Enlarged thyroid glands. Thyroid gland. 
Treatment of goiter. See best surgeon. Thyroid intoxication 
case. May not need treatment. Goiter and children. Begarding 
goiter. Graves' disease. When to remove goiter. Operation often 
necessary. Goiters grow smaller. Goiter. Goiter not contagious. 
Cause and cure of goiter. Treatment for cretinism. Life of cre- 
tin. Operation not dangerous. Goiter and medicine. Thymus 
gland tablets. 

The adrenal bodies. Adrenalin. Addison's disease. 

Raynaud's disease. 

Questions and Answers. — Raynaud's disease. Symptoms of ray- 
naud's disease. Xails turning black. White finger ends. 

XXXII.— THE SPLEEN 583 

XXXIII.— HEART DISEASE 590 

Throbbing and beating. The heart aud exercise. 



xx CONTENTS 

CHAPTER PAGE 

Questions and Answers. — Valvular trouble symptoms. Care with 
heart murmur. See heart specialist. Nervous heart. Nervous 
heart evidence. Nervous heart not serious. Heart trouble. Heart 
and altitude. Find cause. Chronic myocarditis. Nothing out 
of the way. Have your heart examined. Irregular beat of heart. 
Has years to live. Heart trouble. Probably angina pectoris. 
Don't try "remedy." Heart trouble in son. Quick heart. Doctor 
should superintend. Have heart examined. Blood pressure in 
hardening of arteries. Prevention of hardening of arteries. Tis- 
sue change in hardening of arteries. Cause of hardening of ar- 
teries. Water in hardening of arteries. Premature hardening of 
the arteries. Simple life only avails. Treatment of hardening 
of the arteries. Symptoms of hardening of arteries. 

XXXIV.— BLOOD PRESSURE— BLOOD PRESSURE RECORDS . . 605 

Protecting the blood. 

Questions and Answers. — Blood pressure. High blood pressure. 
Temperate living urged. No great danger. Attitude effect exag- 
gerated. On high blood pressure. Treatment of high blood pres- 
sure. Blood pressure at forty. High blood pressure symptoms. 
Blood pressure at 23. Leave the bed. Hemophilia. Nosebleed. 

XXXV.— APOPLEXY 612 

Apoplexy is cerebral hemorrhage. Cause of apoplexy. Warnings and 
prevention of apoplexy. Forms of pseudo apoplexy. 

Questions and Answers. — Not apoplexy sign. Due to apoplexy. Meat 
and apoplexy. 

XXXVI.— BRIGHT'S DISEASE 617 

Warning of bright's. Acute bright's disease. Infection of the kid- 
neys. Chronic bright's disease. Chronic bright's disease with much 
albumin. Very slow bright's disease. Kidney of pregnancy. Albu- 
minuria in pregnancy. Bright's and diabetes. Kidney cures. Bright's 
disease treatment. 

Questions and Answers. — Water and bright's. Bright's disease diets. 
Bright's disease ration. Interstitial nephritis. To avoid uremia. 
Symptoms of bright's disease. Try dieting and exercise. Loss of 
one kidney. Tubercular kidneys. Case is incurable. Danger in 
overeating. Use of the kidneys. Stone in the kidney. Gravel 
in the urine. Salt and bright's disease. Concerning floating kid- 
ney. Osier on floating kidney. Dropsy. Kidney "dopes." 
Bright's and diabetes. 

XXXVII.— DIGESTION 637 

Importance of chewing food. Process of digestion. Digestive trou- 
bles. Exercise and the stomach. Dieting for fermentation. Sugar 
eating. 

Questions and Answers. — Indigestion the cause. Nerves of taste. 
Eat bulkier food. Breath of dyspeptic. Cut down starches. Sugar. 
Indigestion. Catarrh of stomach. Intestinal indigestion. Mean- 



CONTEXTS xxi 

CHAPTER PAGE 

ing of proteid. Salt meat diet. Exercise more; eat less. Don't 
eat apples. Onions and health. Ptomain poisoning protection. 
Appendicitis. How to cure heartburn. Take cheese and milk. 
Pork must be cooked. Drink more water. Buckwheat cakes. Eat 
three meals. California raisins. Cuts out a meal. Effects of 
gum-chewing. Bicarbonate of soda's use. Sour stomach. The 
disease of "bad habits." 

Belching. 

Questions and Answers. — Cause of belching. Excessive belching. 
Must work out own cure. 

Constipation. 

Questions and Answers. — The internal bath. Seeks constipation cure. 
Liver does not cause constipation. Remedy for constipation. Con- 
stipation. Constipation and pregnancy. Water in constipation. 
Castor oil and calomel in constipation. Oatmeal in constipation. 
Wheat for constipation. Senna in constipation. Laxatives. 
Bowel obstruction. What to do. Pumpernickel in constipation. 
Try eating wheat bran. Try eating wheat bran and agar. Use of 
bran bread. ISTo harm from bran. Suggestion for constipated. 
Uncooked bran better. Laxative food. See physician for consti- 
pation. Enema in constipation and indigestion. Home treatment 
for constipation. Food in constipation. What is agar? Keep on 
with the oil. Patent medicine in constipation. 

Seasickness. 

Questions and Answers. — Consult the ship's doctor. To avoid sea- 
sickness. 

XXXVIII.— HERNIA .665 

Questions and Answers. — Hernia. Xo bar to marriage. Rupture. 
Operation should cure. Xeed operation for rupture. Cure for 
rupture. Band may help. Truss will not cure. Knife for cure. 
Rupture in baby. Hernia and rupture. 

XXXIX.— OBESITY AND THINNESS 672 

Too fat or too thin. Reducing and fattening. Scale of weights. 
Obesity. Fat as a sign of age. How to decrease girth. Obesity cures. 
Getting thin. Strain of reducing. 

Questions and Answers. — Oertel diet for obesity. Fifty pounds over- 
weight. One way of getting thin. Reducing weight at 68. Cut 
down quantity of food. Take less food. Reducing weight. Don't 
take medicine. Short cut obesity "cures." Diet held successful. 
Peril in reducing weight. How to check obesity. Reducing weight 
intelligently. Reducing weight too fast. Beware of fat reducers. 
Water and weight. To overcome obesity. Reduce your food. To 
reduce abdomen. Buttermilk and weight. To reduce weight. To 
reduce weight at 50. Reduction of weight. How he reduced 
weight. Reduce quantity of food. Limit to haphazardness. 
Amount varies for persons. Practice is harmful. Should weigh 
160 pounds. Proper weight. Keeping the weight down. 

How to get fat. 



xxii CONTENTS 

CHAPTER 

Questions and Answers. — Bread and fattening food. Weight gain- 
ing foods. Would gain flesh. To increase weight. Weight is too 
low. Will make one fat. How to increase weight. Milk to in- 
crease weight. Eggs to increase weight. Below normal weight. 
How to get fat. Eat more; sleep long. In need of more fat. 
Should increase diet. How to gain. Worry and weight. Would 
lay on fat. 



XL.— THE SKIN 700 

Skin tan. Spare your skin. The skin and bathing. Pimples. 
Eczema. Eczema in babies. Diseases which show themselves in the 
skin. Straw itch. Psoriasis. Boils. Prickly heat. Dermoids. Dis- 
eases contagious through the skin. Hives. 

Questions and Answers. — Eczema loose term. Eczema in babies. 
Cause of dry skin. Holds no theory. Eczema not contagious. 
Has no effect. Eczema. Scalp eczema. Must cleanse daily. Sen- 
sitive skin. What sycosis is. Warts. Let your moles alone. 
Mole on the nose. Have mole cut out. Removal of scar. Treat- 
ment for eczema. Tetter. Scalp eczema. Has flour eczema. 
Cause of fever blisters. Camphor for cold sores. Itch. Cause of 
itching. Has winter itch. Winter itch cure. Palliative for itch- 
ing. Barbers' itch treatment. Dry air rash cause. Cuban itch. 
Bath itch relief. Wrong kind of itch. Nails have diseases. In- 
growing nail treatment. Keep nails oiled. Split finger nails. 
Run-around. Removing tattoo marks. Spots on the face. Bad 
complexion cause. Will discolor the skin. Bleaching the skin. 
Liver spot. White spots on body. Brown patches on face. Sweat- 
ing arm pits. Chapped hands. Cure cracked hands. Psoriasis. 
Treatment of psoriasis. Not a bar to marriage. Psoriasis not 
hereditary. Peroxid and psoriasis. Pityriasis. Have it removed. 
What ringworm is. May be ringworms. Cures for ringworm and 
warts. Cure for ringworm. Scars and their removal. Warts and moles. 
Wrinkles can be reduced. Wrinkles defy lotion. Shingles. Shingles 
not dangerous. Cause of it not known. Boils. Don't poultice a 
boil. Carbuncles. Cause of pimples. Blackheads. Cause of 
whiteheads. Acne. Pimples and blackheads. To prevent pimples. 
Acne vaccine. Alcohol for blackheads. Pimples not blood dis- 
ease. Serum treatment for acne. Cause of hives. Cause and 
treatment of hives. How to avoid the hives. Freed of hives. 
Treatment for hives. How to prevent hives. 



XLL— THE TEETH AND HAIR . 738 

The teeth. The teeth and health. Importance of good teeth. Care of 
teeth necessary. Cavities in teeth. Irregular jaws. Erosions. Pyor- 
rhea. Anemia and dirty teeth. Tooth brushes. 

Questions and Answers. — Pyorrhea curable disease. Pyorrhea not 
contagious. Pyorrhea cures. Bleeding gums. Unclean dental 
tools. Decaying teeth. Pulling wisdom teeth. Some good in 
fletcherizing. Consult your dentist. Go to dentist. Hardening 
the teeth. Keeping the mouth and nose clean. Consult your 



CONTENTS xxiii 

CHAPTER PAGE 

dentist. Loose teeth. Sore gums. May save teeth. Tumor of 
gums. Lime water and gums. Fletcherizing as preventive. Treat- 
ment for pyorrhea. 

The hair. Baldness. 

Questions and Answers. — Has scalp disease. See a skin specialist. 
Care of the hair. Bald head. Care of the hair. To remove dan- 
druif. Superfluous hair. Removal of superfluous hair. Bald in 
spots. Bald spots. Thin hair. Gray hair. Why does hair turn 
gray? Hair turning gray. Keep hair clean. Hair dyes injurious. 
Dyes not to blame. Wash scalp daily. Little absorbed by scalp. 

XLII.— THE FEET . . . . . . . . . .761 

Care of the feet. Slew-footed or pigeon-toed. Flat feet. Low heels. 
Foot habits. Covering of the feet. 

Questions and Answers. — Aching feet. Broken arch remedy. Treat- 
ment for chilblains. Danger in using acid. How to cure bunions. 
Bothered by great toe. For tender feet. For perspiring feet. 
Effect of high heels. Aid for flat feet. Reason for flat feet. 
Wear easy shoes. Chilblains. Itching feet. Causes of cold feet. 
Treatment of feet. Change style of shoe. Cold hands and feet. 
Need of arch support. Treatment of cold feet. Cure for sore 
feet. Support the instep. Has flat feet. Best to consult doctor. 
Swollen feet. 

XLIII.— OBSTETRICS 775 

Precautions at childbirth. Twilight sleep. Care of newborn baby. 
Supplies for childbirth. 

Questions and Answers. — Books on pregnancy. No age limit. Infec- 
tion in childbirth. Presumptive symptoms. Should forget worries. 
"Marking" of child. The nipples. No harm to child. Amenor- 
rhea. No bar to marriage. Is no proof. Abderhalden test tells. 
Hazard is decreased. Danger not great. When stork is expected. 
Prospective mother. Reply to M. W. Reply to R. S. Can't deter- 
mine sex. Will do no harm. Follow doctor's plans. No legal or 
moral right. No need to fear for child. Need not worry. Marry- 
ing at 48. Medicine no help. Fibroid tumors not cancer. Treat- 
ment for fibroid. Operate for fibroid tumor. Radium and fibroids. 
Operation will relieve. Operations no barrier. Should go to 
hospital. No danger to offspring. Artificial change of life. Try 
eating more. Not too late. Affliction not dangerous. Pregnancy 
test. Difference not great. Leukorrhea. Need not fear. Regu- 
larity should rule. Consult your physician. Operation not neces- 
sary. Doctor's guess better. Can regain ground. Will have no 
effect. May last four months. Two books suggested. Read Sle- 
mons' work. Be examined by physician. Morning sickness. Cause 
of "Blue" baby. Should not overeat. No need to fear. Preg- 
nancy. Milk leg. 

XLIV.— THE BABY 795 

Helping baby live. Saving new lives. Nursing the baby. New 
Zealand baby rules. What would you do? Feeding and growth of 



xxiv CONTENTS 

CHAPTER 

babies. Fresh air for the baby. Danger sign with babies. Baby's cry. 
The baby's nerves. Fat babies. Country baby death rate. Heat kills 
babies. Babies in hot weather. Summer complaint. Diarrhea — its 
treatment. Colic in babies. Dyspepsia. Eye of the child. Weaning 
the baby. Weight disturbance in babies. Feeding babies. Feeding 
sick babies. Selection of baby food. Merit of baby foods. 

Questions and Answers. — Soft spot on head. Shape of baby's head. 
Mouse story untrue. Measurements for baby. Broken tooth. 
Nursing the baby. Let the baby sleep. Good place for babies. 
Child is cross-eyed. Cause of worms. May do baby harm. Left- 
handed baby. Let baby sleep out of doors. Not robbed of vitality. 
Avoid use of drugs. Baby with the colic. Dandruff on baby's 
head. Baby's second summer. Feeding the baby. Baby improp- 
erly fed. When the milk fails. Do not boil it. More fruit for 
baby. Mother's milk. Feed baby now. Feeds baby too much. 
Weaning the baby. Nothing to do with the moon. January good 
weaning time. Bowlegs in babies. From babies to baby carriages. 
Cause of stye. No remedy known. Break lad of habit. 



XLV.— CHILDREN 841 

Why is your child "it" ? Evidence of normality. Training the child. 
Five children dead. What the mother of a crippled child ought 
to know. 

Questions and Answers. — Sugar good for children. Candy good for 
children. Bad for child. Kernels in the neck. Aid for weak 
ankles. Bath not harmful. Have children exercise. Keep room 
cooler. Do not use a brace. Boy fitful sleeper. Night terror. 
Nervous while asleep. Little lad dreams. Treatment for children's 
colds. Mouth breathing. Diseases of children. Condition not dan- 
gerous. Children's diseases. Feeding the little ones. Change boy's 
diet. Growing pains of children. Child in need of treatment. 
Promiscuous feeding. Bananas good for child. Take child to 
specialist. Have child examined. Food for young child. Cellu- 
loid toys. Sleep for the child. Baby likes to eat mud. Starch 
craving unnatural. Feeding year-old child. Feeding the baby 
potatoes. Nodding spasm. Cleft palate. Stature. Harelip can 
be cured. 



XLVL— FIRST AID 859 

Internal hemorrhage. Nosebleed. Disclocations. Dislocation of the 
lower jaw. Dislocation of a finger. Rescue of persons at fires. Treat- 
ment of a burn. Electric shock. Some minor ailments. Colic and 
cramps. Transient diarrheas. Nausea and vomiting. Hiccough. 
Neuralgia. Emergencies. Black eye. Foreign bodies in nose. Nose- 
bleed. Choking. Emergencies. Bites of insects. Rusty nail wound. 
Burns. Bruises. Cuts. Artificial respiration. First sunstroke treat- 
ment. First aid requirements. First aid outfits. Poisons and anti- 
dotes. 

Questions and Answers. — Poison oak treatment. Alcohol and snake 
bite. Treatment of wounds. Toxemia. 



CONTEXTS xxv 

CHAPTEPw page 

XLVII.— OCCUPATIONAL DISEASES 893 

Acid burns. Phosphorus poisoning. Accidents and diseases of iron 
workers. Eemedy for being "gassed." Lead poisoning. Preventing 
lead poisoning. Eecognizing lead poisoning. Mercury poisoning. Ar- 
senic and benzine poisoning prevention. Caisson disease. Dusty 
trades. Dust in shoe factories. Men who work in wet air. Sanita- 
tion in the cloak industry. What the workingman should do. 

Questions and Answers. — Regarding matches. Brass chills. Danger 
from dust. Writer's cramp. Protecting workers from heat. Teleg- 
rapher's palsy. Case of a painter. Cause of lead poisoning. Too 
long a workday. Quit working there. 



XLVIIL— HOT WEATHER ADVICE 911 

Work in hot weather. Disease in hot weather. The liver in hot 
weather. Crowds in hot places. Sleeping in hot weather. 

XL1X.— PARASITICAL PESTS 917 

Bedbugs. Straw itch. Itch parasites. Lice. Bedbugs. Fleas. 
Ticks. Stinging pests. Scorpions. Centipedes. Bees, hornets, wasps, 
and yellow jackets. Black flies. Pantry pests. Insects injurious to 
cereals. Methods of control. Brown-tailed moth. Brown tail rash. 
Flies. Flies and typhoid fever. Food and flies. Fly catechism. 
Fly family described. Open season for flies. Preventing fly breed- 
ing. Defense against flies. Why Havana is "flyless." Stables and 
flies. Fall fly danger. How to avert fly menace. Household fly 
trap. A new fly trap. Door fans for flies. Stable flies. Do not 
remove your screen. Who has a new fly slogan? 

Questions and Answers. — Case against flies proved. Plague of small 
flies. To get rid of flies. Bothered by flies. Smudge plan to kill 
flies. Try burning sulphur. How to bar flies. Iron sulphate and 
water. To get rid of ants. Bed bugs. To get rid of fleas. Fungus 
on insect. To get rid of mosquitoes. Insects in flour. To get 
rid of flour bugs. When to remove fly screens. Flyless Havana. 
Keep screens up. Moth miller trouble. Flies like electric mixers. 
Duty of the city. "Sewer bug." Lice in girl's hair. How to re- 
move "nits." Butter and juggers. Butter fatal to chiggers. Seeks 
a preventive. 

L.— LONGEVITY 949 

Efforts of Metchnikoff. Belief of Metchnikoff. Growing old gradu- 
ally. Some plans for a long life. 

LL— CANCER 957 

Importance of cancer knowledge. Cancer knowledge necessary. Can- 
cer of the breast. Cancer of the face. Cancer of the mouth. Cancer 
of the stomach. Diagnosis of cancer of the stomach. Cancer of the 
skin. Cancer of the uterus. Sarcomas. To ward off cancer. Can 
anything be done to cure cancer? Radium, x-rays, and ultra-violet 
rays. 



xxvi CONTENTS 

CHAPTER J, AGfi 

Questions and Answers. — Probably not cancer. Needless cutting 
deplored. Cancer of stomach. See your physician. Senseless 
worry. Cancer cause not known. Cancer. Stomach cancer symp- 
toms. Cancer not inherited. No good for cancer. X-ray and can- 
cer. Fish and cancer. Need of cancer knowledge. Cancer of the 
bladder. Should not cause cancer. Wait three weeks. See a sur- 
geon at once. Might be cancer. Pork doesn't cause cancer. 

LII.— TUMORS 982 

Questions and Answers. — See your physician. Lump in the breast. 
Tumor. Each case different. Let doctor decide. Medicine no 
cure. 

LIII.— CHILE'S METHOD OF ANESTHESIA . . . . .987 

LI V.— EUGENICS 989 

For race betterment. Collecting eugenic data. The optimism of 
eugenics. Problem of the feeble-minded. Eugenics conclusions. 
Tendency of bloods. "The survival of the fittest." "Unto the third 
and fourth generation." The baby science. Eugenics and asylums. 
The immigrant's child. Small families. The only child. 

Questions and Answers. — Pre-natal marking. No cause for worry. 
Cretinism. Exceptions not convincing. Have effect on child. 
Marriage of cousins. Law forbids marriage. Size of family. Eu- 
genics. Birthmarks. Question of physical condition. No bar to 
marriage. Marriage of cousins. Second cousins may marry. In- 
termarriage. Blindness not inheritable. Such marriage forbidden. 
Marriage of double relations. Should cousins wed ? Mendel theory 
of eugenics. Eugenics literature. Risk four cents. Advice on 
eugenics. Book on eugenics. Mentality of twins. Reason for 
birthmarks. Fright and birthmarks. Deafmutism inheritable. 
Eugenics no fad. Books on eugenics. 

LV.— MASSAGE 1026 

Massage a curative aid. 

LVL— EXERCISE 1032 

Learn how to walk. Athletic games. Playing golf. Playing billiards. 
Archery. Swimming. Exercises for convalescents. Exercises for 
children. The play cure. "The outside of a horse is good for the 
inside of a man." 

Questions and Answers. — Expanding the chest. Exercise rests tire. 
Play in open air. Not injurious to health. Exercise for muscle. 
Too much exercise. Needs outdoor exercise. Physical exercise. 
Horseback riding. Riding astride. Skating fine exercise. Advice 
on tennis. Gymnastic dancing. Enter a gymnasium. Needs more 
exercise. Should take exercise. Exercise after operation. Ex- 
ercise for women. Special exercise necessary. S. B.'s exercises. 
Benefit from massage. Exercise to prevent cramps. Swimming 
better exercise. Effect of swimming. Exercise before breakfast. 



CONTENTS xxvii 

CHAPTER PAGE 

Exercise out of doors. Do gymnasium work. Rowing good exer- 
cise. Stop the exercise. Bathing bracing practice. Massage and 
exercise. Walking good for people. Continue swimming. Roller 
skating example. Exercise in the open. To strengthen the ankle. 
Take more exercise. In need of exercise. More exercise needed. 

LVII.— POSTURE— HEIGHT 1059 

Posture. Man and his posture. Stooping shoulders. Narrow chests. 
Vertical line test. 

Questions and Answers. — Stoop-shouldered girl. Stoop shoulders. 

Height. Increasing the height. Long-bodied people. 

Questions and Answers. — Wants to increase height. Will not grow. 

Rules for height. How to grow taller. To increase height. 

LVIIL— THE MUSCLES 1073 

Leg and arm muscles. Muscle sagging. 

Questions and Answers. — Walking will help. Deep breathing ben- 
efits. Arm muscles exercise. Cramps while swimming. 

LIX.— HOUSING 1084 

Where shall one live? Houses and housing. Housing problems in 
America. Housing plans. Housing plans. Influence of housing. 
Effect of good housing. Rehousing financial plan. Rehousing in 
Liverpool. Bad housing punishment. Disease history of houses. 
Congestion of population. Price of land. Prevent land sweating. 
More about town planning. Flat and cottage. 

Questions and Answers. — Bad housing conditions. 

LX.— THE HOME 1121 

Sites for buildings. Selecting a house. Sunlight in the house. San- 
itary bathrooms. Keeping the house. Kitchens, ice boxes, pantries 
and closets. Cold walls. Damp walls. Curtains and carpets. A 
sensible camp. Porches. Arrangement of house. Spring cleaning. 

Questions and Answers. — House doctor needed. Space in tenements. 
Safe but wasteful. Sunlight in bedrooms. Poor lighting in hotels. 
Cleaning the sink. No sunlight in bedrooms. 

LXL— VENTILATION— HEATING— HUMIDITY 1144 

Ventilation. Value of fresh air. Ventilation and efficiency. Errors 
in ventilation. Why ventilation fails. Ventilating offices, schools 
and stores. Remedies for poor ventilation. Temperature of incoming 
air. Limitations of gravity ventilation. Effects of wind on ventila- 
tion. Ventilation by windows. The philosophy of fanning. Ozone. 
Living rooms. For fresh air duct. Ventilation of the bedroom. 

Questions and Answers. — Put up windows. Deflectors for open win- 
dows. Suggestion on ventilation. Sleeping room regulation. 
Regulation is necessary. Ventilate room. Sleeping out of doors. 
Window-ventilated office. How to make deflector. Sleeping in a 



xxviii CONTENTS 

CHAPTER 

draft. How to ventilate a room. Yentilation. Outdoor sleeping. 
Open windows in winter. Drafts and colds. Kitchen air. For 
well-ventilated cars. More ventilation. Ventilating a house. Air 
the house well. To insure pure air. Method to be avoided. Bad 
air in a basement. Coughing in theaters. Church ventilation. 

Heating. Healthful heating of houses. Heating the house. Problems 
of heating. Types of heating. Using heat. Get the thermometer 
habit. Thermometers inaccurate. 

Questions and Answers. — Thermometers inaccurate. Care of ther- 
mometer. Stove is explanation. Treatment of furnace heat. 
Keeping off frost. Furnace may lack capacity. Would save heat. 
Keeping warm at night. Outside air necessary. Storm window 
problem. Cold sleeping quarters. Have fresh air enter. Proper 
heat for flats. Recirculating system bad. Keeping warm prob- 
lem. Correcting furnace trouble. Not as healthy. Steam heat 
itch. 

Humidity. Frosted windows. Method of humidifying. Why flowers 
die. Wet bulb thermometers. A practical suggestion. Dry air. Get 
the thermometer habit. Raising the humidity. 

Questions and Answers. — Arrangement for humidity. Ideal humid- 
ity. Dry air explanation. Bad air effects. Between 50 and 70. 
Peril to picture operators. Should have hygrometers. Have hu- 
midifier attached. Dry air and moist. Good compromise humid- 
ity. Radiators and humidity. Call in steamfitter. Plan to in- 
crease humidity. Humidity by pans. Use the hygrometer. Room 
needs moisture. Humidity should exceed. To make a hygrometer. 
Humidity discussed. Air too dry. More humidity needed. Itch- 
ing from air too dry. Dirt bands on ceiling. Winter itch treat- 
ment. 



LXIL— GARBAGE 1214 

How to dispose of garbage. Dumps. Garbage reduction. Burning 
garbage. Garbage on the soil. Feeding to hogs. St. Joseph's garbage 
report. Stable manure. 

Questions and Answers. — Disposal of garbage. Burning out garbage 
cans. Burning leaves. Danger has passed. Garbage as compost. 

LXI1L— INSURANCE 1223 

Effect of health insurance. Social insurance. Industrial insurance. 

LXIV.— HOSPITALS— SCHOOLS 1226 

Value of the hospital. Who should go to a hospital. Contagion in 
hospital. Schools. School efficiency effort. School hygiene. School- 
room ventilation. Medical school inspection. Feeding growing gen- 
eration. Neglected children. Larger use of the schools. School lab- 
oratories. Village school hygiene. Safeguarding the health of the 
country school teacher. 

Questions and Answers. — Heating schoolrooms. Help for teacher's 
nerves. Purpose of school inspection. Systematic play for both. 



CONTENTS xxix 

CHAPTER PAGE 

May be clue to dry air. Have windows opened. School session too 
long. Let boy remain in school. Let him play with children. 
School inspection barred. Has some infection. 

LXV.— SEX ORGANS OF WOMAN 1274 

The female sex organs. Menstruation. Normal menstruation. Hy- 
giene of menstruation. Scanty menstruation. Amenorrhea or ab- 
sence of menstruation. Menorrhagia and metrorrhagia. Dysmenor- 
rhea. Diagnosing the cause of sterility. 

Questions and Answers. — Baths during menstruation. Change of 
life. Menorrhagia. Amenorrhea. Too young for change of life. 
Normal menstruation. Leukorrhea. Very scanty menstruation. 
Leukorrhea. Can ride horseback during menstruation. Scanty 
menstruation not a sign of pregnancy. Amenorrhea. Complete 
recovery after severe operation. Is pregnancy safe? When can 
pregnancy be diagnosed ? Children desired. Phantom tumor. An 
old husband and a younger wife. Shall corsets be worn during 
pregnancy? What is safe for a pregnant woman? Shall a woman 
42 marry? Child-bearing and diseased ovaries. Shall she marry? 
Care during pregnancy. Consult a physician at six months' preg- 
nancy. Ergot will not cause miscarriage. To overcome sterility. 

LXVL— VENEREAL DISEASES 1286 

Venereal diseases. Venereal disease can be banished. So-called 
venereal diseases. "No worse than a cold." Venereal diseases and 
blindness. Syphilis. The venereal peril. Advertising doctors — men's 
diseases. Measures for control. How to know syphilis. How to know 
gonorrhea. Method now in use in II. S. Army. Prostitution in rela- 
tion to venereal disease. Gonococcal infections in children. Marriage 
requirements. Hospitals and dispensaries. Insanity and venereal 
disease. Inherited venereal disease. Venereal diseases in New York 
City. Continence. Night losses and wet dreams. Self -abuse. Lost 
manhood. Varicocele. When can a syphilitic man marry? When 
can a syphilitic woman marry? Marriage after infection with gon- 
ococcus. 

Questions and Answers. — Inherited syphilis. Insufficiently treated 
syphilis. Contagiousness of syphilis. Safety of salvarsan. Infec- 
tion from an unclean toilet. Cure of syphilis. Eelapse in syphilis. 
Curability of syphilis. Neglected gonorrhea. Gonorrhea with few 
symptoms. Gleet. Gonorrhea not inheritable. Contagiousness of 
gonorrhea. Varicocele. Undescended testicles. Spermatorrhea. 
Circumcision. Night losses. Mucus from urethra. Erections in a 
child of no consequence. Self-abuse. Masturbation in a child. 
Stupidity and self-abuse. A worrier. Fear and worry. A sexual 
neurasthenic. 

GENERAL INDEX 1315 

INDEX TO QUESTIONS AND ANSWERS . . . . . - . . 1349 



LIST OF ILLUSTRATIONS 

FIG. PAGE 

1. — Which path are you on? ......... 1 

2.— Health 4 

3.— Why? 6 

4 Temple of health 7 

5. — Adenoids ............ 10 

6. — Nasal syringe ........... 11 

7. — Atomizer for spraying oils ......... 13 

8. — Throat inspection ........... 15 

9. — Location of glands which frequently enlarge ...... 17 

10. — Peritonsillar abscess . . . . . . , . . .18 

11. — Headquarters for gossip and germs <£ ...... 21 

12. — Muzzle the microbe .......... 24 

13. — The double cross 26 

14. — Adenoids ............ 27 

15. — Looking down the windpipe. Showing vocal cords ...... 40 

16. — Average range of the human voice ........ 41 

17 — Location of lobes of lung and of diaphragmatic pleura . . . ..46 

18. — Wormwood . . . . . . ... . . . .48 

19.— Eagweed 50 

20. — Pneumonia germ ........... 57 

21. — Kussell Sage Foundation report ........ 60 

22. — Pleurisy with effusion .......... 65 

23. — Diagram showing a bronchus branching to end in air sacs ... 66 

24. — Consumption can be cured ......... 70 

25. — See a good doctor . . 71 

26. — Cures in ease of consumption ......... 72 

27. — Sunlight — Out- door air 73 

28. — To cure consumption .......... 75 

29. — To cure consumption . . . . . . . . . .75 

30. — A careful consumptive .......... 76 

31. — A careful consumptive .......... 77 

32. — Look out for consumption ......... 78 

33. — A careful consumptive .......... 79 

34. — A careful consumptive .......... 80 

35. — A careful consumptive .......... 80 

36. — (A) Chest in rickets badly deformed; (B) Deep narrow chest prone to 

consumption ........... 81 

37. — To avoid consumption .......... 82 

38. — To avoid consumption .......... 82 

39. — To avoid consumption .......... 83 

40. — To avoid consumption .......... 83 

41. — To avoid consumption .......... 84 

42. — Cut of window tent showing ventilation .86 

43. — Building plan for sleeping porch 87 

44. — Mean rainfall for different parts of United States 90 

xxxi 



XXX11 



LIST OF ILLUSTRATIONS 



FIG. PAGE 

45 Sputum eup 92 

46. — To fold a paper drinking cup ... . . . . . . .95 

47. — Pocket sputum cup . . . . . . . . .96 

48. — Eespiration ............ 99 

49. — Frame for attached sleeping porch ........ 101 

50 — Hip joint disease ........... 102 

51. — Window ventilation .......... 103 

52. — Eustic house for sleeping out ......... 104 

53. — Exercises which develop the muscles of shoulders, chest, back and abdomen 107 
54. — Position of lens during accommodation . . . . . . .111 

55. — Save your baby's sight .......... 112 

56. — Astigmatism chart ........... 113 

57. — Diagrammatic section of eyeball . . . . . . . .115 

58. — Foreign body on surface of everted upper lid . . . . . .116 

59. — Method of everting upper lid ........ . 116 

60. — Eyedropper 118 

61. — Normal blind area ........... 121 

123 
124 
125 
126 
127 
128 
129 

133 
135 



as to contagion 



in his own 



62. — Outside of eyeball ........... 

63. — Far-sighted eye focusing parallel rays of light behind retina 

64. — Focusing of light rays in a normal eye ....... 

65. — Near-sighted eye focusing parallel rays from a distant object . 

66. — Far-sighted eye showing focusing of rays from near and far objects . 

67. — Simple hyperopic astigmatism corrected by a convex cylindrical glass 

68. — Simple hyperopic astimatism ......... 

69. — Connections between external and middle ear, mastoid cells and throat and 

nose cavity ........... 

70. — Section of left ear and portion of skull ....... 

71. — Cross-section (A) of head of a normal child and (B) of one whose adenoids 

and tonsils have enlarged so as to block the nasal air passage, thereby 

making a mouth breather of him 
72. — Food values of milk .... 

73.— Buffalo gnat 

74. — Present social conditions and their prevention 
75. — Alert as to contagion in his cattle — indifferent 

family ...... 

76. — A good type of dry earth privy 

77. — Framework for model privy house 

78 — A good cheap privy .... 

79. — Diagram of gland groups in the groin and regions which should be examined 

for sources of infection when these glands are enlarged 
80. — Location of lymph glands which frequently enlarge . 
81. — Shape of skull in rickets 
82. — Cranial contours (comparative) 

83.— "Pigeon chest" 

84. — Bound type of chest .... 

85. — Flat type of chest ..... 

86. — Bulging backward on account of scoliosis . 

87. — Marked shrinkage of left lung, due to post-pneumonic emphysema 

88. — (A) Nearly normal stomach; (B) Dilated stomach 

89. — Shape of head in rickets .... 

90. — Bow legs ...,,,. 

91. — Knock knees . . . , 

92. — Decrease of contagious disease in New York State 

93, — Decline in diphtheria in New York State , 



146 
159 
166 

167 

169 
173 
175 
177 

182 
183 
185 
186 
187 
187 
188 
188 
188 
188 
189 
190 
190 
192 
194 



LIST OF ILLUSTRATIONS 



xxxm 



94. — Harm from not reporting contagion 

95. — How one school spread scarlet fever 

96. — Disgusting .... 

97. — Study of rodent plague focus . 

98. — At which shop shall we buy? 

99. — Fly-speck greatly magnified, showing dangerous germs 
100. — Pot method of burning sulphur 
101. — Eoom prepared for fumigation 
102. — Formaldehyd sterilizer 
103. — Vaccination prevents smallpox 
104. — Before and after smallpox 

105. — Localized epidemics of typhoid due to milk; 1910 and 191 
106. — Measles here ........ 

107. — Atrophy of spinal cord after infantile paralysis 

108. — Diagrams showing areas in cord most affected by infantile paralysis 

109. — Age distribution of cases of infantile paralysis 

110. — Seasonal distribution of infantile paralysis 

111. — Braces to prevent deformity after infantile paralysis 

112. — Shoes to prevent deformity after infantile paralysis 

113. — Massachusetts Hospital School for Crippled Children 

114. — Adult female mosquito, showing parts 

115. — Larva ....... 

116.— Pupa 

117. — The pitcher in the spare room . 

118. — Anopheles ...... 

119. — Deposit of eggs of the Anopheles 

120. — Position of Anopheles larva in obtaining air 

121. — Usual position of larva in obtaining air 

122. — Culex pungens or common house mosquito; female 

123. — Manner in which the eggs of the Culex pungens, or common house mosquito, 

are deposited . 
124. — Culex solicitans, salt water swamp or striped-legged mosquito 
125. — Stegomyia, or yellow fever mosquito; female 
126. — Anopheles, or malarial mosquito; female . 
127. — Resting attitudes of the Culex and Anopheles 
128. — Where mosquitoes breed . 
129. — How to prevent mosquitoes 
130. — Eat guard for a ship 's cables 
131. — The human flea 
132.— Dog flea ... 

133 — Clinical thermometer 
134. — Typhoid fever death-rates in German cities, showing decrease in last three 

decades . 
135. — The fly as carrier of typhoid 
136.— Typhoid fever 
137. — Deadly parallels 
138. — Well water and typhoid fever 
139.— Safe well 
140.— Jack and Jill . 
141. — To prevent typhoid 
142. — Taking patent medicine by the clock 
143. — Penny wise and pound foolish. Headache medicine 
144. — You can't float a balloon without gas 
145.— Sunlight 



PAGE 

196 
198 
200 
202 
204 
205 
207 
209 
210 
215 
223 
227 
241 
249 
250 
251 
252 
256 
256 
260 
265 
266 
267 
270 
271 
273 
274 
275 
277 

278 
279 
280 
282 
283 
286 
287 
294 
296 
297 
303 

306 
307 
309 
312 
314 
316 
318 
320 
327 
331 
332 
335 



XXXIV 



LIST OF ILLUSTRATIONS 



seat 



of pain in 



of pain in 



of the pain 
the eye, orbit and 



146. — Tropical ameba cause abscess of the liver, dysentery and possibly diarrhea 

147. — The spine. Lateral aspect ..... 

148. — Tracts in the spinal cord ..... 

149. — F. site of frontal sinuses ..... 

150. — Showing location of headaches, according to their causes 

151. — The possible causes of pain in the foot and heel 

152. — Pain or tenderness at various points along the spine . 

153. — The general diagnostic indications to be derived from the seat 

the head and face ...... 

154. — The possible causes of pain in various parts of the body 
155. — The possible causes of pain in various parts of the body 
156. — The general diagnostic indications to be derived from th 

the face and neck ...... 

157. — The possible causes of pain in various parts of the body 
158. — The causes of localized headache according to the exact site 
159. — -Trifacial nerve ....... 

160. — Nerve of sensation to the soft palate, the teeth, the nose, 

the sinuses of the upper face 
161. — Distribution of nerves of sensation of the head 
162. — Family history showing Huntington's chorea 
163. — Composition functions and uses of food 
164. — Bread and other cereal foods . 
165. — Cereal grains ...... 

166. — Meat, fresh and cured .... 

167. — Diagram of cuts of beef 

168. — Diagram of cuts of pork 

169. — Diagram of cuts of lamb and mutton 

170. — Diagram of cuts of veal 

171. — Fish, fish products and oysters 

172. — Eggs and cheese ..... 

173. — Fruit and fruit products .... 

174. — Nuts and nut products .... 

175. — Eoots and succulent vegetables 

176. — Fresh and dried fruit .... 

177. — Legumes and corn ..... 

178. — Butter and other fat-yielding foods . 
179. — Milk and milk products .... 

180. — Illinois State Board of Health, cartoon No. 10 
181. — Sugar and similar foods .... 

182. — Dietary standards ..... 

183. — For sterilizing by heat, as in canning tomatoes 

184. — Rochester home-made ice-box 

185. — Strauss home pasteurizer 

186. — Mother's milk for mother's babe, cow's milk for calves 

187. — Cheap home-made ice-box 

188. — A very poor milk pail .... 

189. — A good milk pail ..... 

190.— Why? 



PAGE 

358 



milk 



after 



pasteurization or 



191. — Keep baby's milk clean and cool 

192. — Arrangement of apparatus for rapidly cooling 

sterilization ..... 
193. — Pasteurization at home . 
194, — Time and temperature at which some bacteria are killed and at which the 

composition of milk is changed ....... 



535 



LIST OF ILLUSTRATIONS xxxv 

FIG. PAGE 

195. — Lymph vessels and glands of arm and hand ...... 548 

196. — Thyroid gland. Subclavian artery (to arm) and some of the branches. Com- 
mon carotid artery (to head and neck) ...... 568 

197. — Thyroid gland. External carotid artery (to head and neck) and some of 

its branches ........... 570 

198. — Adrenal glands (or suprarenals) . Kidneys, abdominal aorta and some of 

its branches ........... 576 

199. — Diagram showing division of stomach into two physiological parts . . 583 

200. — American Public Health. Element of mortality ..... 584 

201. — The general death rate of American cities, 1815-1914 .... 586 

202. — Investigation of sickness in Albany County, New York, by the State Depart- 
ment of Health 588 

203. — Heart and the great vessels which lead into and out from the heart . . 590 
204. — Diagrammatic section of heart showing cavities and vessels . . .591 
205. — Sketch showing approximate location of gall bladder (gb), appendix (a), 

naval (N), crest of ilium — hip bone — (H), and rib border (R) . . 593 
206.— -Scheme showing circulation of the blood . . . . . . .596 

207. — Femoral artery and its branches . . . . . . .597 

208. — Brachial artery (arm) and its branches ....... 598 

209. — Veins, showing (a) valves open when blood is flowing .... 601 

210. — Diagram explanatory of arterial tension . . . . . . . 605 

211. — Method of taking blood pressure ........ 606 

212. — Method of taking blood pressure ........ 607 

213. — Method of collecting a sample of urine from a male baby .... 617 

214. — Test tube used in testing urine for sugar and albumin .... 618 

215. — Half a kidney showing suprarenal (or adrenal) kidney structure, pelvis of 

kidney and ureter .......... 618 

216.— Bed-grapple 619 

217. — A human kidney a little more than one-half natural size in an adult . . 620 

218.— Head coil 621 

219. — Cold water coil applied to abdomen ........ 622 

220. — Arrangements for prolonged bath ........ 623 

221. — Section of a tooth, showing enamel, dentine and pulp .... 637 

222.— The three salivary glands 638 

223.— The jaws and the teeth 639 

224. — Baby teeth, except the six-year molars ....... 639 

225. — Diagram illustrating digestive organs ....... 641 

226. — The pancreas, partly cut away, so as to show the duct which collects the 

pancreatic juice and empties it into the duodenum .... 642 

227. — Digestive apparatus .......... 644 

228. — Position of abdominal contents 646 

229 Trichina in muscle 650 

230. — V-shaped colon may cause so-called intestinal indigestion .... 655 

231. — Method of applying adhesive strips for maintaining reduction in infantile 

umbilical hernia .......... 655 

232. — A hernia sack is a pouch of peritoneum ....... 666 

233. — Sites of ruptures: 1 and 2, epigastric hernia; 3, umbilical hernia; 4, inguinal 

hernia; 5, femoral hernia ......... 666 

234. — Skein of worsted truss 667 

235. — Abdominal support, plaster and webbing . . . . . . .670 

236. — Section of hair showing the epithelial cells which produce it and sebaceous 

glands ............ 701 

237. — Section of skin showing hair, sebaceous gland, sweat gland, and blood 

vessels 702 



XXXVI 



LIST OF ILLUSTRATIONS 



tides, which, fermenting, form acid 



dental disease 



FIG. 

238.— Eed bugs 

239. — Infections at root of, beneath and near end of nail 

240. — Hookworms 

241. — Hookworms, actual size . 

242. — Itch mite. Female 

243.— Itch mite. Male 

244. — Crab louse 

245. — Ringworm of the scalp 

246. — Uncared for teeth, showing food par 

247. — Uncared for teeth. Acid attacking the lime in the enamel rods . 

248. — Uncared for teeth, showing decay attacking dentine 

249. — Uncared for teeth. Further progress of decay — tooth begins to ache 

250. — Uncared for teeth. Undermining and breaking down of the enamel walls 

251. — Uncared for teeth. Death of dental pulp or nerve . 

252. — Points usually neglected in brushing teeth and where decay begins 

253. — Growth and multiplication of bacteria in such a tooth in 24 hours 

254. — Temporary and permanent teeth 

255. — First and second lines of defense against 

256. — Bones of right foot 

257. — Shoe to prevent or cure bow-legs in children 

258.— " Toe-in " shoe 

259. — Ankle and arch supporting shoes 

260. — Print of foot with high instep and print of flat foot with pinched toes 

261. — Weak feet — seen behind . 

262. — Weak feet — seen in front 

263. — A print of normal foot 

264.— Modified Thomas heel 

265. — Shoes should have a broad toe 

266. — A harmful, narrow-shaped toe . 

267. — Toes pressed out of position, weakening 

the foot . . 

268. — A narrow-toed shoe and the natural shape 

body 
269. — Cross section of a corn . 
270. — The rocker 

271 The flat sole . . 

272. — Bed rest and table . 

273. — Pregnant uterus containing young embryo ..... 

274. — Section of ovary .......... 

275. — Massage of the breasts to increase their size ..... 

276. — Massage of the breasts to decrease their size ..... 

277. — New York State Department of Health ...... 

278. — Comparison of the health of city and country babies .... 

279. — Shape of a baby's jaw ......... 

280. — Shape of an adult's jaw ......... 

281. — The relative length of trunk and legs in a baby, a youth and an adult 
282. — Rate of growth of babies ........ 

283. — Rate of growth of children ........ 

284. — Correct method of holding a baby ....... 

285. — Incorrect method of holding a baby . : . . • . 

286. — Bones of a baby's skull, showing "soft spot" .... 

287. — Hand-I-Hold mitts to prevent thumb sucking 

288. — How to place baby in his bath ....... 

389. — Screened bed for out of doors sleeping ,..,., 



both the instep and the ball of 
of the foot when supporting the 



LIST OF ILLUSTRATIONS 



XXXVll 



FIG. PAGE 

290.— Chicago State Board of Health— Comfort vs. looks 812 

291. — Feeding tube lor premature baby ........ 815 

292 (A) Nipple with proper perforation; (B) Nipple with faulty perforation, 

permitting milk to run too freely ....... 816 

293. — Lactometer for testing milk . . . . . . . . .818 

294. — Simple milk testing apparatus . . . . . . . . .819 

295. — Chap in dipper for removing top milk . . . . . . .819 

296. — Breast pump in use . . . . . . . . . .821 

297. — Diagram showing construction of breast pump ...... 822 

298. — Arnold sterilizer 823 

299.— Out-of-door pen 823 

300.— The right way 824 

301. — Cuts showing deciduous teeth ......... 825 

302. — The wrong way 826 

303.— What kills the babies? 828 

304.— Make baby's milk safe 830 

305. — Why, oh why pasteurize if you don't swat the flies! . . . . .831 

306. — Tape worm. (A) magnified head; (B) segments; (C) egg . . . 834 

307. — Eound worm greatly magnified ........ 834 

308.— Pinworms 835 

309. — Method by which one man can carry a wounded man ..... 859 

310. — Another method by which one man can carry a wounded man . . . 859 

311. — A short stretcher made with two rifles ....... 860 

312. — Method by which two men can carry a wounded man ..... 861 

313. — Compress the carotid artery for severe hemorrhage about the head and neck 862 

314. — Digital compression of subclavian artery ....... 862 

315. — Diagram showing position of important arteries ..... 863 

316. — Digital compression of the femoral artery ...... 864 

317. — Tourniquet to control hemorrhage in the forearm or hand .... 864 

318. — Compressing the femoral artery with tourniquet and pad for severe hemor- 
rhage in leg ........... 865 

319. — Compressing brachial artery for severe hemorrhage in the elbow, forearm 

and hand ........... 866 

320. — Artificial respiration, inspiration, pressure off . . . . . . 867 

321. — Artificial respiration, expiration, pressure on . . . . . 867 

322. — Blanket stretcher 868 

323. — A pillow used as a temporary splint in fracture of the leg .... 868 

324. — Gun used as a temporary splint in fracture of the femur .... 868 

325. — Sling made from coat .......... 869 

326.— First aid in fracture of leg 809 

327. — First aid treatment of fracture of both bones of leg . . . . 870 

328.— Fracture of nose . 870 

329. — Fracture of finger. Wooden splint applied to palm surface . . . 870 

330. — Break of bone in back of hand ........ 871 

331.— Fracture of wrist 871 

332. — Dislocation of both bones of the forearm backward, showing position of the 
ends of the dislocated bones, deformity of elbow, and position of 

forearm 872 

333. — Artificial respiration, Silvester method. Expiration . - . . . . 873 

334. — Artificial respiration, Silvester method. Inspiration .... 873 

335. — One method of resuscitation after drowning ...... 874 

336. — Artificial respiration. Hall method ........ 875 

337. — Triangular bandage . . . . . . . . . .876 

338.— Triangular bandage ,,,.,. , . , . 876 



XXXV111 



LIST OF ILLUSTRATIONS 



FIG. 

339. 

340. 



the 



Method of rolling a bandage 

Triangle bandage for head 
341. — Four-tailed bandage for fracture of lower jaw 
342. — Four-tailed bandage for chin . 
343. — Double-headed, knotted bandage 
344. — Figure of eight of the hand 
345. — Cravat bandage for hand 
346. — Adhesive plaster for sprain of the thumb 

347 Bandaging wrist and hand 

348. — Spiral reverse bandage 

349. — Bandaging elbow 

350. — Triangular bandage applied to shoulder, hand and elbow 

351. — Triangular bandage used for arm sling . 

352. — Triangular bandages used for arm slings 

353. — Triangular bandage for collar bone fracture 

354. — Dressing for collar bone fracture 

355. — Triangular bandage of breast . 

356. — Figure-of-eight spica bandage of shoulder 

357. — Temporary dressing for fracture of clavicle 

358. — Strapping with adhesive plaster for broken rib 

359. — Cravat bandage for knee 

360. — Spiral reverse bandage of thigh showing introduction of 

361. — Spiral reverse bandage of thigh completed 

362. — Bandaging hip and abdomen . 

363. — Triangle bandage of hip .... 

364. — Good method of strapping a sprained ankle with adhesive plaster 

365. — Bandaging leg. Spiral reverse . 

366. — Figure-of-eight bandage of the ankle and foot 

367. — Triangle bandage of foot 

368.— Eeef knot 

369. — Grannie knots ..... 

370. — Wrist drop due to lead poisoning . 

371. — Drager oxygen apparatus for use in mines 

372. — Eespirator 

373. — Showing the choking with soot of a breathing pore of a leaf of 

tree in seeds ..... 
374. — Cabinet for sand blasting 
375. — A harvest mite ..... 
376. — Lice and nit . 

377.— Bedbug 

378. — Trap for cockroaches .... 

379.— Cockroach 

380. — Larder beetle ..... 

381. — Larva of larder beetle .... 
382. — Croton bug carrying egg capsule, natural size 
383. — Case making clothes moth 
384. — Webbing clothes moth 
385. — Black carpet beetle 



386. — Larva of above 

387.— Fish moth 

388. — Where do you eat? 

389. — The Hodge fly trap on a garbage can 

390. — Parasite ticks on the body of a house fly 

391.— Flies— milk 



first 



a silver fir 



LIST OF ILLUSTRATIONS 



XXXIX 



and fly-proof cover 



FIG. 

392. — Fly season 

393. — Fly season 

394.— Fly food 

395. — Giant fly trap 

396. — Swat them early 

397. — Plan for the Swain manure bin 

398. — Flies all over town . 

399.— A day in the life of a fly 

400. — Cancer a curable disease 

401. — Diagram showing relative importance of cancer as a cause of deaths in 

Michigan during the seven years 1901-1907 
402. — Pedigree of a family in which the father 's parents are both nervous and have 

four nervous children 
403. — Pedigree of family with color-blindness 
404. — Pedigree of family showing degeneration 
405. — Pedigree of family with deaf mutes in a large proportion in the later 

generations ..... 
406. — Pedigree of a family containing albinism 
407. — Pedigree of a feeble-minded family in which criminalistic and licentious 

traits also appear ........ 

408. — Family history showing feeble-mindedness .... 

409. — Family history showing deaf mutism ...... 

410. — History (condensed and incomplete) of three markedly able families 

411. — Pedigree showing hereditary persistence of color-blindness 

412. — Pedigree of a family containing color-blind members 

413. — Pedigree showing hereditary transmission of hemophilia . 

414. — Exercise bars to be attached to window ...... 

415. — Door exercising bar ........ 

416. — Exercise for all muscles, especially for leg and shoulder muscles 
417. — Exercise for all muscles, especially for muscles of abdominal wall 
418. — Mild exercise for trunk and leg muscles 

419. — The skeleton 

420. — Upper surface of left clavicle or collar bone 

421. — Fibula, lower leg, tied in a knot, after maceration in a dilute acid 

422. — Left scapula, or shoulder blade 

423. — Eight femur, or thigh bone 

424. — Bones of the left hand, palmar surface . 

425. — Left humerus ...... 

426. — Left radius and ulna, or bones of the forearm 
427. — Thorax, anterior view .... 

428. — Thorax, posterior view .... 

429. — Exercises to develop the chest . 

430. — Bad posture due to desk which is too high 

431. — Bad posture due to desk which is too low 

432. — Faulty posture favoring enteroptosis 

433. — Faulty posture enteroptosis 

434. — Normal broad chest .... 

435. — Enteroptotic build ..... 

436. — Enteroptosis, showing head forward, shoulder blades and lower part of belly 

prominent .... 

437. — Belt for enteroptosis 
438. — Faulty posture favoring enteroptosis 
439. — Normal chest and abdomen 
440. — Flat chest and sagging abdomen 



PAGE 

929 
930 
931 
931 
932 
935 
937 
939 
959 

961 

989 
990 
990 

990 
991 

992 
994 
995 
996 
1000 
1000 
1004 
1026 
1027 
1027 
1029 
1030 
1032 
1033 
1033 
1034 
1035 
1037 
1039 
1039 
1040 
1040 
1048 
1059 
1059 
1060 
1060 
1061 
1061 

1062 
1063 
1064 
1065 
1065 



xl LIST OF ILLUSTRATIONS 

mG - PAG2 

441. — Showing difference between Fig. 439 and Fig. 440 ..... 1065 

442. — Normal chest with ribs running normally ...... 1066 

443. — Eibs running more nearly perpendicular in a poorly developed chest and 

sagging abdomen .......... 1066 

444. — Normal angle of ribs in front of chest. Normal well developed chest . .1067 

445. — Narrow angle of ribs in front of chest. A very poor sign .... 1067 

446. — Biceps muscle as it appears when arm is extended . . . . .1073 

447. — The bones of the upper extremity with biceps muscle .... 1074 

448. — Biceps muscle as it appears when arm is bent ...... 1074 

449. — Great muscles of the back, neck and arm ....... 1075 

450. — Various types of striped or voluntary muscles . . . . . .1076 

451. — Muscles ............ 1078 

452. — Diagram of a bad tenement in Illinois ....... 1085 

453. — Diagram giving an analysis of conditions in 1,003 houses in Philadelphia . 1086 
454. — A certain district in Philadelphia ........ 1089 

455. — Chart showing comparative standing of localities as " cities of homes" . 1091 

456. — Ball's motto 1092 

457. — Floor plan of one of a series of basement apartments .... 1093 

458. — Six rooms, one behind the other; outside windows only in front and rear . 1094 
459. — Three out of five rooms dark ......... 1094 

460. — Basement apartments. Rear rooms virtually unlighted cellar rooms . . 1096 

461. — Section of floor plan in a new apartment house (1912) .... 1098 

462. — Dark, unventilated rooms and toilets in buildings ..... 1100 

463. — Dark, unventilated basement rooms and toilets found in some buildings . 1101 

464. — Typical floor plan, showing dark basement rooms in one section of build- 
ing shown in figures ......... 1102 

465. — Water may become impure in badly located wells from surface drainage . 1106 
466. — Wrong construction of a well ......... 1107 

467. — Proper construction of a well ......... 1108 

468.— Ground water 1108 

469. — Wells curbed with brick, stone, crock or wood are improperly protected and 
seldom safe if there is any source of dangerous contamination in 
the vicinity ........... 1108 

470. — Safe well cement curbing ......... 1109 

471. — Diagram showing how a well (with water proof wall) may extend through 

danger zones and risky zones to reach water in safe zone . . . 1110 

472.— William Penn 's plan of the city of Philadelphia 1112 

473. — The usual way — the water front shut off . . . . . . . 1113 

474. — An admirable exception. A promenade along the shore .... 1113 

475. — Showing difference between haphazard and scientific street planning of 

irregular plot ........... 1115 

476. — A house for each family ......... 1117 

477. — Mechanics' homes, six rooms and bath ....... 1118 

478. — Another type of mechanics' homes ........ 1119 

479. — Two springs. One protected from surface contamination; the other not . 1121 

480. — Popular idea of how wells become infected from surface pollution . . 1122 

481. — Ventilating by means of window lowered at top, raised at bottom . . 1137 

482.— Window ventilator 1139 

483. — Diagrammatic sketch of various provisions for ventilation .... 1145 

484. — The position of inlets and outlets, and their relation to the air currents in 

a room ............ 1146 

485. — Window ventilator with deflector ........ 1147 

486. — Influence of closed windows on room air current on a cold day. Hot air heat 1172 
487. — Hygrometer composed of wet and dry bulb thermometers .... 1193 



LIST OF ILLUSTEATIOISTS 

FIG. 

488. — Bryce method of humidifying a house heated by hot water 

489. — Kentucky type privy with septic tank .... 

490. — Specifications for Kentucky type septic tank . 

491. — Cheap sanitary dry earth bucket privy .... 

492. — Leaching cesspool constructed of field stones 

493. — Hollow brick cesspool with overflow into agricultural tile . 

494. — Concrete septic tank and dosing chamber attached, for household 

10 persons ........ 

495. — Cheap wooden septic tank for household of not over 10 persons 
496. — Design for a pit privy ..... 

497. — The pit privy, simplest form .... 

498.' — Sewage disposal plant for private home . 

499. — Typical sewage disposal by subsurface irrigation 

500. — McCabe drinking fountain attached to a pump . 

501. — Home-made filter for domestic or school use . 

502. — Antiseptic tank or chemical system for one-room schools 

503. — Perspective of modern one-room school 

504. — Showing stairway to basement 

505. — A less expensive school house 

506. — One-room school 

507. — Foundation plan 

508. — Foundation plan 

509. — First floor plan 

510. — Inexpensive cloakrooms, entry and fuel house 

511. — Showing old style country school house and manner in which 

may be modernized at small cost 

512. — The same 

513. — Jacketed stove for heating and ventilating one-room schools 

514. — Double flue chimney ventilation 

515. — Single flue ventilation .... 

516. — Construction of a double flue chimney 

517. — Heater with jacket not reaching the floor 

518. — Female reproductive organs 

519. — Section of female pelvis, showing location of organs 



xli 



PAGE 

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. 1206 
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. 1209 
of not over 

. 1210 
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. 1212 
. 1214 
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. 1234 
. 1235 
. 1235 
. 1240 
. 1241 
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. 1259 
a one 

. 1260 
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such 



HOW TO KEEP WELL 



CHAPTEE I 



Introduction 



THE ADVENT OP PREVENTIVE MEDICINE— JUST A START 



Between birth and death is life. Life occupies itself with its own con- 
tinuation. Human life seeks to promote not only its continuation but to make 
it enjoyable. We were long in finding that out. 

For a long time the starting and stopping points were considered most 
important. Life itself, the journey from oirth to death, was not well under- 





STARTING THE BATTLE OF 
LIFE WITH PERFECT HEALTH 




WHICH PATH ARE YOU ON? 



North Carolina Health Bulletin. 



Fig. 1. 

1 



2 INTRODUCTION 

stood. It was not studied, measured, much thought about or valued. A per- 
son lived until he died — that was definite. 

Whether he lived a healthy, enjoyable life and died at a good old age, or 
dragged out a miserable existence, pestered by many ills, devoured by fierce 
diseases, and died young, was no one's concern. Most men fell early victims to 
this ignorance and general indifference. 

There was a reason for this then, as there is no reason for the existence 
of the same state of affairs now. Food was scarce, life was cheap, health a 
negligible quantity, death a release for the victim, a relief to the survivors. 
They went away unwept. 

It is different now, at least in one respect. Wealth is piled up. The in- 
dividual can produce more than he can use. He is a valuable economic asset 
to the state. 

In the other respect, in longer and healthier life, much is still as it used 
to be. Infant mortality, contagious diseases, tuberculosis, social diseases, occu- 
pational diseases, and the general waste of health and life attest this. 

An initial improvement is, however, noticeable. Preventive medicine 
is becoming an established science; the laws of health and disease are better 
understood; conservation of health is becoming a national policy. The people 
are waking up. A new era is at hand. 



WHAT IS HEALTH? 

When man emerged from the purely animal state and woke up homo 
sapiens, he found life hard and death easy. Of health he at first knew only 
through disease. When he was tortured by pain or any other physical ill, he 
prayed for deliverance. When deliverance came he blessed it as health. 

That health is a godsend of man's making did not occur to him. For 
many centuries health was considered as something beyond the control of man. 
It was a gift from the gods, given or taken at the caprice of unknown powers. 
That our own conduct and mode of life brings health or disease was not recog- 
nized until much later. 

That health is the. greatest asset of life the following, from an ancient 
author, testifies : 

"0 blessed health ! Thou art above all gold and treasure, the poor man's 
riches, the rich man's bliss — without thee there can be no happiness." 

Modern medical science teaches that health is the harmonious and pain- 
less co-operation of all the organs and parts of the body: of the unconscious 
and adequate response of the whole body to the various changes in the en- 
vironment. It depends on natural laws as much as the flowing of water down 
hill. 

We are not the playground for good and evil spirits who torture and 
trifle with us while we helplessly look on. Eather are we living machines, 
more finely built and more properly adjusted than any other machines in 
existence. 

Your machine is subject to all the great laws of nature, in charge of an 
engineer who should be well fitted for his post by virtue of his intelligence. 

// intelligence and a clear understanding of the laws of life were more 



HEALTH CAN BE BOUGHT 3 

widely spread, and if these laws (which are simple in the mam) were more 
carefully practiced, there would not be so much disease and suffering. As it 
is, universal lifelong health is the far-off dream of a few workers in the field 
of human health conservation. The many neither think of health nor have it. 
We may all ask with the prophet Jeremiah: "Is there no balm in Gilead? 
Is there no physician there? Why then is not the health of the daughter of 
my people recovered?" 

There is balm in Gilead and elsewhere, and that is scientific understand- 
ing of the laws of life. There is a physician there, and that is the application 
of nature's laws to life and the removal of all hindrances to health. There 
is recovery possible, just as soon as we understand that we cannot hold our life 
positions unless we make good as engineers of the human machine. 



HEALTH CAN BE BOUGHT 

There is a popular idea prevalent concerning health to which frequent 
expression is given thus : "You can buy everything for money, but you can't 
buy health." 

This is erroneous. The truth is that we cannot buy health after it is 
thrown away and broken. Second-handed, tinkered-up health is hard to buy, 
nor is it worth much. But good, first-rate health can be bought, like any other 
commodity. 

Let it be clearly understood that health and money are convertible things. 
That health is sold and thrown away for money is a well established fact. 
With foresight and wisdom, the reverse can be made true. 

We can get health for money. It can be had at less cost in the end if 
bought in season. The proper time to buy health for yourself and your family 
is before the present supply (I am afraid we have not much on hand; we have 
been shortly supplied to begin with) is exhausted. 

I am led to write about this subject for the reason that the people of 
Chicago will soon be in the market to buy a supply of good, vigorous, first- 
rate health to last them for a year. Individual bargaining is impossible. We 
do not know enough about it; also it would cost too much to order in small 
lots. 

We must authorize our representatives, whosoever they may be, to repre- 
sent us in this matter. They, with their expert assistant, the commissioner 
of health, can buy it and deliver it to us at reasonable rates and guarantee 
satisfaction. 

New, how much money are we going to give them for health protection, 
for insuring the health and lives of ourselves and of our children? Last 
year (surely, I do not want to embarrass any citizens, but the truth must 
be faced), last year, I say, we each handed our representatives the magnifi- 
cent sum of twenty-five cents and told them to buy us health protection for 
that amount. 

Did we really expect to get efficient protection for that sum ? If we did, 
we have much to learn. If we did not, we have been playing the fool with 
ourselves. In either case we have much to regret. 

The impossibility of buying health protection for the community at 




I 

CO 



♦ * 



I 






z 
Jo 

0> o 
- UJ 



O 



to 



£ 



1 



ENDING WELL 5 

twenty-five cents a head for a year is proved by several thousand unnecessary 
deaths during the year. 

We thought we were striking a splendid bargain; but figure it up. Fig- 
ure up the loss of time, your doctor's and undertaker's bills, and you will find 
that you have lost out; that you have paid dearly for what you thought you 
bought cheaply. We have lost both in money and in lives. 

Let us be sensible this time. A twenty-five-cent health department cannot 
efficiently protect us. Other cities are paying from fifty cents to one dollar 
per head. Chicago has done wonders with the little it has had, but it fell short 
pitifully in proportion to the amount of good that could be accomplished with 
a more liberal appropriation for health purposes. 

A dollar a head is not too much. We spend much more privately and col- 
lectively for things that are of far less importance. 

Chicago cannot afford to have its babies die and its most useful men and 
women carried off in the prime of life. Municipal thrift at the expense of 
the lives of its citizens is a criminal blunder. 

Buy health when it is still possible to buy it — before the hand of disease 
is laid on it. Buy it and pay for it and insist on getting your money's worth. 

When we authorize our mayor and councilmen to buy health for the city 
for next year it must be with the understanding that they can invest a dollar 
for each citizen of our community for the protection of his life. 



ENDING WELL 

Metchnikoff writes of the possibility of eternal life. He speculates on the 
possibility that some day the human body will be shielded from all accidents, 
a proper adjustment between work and food will be maintained, and the body 
will be subjected to no adverse influences except legitimate wear and tear. 

Among accidents he not only includes such palpable incidents as being 
run over by street cars, gored by bulls, and falling into thrashing machines, 
but also all bacterial diseases and intoxications. He says that in a properly 
regulated society there will be no scarlet fever, diphtheria, consumption, or 
pneumonia. In the list of accidents he would include inflammatory rheuma- 
tism, diarrheas, and appendicitis. 

Of course that day is far off. 

Chronic bacterial infection of the intestinal tract causes putrefactions and 
absorption of bacterial products, which he holds to be largely responsible for 
what we now call senility. Bright's disease and heart disease he considers 
divisible into two parts — the large part the result of old infections ; the smaller 
part the result of a bad adjustment between food and work. 

A proper adjustment between food and work is remote. 

These things having been adjusted, he suggests that the body cells may 
be able perpetually to repair wear. While we are waiting it is comforting to 
know that human life is longer each year. 

Men engaged in handling live stock say that an animal should live five 
times as many years as it takes it to get its growth. On this basis the proper 
age of man at death is at least one hundred years. 

In 1909 in Chicago eight men died who were over 100; 146 died between 




WHY? 




/ -f 




Ma John Mary Ben Sam 



A FLY VISITED AN 

COLLECTED SOME 
THEN GATHERED 
GERMS FROTlSArfS 
DROWNED IN THE 
FAMILY ORANK 




OPEN PRIVY AND 
TYPHOID GERMS. 
TUBERCULOSIS 
SPIT. AND LATER 
miK PAIL THE 
THE MILK 



f 



^AllfTlE LATER PA AND MA AND 

LITTLE BEN BEGAN TO FEEL TIRED > 

ALL THE TIME AND TO COUGH A GREAT ) 

DEAL. JOHN AND MARY CAME DOWN 

^-v WITH TYPHOID FEVER SAM 

V^ ^A I DIED-NOBODY CARED, AND 

%??^ EVERYBODY AVOIDED THEM 

>va *£ ES it 



HOG CHOLERA GERMS OOr INTO T«f 
PIGS FEED, AND THE HOGS BECAME 
SKK BUT /MOT FOP LONG HOG 
CHOLERA SERUM WAS RUSH- 
EO TO THEM AND IXPtRT VET- 
ERINARIANS w ERE HURRlCOlv 
C AILED 




THE RESULT 



y\ 



Fig. 3. 



TflE RE$ULT 

Chicago Health Department. 



ENDING WELL 



90 and 100. This was just about an average year in this particular. In this 
year 3,530 died at ages in excess of three score and ten. 

Irving Fisher's Bulletin on National Vitality shows this lengthening 
of human life present wherever civilization has reached its higher planes. He 
says that in England in the last quarter of the nineteenth century the average 
length of life was increasing at the rate of fourteen to sixteen years per cen- 




^/^ODERftTION^^ 



THE TEMPLE 0T HEALTH 
IS FOUNDED ON MODERATIONS. 
ITS FOUR MAIN PILLARS ARE: 
FRESH AIR ♦ , , GOOD FOOD, 
EXERCISE AND REST. §§© 



Fig. 4. 



Louisiana Almancc, 1916. 



tury. In Massachusetts the rate of increase in the last half of the century was 
fourteen years per century. 

Many false conclusions can be drawn from such figures; yet, after the 
application of proper corrective factors, it stands out that the average of 
human life is getting longer and an increasing number of people are living to 
a ripe old age. 

This is because it deserves to be so. Occasionally you find an old rake 



8 INTRODUCTION 

who is tobacco-soaked or whisky-soaked or obese and who boasts that he has 
consistently violated every law of health. A careful study of the heredity 
and life history of even these shows that "there's a reason/' 

The truth is that the right to a long life is being earned. 

Then let us be merry. 



CHAPTEK II 

The Nose 

Most of the organs are built with plenty of leeway. Half of the kidneys 
could be removed, and what would be left could do the work without crowding. 
The heart pumps away, working under low pressure, and holding much more 
than half its power in reserve. The engine builders long ago told us that that 
was the best way to get wear out of an engine. 

The nose does not measure up to that standard. It is unlike the other 
organs. It works on a narrow margin. If there is too much room, the air is 
not cleaned of dirt and germs and it reaches the large air tubes too dry and 
too cold. If there is too little room, not enough air can pass through and the 
mouth opens to allow the deficit to be made up. 

The nose is the only part of the body that is infected a good part of the 
time. Besides the two main openings, one to the outside air and the other 
to the back of the mouth, there are seven openings into each side of the nose, 
or fourteen openings in all. Each of these openings drains some cavity, or 
was put there for the purpose of draining it. Some of the drains are habitu- 
ally clogged. 

One duct runs from the eyes into the nose. This duct is exceedingly 
necessary. The tears are needed to keep the eyes clean, and there must be a 
drain through which the wash can run off. 

It is a large duct running from an open cavity, the front of the eye, 
to an open area, the nose. Down it there habitually flows a stream of fluid. 
This fluid is a good washing compound, one of the best. No widely advertised 
eye wash is to be compared with the tears as a wash. 

Under these circumstances the tear ducts are seldom infected. Even 
when an infection travels to the eyes from the nose, or the other way, a few 
days of discomfort is the only harm. 

The large duct keeps itself clean; also it keeps the upper cavity drained. 
We except the tear duct, or nasal duct, from our bill of complaint against the 
nose. 

In the back of the nose, where it joins with the mouth to make the 
upper part of the throat, called by the anatomists the nasopharynx, there is 
an opening on each side. This is the opening of a duct which drains the 
middle ear. It is called the eustachian tube. It is a branch sewer, draining 
into the great sewer, the nose. 

The middle ear is a small cavity on the rear side of the ear drum. There 
had to be a cavity there ; it had to have air in it ; it had to drain, and probably 
no better place was at hand than the nose. 

Now, this little tube makes a lot of trouble. There is not much to drain 
down this tube, but it must be kept open to equalize the air pressure. This 
makes an arrangement that is subject to infection with air germs. 

9 



10 



THE NOSE 



Bacteria of scarlet fever, of diphtheria, of ordinary sore throat, of ordi- 
nary colds, travel up this tube to the middle ear cavity. 

When a cavity is right out in front, as is the eye, keeping it drained and 





Location of Adenoids in 
posterior nasal passage, d 
fypicaJ expression of victim. 



Adenoids cause mouth 
breathing, frequent colds, 
catarrh, dea/rcess and 
de/ormitg of the jaw 3 
chest 

They induce stupidity e? 
skint mental 8 phusicaJ 
c|rowtl\. 



Do/s'T Let Your Ould 

5& 50 /iANDICAPPED. 

TKe removed o/adenoids 
is a<. simple e\nd brie/ 1 — 
operation,. 

GivE YourOiilda 
C/iance fo Breath Er 




Cross section of head 
showing Adenoids (A) 



Chicago Health Depbri 'ment -Educ&iionaJ Poster 5er/es AtSJJO 

Fig. 5. 

cleaned is easy. When a cavity is stuck away up in the attic behind a curtain, 
as is the middle ear, keeping it clean, drained and free from infection is diffi- 
cult. But at that, our bill of complaint against the nose must allow that the 
cavity had to be there and that it had to drain somewhere. 

In addition, there are five other openings. Some are near-openings into 




THE NOSE 11 

each side of the nose — ten in all. One of these drains is a cavity in the bones 
of the forehead just above the eyes. 

Why there should be a cavity there nobody knows. It gives the overhang- 
ing forehead the beetling brow, but that does no good of which anybody knows. 

A prominence in this locality is frequently held to indicate mental power. 
What it does mean is a hole in the head, and an easily infected one at that. 
So long as the hole was there it had to be drained, and about the most con- 
venient sewer to empty the drain into was the upper front part of the nose. 

Directly above the teeth lies another cavity in the bone called the antrum. 
The roots of the jaw teeth sometimes run up into this cavity. This cavity is 
below and just outside the nose. Being there, though nobody knows why, it 
had to be drained. So a delicate drain empties its contents into the nose. 

Back behind the nose and somewhat above it lies another cavity, the 
sphenoidal sinus. Why it is there nobody knows. That space might have been 
filled in with solid bone without materially increasing the weight of the body. 

The face might have been flattened in a little, doing away with the last 
two cavities — the antrum and sphenoidal — and in time we should have learned 
to admire the new type 
of beauty as much as 
we do the present type. 
Be that as it may, the 
cavity is there, and it 
had to drain. The 
duct empties into the Fig. 6.— Nasal Syringe. 

nose. 

Lodged away up in the attic are three cavities called the ethnoid cells. 
They are irregular in shape and size and they do not always have three open- 
ings that remain open. But those were the plans and specifications. The bill 
of specifications in our complaint against the nose contains several entries. 
As we should expect, these cavities, hard to drain, are frequently infected. 
There is no reason why infection cannot travel from the nose up these ducts. 

The ducts do well enough as drains, as long as the amount to be drained 
is normal. But when inflamed or when the cavity wall is secreting pus, the 
drains do not work well. The sewer system clogs and the cellars overflow. 

Wherever it may be, no suppuration tends to end unless the suppurating 
area can drain well. It is for that reason that white swelling keeps on run- 
ning for so long; that hip joint suppuration is so chronic; that pus in the 
pleural cavity is so hard to heal. 

When an ordinary cold starts the discharge is watery. In a few days it 
is pus. If the pus germs travel up these ducts and infect the cavity with a 
chronic suppurating process we have what is called catarrh. A great many 
people have catarrh. 

As we expected when we found all of these nooks, corners and cavities 
leading off from the nose, we find troubles frequent. This faulty construction 
puts the nose on the sick list most of the time. 

When the air enters at the front of the nose it is cold, dry and dirty. 
If the nose were a tube with a plain-, slick, smooth wall, the air would whistle 
through it without much friction, but it would reach the larynx cold, dry and 
dirty. 



12 THE NOSE 

In order to condition the air, three baffles are hung on the outer wall of 
each nose. They are long, bony curtains that hang down in the nose from 
above. These are called turbinated bones. 

They had to be there to make things right, but their being there creates 
new fissures and nooks that do not clean themselves as well as a free surface 
should. 

These turbinated bones and the membrane covering them can swell and 
shrink. If the air is dry and cold they fill up with blood, and, in consequence, 
swell. If the air is warm they contain less blood and are smaller. 

The space in the nose is pretty closely adapted to the amount of air pass- 
ing through. If these bones swell much or a polyp grows somewhere, or if the 
person becomes obese and fat is crowded into every loose place, breathing 
becomes obstructed. 

The mucous membrane of the nose is lined by ciliated cells, just the type 
of cells best suited for a surface that must keep itself clean. In other words, 
the nose is a self-sweeper. 

Now the air, as it enters the nose, is extremely foul. It contains much 
soot, dust, dirt, and germ life. The wet, warm, sticky surfaces remove most of 
this dirt, and the sweepers sweep it away. Some of it, however, fails to be 
removed. No sweeper is perfect in its action. 

The dirt particles that get by the surface epithelium are picked up by the 
lymphatics. They are carried in the lymph stream to the nearest lymph node. 
Here they are stopped. 

The first line of lymph nodes in the nose and upper throat is so highly 
important that each has been given a name of its own. The best known of 
these is the tonsil. The next best known is that gland of which the average 
person has heard, calling it the adenoid. 



A BABY'S NOSE 

A baby's nose consists of two holes in the face — a lick and a promise 
proposition. The nose of an adult is the most prominent and the most in- 
dividual part of the face. No other organ changes so many hundred per cent 
from babyhood to maturity as does the nose. 

A baby's brain is nearly as large as that of an adult, but a baby's nose 
does little more than mark the area to be given over to nose purposes. But the 
looks phase is the least important phase of the question. 

The nose is the instrument of breathing. Its work is to convert the air 
as it is into air fit to be breathed. 

The air must be warmed, moistened, and cleaned. This must be accom- 
plished in a few inches of travel. The amount to be passed through is larges, 
and the time is short. 

The nose must be just right — not too large, not too small, with plenty of 
cleaning surface, and not too much. A distinguished writer holds that the 
reason negroes cannot stand cold weather is because of the fact that their 
noses flare out and the air is not properly conditioned before it gets into the 
lungs. 

The usual difficulty is that the nose is too small, and there is not enough 



A BABY'S NOSE 



13 



air room. For this there are several reasons. Sometimes one is present and 
sometimes another. 

Adenoids and enlarged tonsils in children narrow the nose space. The 
child breathes through its mouth, and the nose, unused, does not develop nor- 
mally. The upper jaw does not spread from side to side as it should; the roof 
of the mouth arches up and shuts off some of the nose space. 

The midbone of the nose, called the septum, is set on the upper side of 
the roof of the mouth, and, as the roof arches up, the septum crumples up 
somewhat like an S. When the side bones grow out to moisten, warm, and 
clean the air, not much space is left for the air to pass through. 

What's to be done about it? Several 
things. Clean out the adenoids and ton- 
sils, when these are enlarged and obstruct- 
ing. Stop children from sucking their 
thumbs, or pacifiers, or nipples — habits 
which narrow the upper jaw, raise the 
roof of the palate, and narrow the nose 
space. 

For your children do everything pos- 
sible to stimulate the growth of a large, 
tony frame and a strong mass of muscles. 
See that there is plenty of play with its 
consequent deep, full breathing, and cor- 
rect mouth breathing. 

Until the youth has reached about twenty-five it is easily possible to 
spread the upper jaw, drop the arch of the roof, and thus increase the nose 
space. This is done by jackscrews pressing the sides of the upper jaw apart. 

After twenty-five not much can be done. Cutting off spurs, straightening 
the septum, and removing turbinates help a little. The real remedy is to see 
that the upper jaw is broad enough and the mouth roof low enough in child- 
hood and youth. 




Fig. 7. — Atomizer for Spraying Oils. 



Chronic Nose Infection. — L. K. A. writes: "I have heen troubled for 
years with a hawking and spitting of thick mucus, sometimes very dark. 
I am well and strong and breathe through nose and sleep with window 
open. I catch cold easily, but never have sore throat/' 

Eeply. — The color results from dust and smoke in the air breathed. 
That feature is of no consequence. You have a mild chronic infection in 
your nose or throat. It probably will never do you much harm. You 
may get along just as well if you keep your nose and throat clean and 
let it go at that. 



Have Your Nose Examined. — C. A. M. writes: "I seem to have trouble 
with my nose, especially one side. A dull feeling is felt on that side, 
which feels as though something was pressing against the bone. I am 
always clearing my throat, which is very disagreeable. I've been spraying 
my nose with a salt solution, which helps, but only for the time being. 
Do you think I ought to see a physician, or could I help myself in any 



way. 



Keply. — Have your nose examined and proper treatment given. 



14 THE NOSE 

Mouth Breathing Dangerous. — S. B. J. writes: "I have lately fallen 
into the habit of sleeping with my mouth open. I sleep on the right side — 
never on the bach. Is there any way in which this habit can be corrected?" 

Reply. — Mouth breathing is the stepping-stone from minor diseases 
and obstructions in the nose to more serious diseases in the chest. It may 
sometimes persist after the obstruction in the nose has been removed. It is 
rarely due to habit only. If you are unable to breathe through the nose, 
an obstruction is present which should be removed. Have this looked 
into. 

Chronic Nose Trouble. — A. G. J. writes: "I am troubled with pain in 
my shoulders and chest, and I spit blood occasionally. I have been treated 
by a specialist for catarrh. Do you think the bloody sputum comes from 
that? I have been examined by four different doctors and t\ey all said my 
lungs are in good shape." 

Reply. — Yes. I assume by "sputum" you mean bloody nose and throat 
secretions. Such bloody secretion does not mean consumption. On the 
other hand, it could come from a chronic nose trouble. 

Obstructed Nostrils. — 0. M. 0. writes: "During the rainy seasons of 
the spring and fall I am afflicted with a sore chest and stoppage of the 
nose. What course should be followed out that will serve to remedy this?" 

Reply. — If your nose stops up it is because the air passage is too nar- 
row. You may have polyps. You may have enlarged turbinated bones 
growing into and filling up the air space. Neither of these conditions is 
remedied by medicines. Go to a specialist and if obstructions are found 
have them removed. 

Mouth Breathing. — I. V. W. writes: "What is the most effective way 
to overcome the habit of breathing through the mouth at night? During 
the day I have no trouble breathing through my nostrils, but at night, on 
retiring, it seems I cannot get enough air through them." 

Reply. — You should have a nose specialist remove the obstruction from 
your nose. In some cases, harness to keep the mouth shut suffices, but the 
cases are few. It is usually a question of breathing room. 

Harm of Mouth Beathing. — B. W. I. writes: "Does a mouth breather 
contract a cold more readily than a nose breather? Does mouth breathing 
do any other harm? How can it be overcome?" 

Reply. — 1. Yes. 

2. Increases infections of the lungs, bronchi, and throat other than 
colds. Increases infections of the glands of the neck. Changes the facial 
expression in children. Causes snoring. Disturbs sleep somewhat. 

3. Remove the obstruction. 

Cause of Mouth Breathing. — T. H. B.' writes: "Is it injurious to 
breathe through the mouth while asleep? Is there a preventive?" 

Reply. — It is. The nose has been devised as the best possible breathing 
channel. Breath taken in through the mouth is not warmed and cleaned 
as well as it should be. Among other things, mouth breathing leads to 
adenoids, enlarged tonsils, and enlarged glands. To sleep on the side helps ; 
to sleep in a cold room helps; to remove bony obstructions in the nose 
helps. There are devices for keeping the mouth closed at night. 



CHAPTER III 



The Tonsils 



The tonsils are in the back portion of the mouth ; the adenoids are higher 
tip, being behind the soft palate. The lymph nodes are there to stop foreign 
bodies and prevent them from getting into the blood stream. As the first 
breastworks they are excellently placed. 

The air route (the nose, pharynx, larynx, bronchial tubes) crosses the 
food route (mouth, pharynx, esophagus) at the back of the mouth (the 
fauces). 

This part of the tube serves a double purpose. It is a single-track stretch 
in a double-track system. It is as though an electric line crossed a steam line, 
and for a few miles the two services ran on a single track. 

Since this piece of track (the 
pharynx) is to serve also as a 
food track, it cannot be lined with 
the delicate, wavy, ciliated cells 
found elsewhere in the air track. 
It must be lined by flat epithelium 
cells adapted to pressure. 

As it carries air containing 
dirt and bacteria and as flat cells 
are not as efficient air cleaners 
as the ciliated kind, infection 
would be exceedingly liable to get 
through at this point, and to pro- 
vide against it a breastwork of 
lymph tissue, called the tonsils, 
has been thrown up. 

Unfortunately, the tonsils contain one structure in addition to the lymph 
nodes. On the surface are ten to twelve deep pockets, called crypts. The 
crypts are about one-third to two-thirds of an inch deep. 

There are many theories as to these crypts. Some think that bacteria 
grow in them; that they act as test tubes and that the toxins being absorbed 
constantly in time make one immune; in other words, that they do good. 

Being deep, narrow, blind pouches, they do not easily clean themselves. 
In fact, they are extremely apt to fill up with decomposing epithelium bacteria 
and remnants. Such are the little, round, offensive balls which some people 
find at times in their mouths. 

In recent years physicians have found pneumococci, or one of the pus 
cocci, in these crypts in many cases of rheumatism and rheumatic arthritis. 

There are those who think the tonsillar crypts serve as a purpose and 
others who think they do harm. I think the best arguments are with the 

15 




Fig. 8. — Throat Inspection. 



16 THE TONSILS 

latter group. In filing specifications to a bill of complaint, I think we should 
include the tonsillar crypts. 

There is much controversy over the lymph gland portion of the tonsil. 
Some think it helps to make blood; others that it protects the body against 
disease ; others that it helps in other ways. 

On the other hand there is a large group which thinks the tonsil serves no 
good purpose at all, whether well or sick. 

In a discussion before the staff of Mount Sinai Hospital, Dr. Freedman 
summarized his views with this sentence : 

"Removal of the tonsil does not remove from. the body any organ or tissue 
absolutely necessary to the system, but, if not diseased, Us removal has left the 
individual with one defense less/' 

If a foreign body gets by the lymph tissues in the tonsil, it still has to 
pass through some glands in the upper part of the neck below the angle of the 
jaw. If it gets by these it has to run by a third barrier, deeper and lower 
down in the neck. 

It happens that infections frequently get into the system through the 
tonsils. Some, referring to this, have called it a portal of entry. Some have 
said that the tonsil is put there to absorb. 

The view held by the better physicians is that the mouth and nose are 
great portals of entry and that the tonsils stand there, as Goodale says, as 
"sentinels of the body" In their effort to protect the body they frequently 
become inflamed. 

Freedman says : "When an infection enters through the tonsils, there is 
great likelihood that the tonsil attempts to overcome the invader, and, failing 
in this, the next lymph glands in order of defense take up the battle. How- 
ever, if the tonsil is so diseased that its ability to cope with an infection is so 
far reduced that on very slight provocation it becomes inflamed and too fre- 
quently in the battl-e between it and the invading bacteria it becomes the loser, 
so that constitutional symptoms intervene, it is then fair to presume that no 
longer is it a sentinel, but rather an obstacle of defense and may then actually 
serve as a portal of entry for disease." 

This, put in another way, means that if the teeth, nose and tonsils can 
be put in good condition; if the tonsils do not often become inflamed, and if 
they do not interfere greatly with breathing, they should not be removed. 
Under these circumstances they help to protect against infection. 

If attacks of tonsillitis are frequent, if the tonsils are enlarged chroni- 
cally, if they cannot be kept clean, then they should be removed. 

In a certain sense tonsils can be outgrown. Tonsils enlarged enough to 
interfere with breathing in children in time may get much smaller. Good 
judgment is required to decide which cases can be left to outgrow their 
trouble. 

KEEP TONSILS CLEAN 

When inspection shows the tonsils and adenoids enlarged, when the his- 
tory records frequent sore throats and colds, and occasional earaches, the 
doctor is called upon to decide whether the enlarged structures should or 
should not be removed. After a gland has been swollen for some time, has 



PLATE I 




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TalllilHUI 1 - -■- ,;'--ft^--- 



The Shape and Relations of the Thoracic and 

Abdominal Viscera, 

Anterior Aspect (Semi-diagrammatic) 



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SUPERIOR 
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PLATE II 



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The Shape and Relations of the Thoracic and 

Abdominal Viscera, 

Posterior Aspect (Semi-diagrammatic) 



KEEP TONSILS CLEAN 



17 



been soaked in poison for a long time, it is a different structure from the 
normal gland with which the body was originally endowed. It has become 
like a befouled filter, befouled from the liquids that filter through it. 

We must not forget, however, that when we are considering the tonsils 
and adenoids we are not yet at the source of the stream. The man who studies 
the Mississippi at St. Louis is nearer the source than the one who studies it 
at New Orleans, but he is still far from the source. If he were trying to find 
out the source of high water he must get information about melting snows in 
Montana or rains in Ohio. 

The tonsils and adenoids stand at 
one gate; behind them lie the ears, the 
lungs, the joints, the blood stream. 
When they are diseased it is because 
they are doing their best to protect the 
structures which lie behind them from 
the pollution which lies in front of 
them. 

One of these fields of pollution is 
the teeth. The dentists tell us that 
we should clean the teeth every day 
as well as we can, and that several 
times a year we should go to a dentist 
for a complete cleaning. That is good 
sense. 

Some of us follow it. Unfortu- 
nately, the grown people follow it bet- 
ter than the children, while, unfor- 
tunately, the children need to follow 
it more than do the grown people. 

The mouth cleans itself well with 
the exception of the teeth, the upper 
surface of the tongue and the tonsils. 
The tongue can be washed, and, when 
necessary, scraped with the edge of a 
spoon. 

I think the tonsils should be 
systematically cleaned. A cleansing 
.gargle, used each morning, is of some 
service. Various instruments for 
cleaning the crypts have been devised. 
Some empty by suction, others by 
pressing. I understand that none of 

these is wholly satisfactory at present, but when periodic visits to the throat 
man are as customary as periodic visits to the dentist, the former will perfect 
his appliances for cleaning the crypts of the tonsil. 

Absorption from the nose is largely responsible for swelling of the ade- 
noids. Snufflers are most subject to adenoids. The first inch of the nose is 
easily cleaned. A piece of cotton and some boracic acid solution (68 grains to 
one pint) will suffice to clean this portion of the nose. 




Fig. 9. — Location of Glands Which 
Frequently Enlarge. Causes of En- 
largement: 1. Disease of the ear. 
Eruptions about the face. 2. Eruption 
of the scalp, mastoiditis. 3. Infections 
of the chin, tongue and lower lip. 4. In- 
fections of the mouth and teeth. 5. In- 
fections of the tonsils. 6. Pharyngeal 
infections. 7 and 8. Infections of the 
scalp and pharynx. Tubercular infec- 
tions are especially frequent in 7 and 8. 
Diphtheria in 4, 5, 6, 7 and 8. Scarlet 
Fever in 5, 6 and 7. 



18 



THE TONSILS 



To cleanse the deeper parts many use sprays and douches. As to this 
custom I have my doubts. The secretion of the nose is a good wash, and 
probably all that is required for a normal nose. 

Has Tonsil Trouble. — A. M. writes: "I have tonsil trouble. I wish to 
have the tonsils cut out, but friends advise me not to, for the reason that 
the lungs will be exposed to dust and dirt. Will you please advise?" 

Reply. — If the tonsils are in good condition they protect the remainder 
of the body. If they are much diseased they do not. Therefore, if your 
tonsils are much disordered have them out. 



Keeping Tonsils Clean. — 67. H. writes: 




Fig. 10. — Peritonsillar Abscess. 



"I notice you suggest putting 
the nose, teeth, and tonsils in 
order and keeping them clean 
as a preventive against rheu- 
matism. How would you do 
this?" 

Reply. — Some people can 
cleanse their tonsils by mas- 
saging with the finger or with 
some blunt instrument — for 
instance, the end of a spoon 
handle. This should not be 
done oftener than once a week, 
and usually it will not be nec- 
essary to do so often. Others 
must have it done for them. 



Effect of Infected Tonsils. 

— Reader writes: "Will you please tell me what evil effects are apt to come 
from infected tonsils? Could they cause a bad breath?" 

Reply. — Mouth breathing, enlarged neck glands, pallor, frequent sore 
throat, deafness, sometimes tuberculosis. As to bad breath, yes. 

Tonsillar Crypts. — G. E. R. writes: "Are the white, cheesy particles 
which form in the crypts of tonsils infectious? And should tonsils having 
these crypts be removed to prevent poisons going through the system?" 

Reply. — These cheesy particles are composed of bacteria, decomposing 
epithelial cells, and food remnants. They may contain pus germs and 
tubercle bacilli. They are partly responsible for enlarged glands in the 
neck and what used to be called scrofula. If they can be removed easily 
by the patient or his physician and are so removed from time to time, 
the tonsils need not be cut out. If these masses form and are not removed 
the tonsils should be cut out. 



Keeping Crypts Clean. — T. L. writes: "Please tell me how the tonsil 
crypts may be kept clean." 

Reply. — Washing with tooth washes will suffice for surface accumula- 
tions. Accumulations in the crypts can be squeezed out by going over the 
tonsils with a loop made of smooth wire. Some can do this for them- 
selves ; others must have it done periodically by their doctor or dentist. 



KEEP TONSILS CLEAN 19 

Does Not Weaken Lungs. — Miss F. writes: "As I am troubled with 
tonsillitis, getting it every year, sometimes twice, I would have you advise 
me whether this indicates that my tonsils are diseased. What are diseased 
tonsils? Would having them removed make the lungs weak? Many people 
advise me not to have them removed; others think it beneficial." 

Reply. — That you have tonsillitis once or twice a year does not neces- 
sarily mean that your tonsils are abnormal, or that they should be removed. 
If they are large and boggy, have crypts that fill up with debris, or if you 
have quinsy once or twice a year, they had better be removed. In other 
words, decide the question on the basis of the condition of your tonsils. 
Get the best advice available, and follow it. Removal of the tonsils does 
not make the lungs weak. 

Developing the Lungs. — D. W. writes: "Please give directions for a 
mode of life which will tend to develop strong, healthy lungs in a child. 
The child's father at one time had pulmonary tuberculosis/' 

Reply. — The best way to develop the lungs is to develop the legs. Keep 
the child in the open air as much as possible. See that the nursery is well 
ventilated and that the temperature there is kept low. Be on the watch 
for the perfection of a method immunizing against consumption. It should 
come before long. 

Fresh Air Counts. — H. W. H. writes: "I sleep upon a sleeping porch, 
but am afraid that I do not get the benefits of the fresh air, because when 
sleeping I breathe through the mouth. A chin truss is said to make nose 
breathing necessary, cure colds, throat troubles, etc. Do you consider it a 
good thing? If not, could you tell me any better method? Also, could you 
advise me on this point? I wish to get 'fattened up' and have a chance 
to get both filtered, artesian water, and fresh, pure, cow's milk — as much 
as I want of either. Having heard both the 'milk diet' and 'plenty of fresh 
water recommended highly, I am undecided which to adopt. Which is 
more fattening? When I have adopted one, should I cut the other one out 



Reply. — 1. It is the fresh air that you get into your lungs that counts. 
The air you fail to get is of no value to you. Mouth breathing does not 
allow the air to enter the lungs freely. Another disadvantage is that air 
taken directly through the mouth is not properly warmed, moistened, and 
filtered. Mouth breathing is caused by some obstruction in the nose or the 
pharynx, an overgrown bone or a foreign growth in the nose, enlarged 
tonsils, or adenoids in the throat. To stop mouth breathing, these should 
be removed. Rarely, mouth breathing persists as a habit for a short time 
which can be easily overcome by letting the nose go ahead with its work 
and keeping the mouth shut. I have no faith in the chin truss cure-all 
and do not recommend it. 

2. Good water and pure milk are both good things. To "fatten up/' 
something is needed besides. Plenty of good simple food, exercise in 
the open air, and a cheerful disposition will help considerably. 



CHAPTEE IV 

Adenoids 

There are at least six tonsils. The two large ones on the side of the 
throat back of the palate are known as the faucial tonsils. When the word 
tonsil is used, it is these large masses, the faucial tonsils, that are referred to. 
In addition there are four other tonsils, and the six together make a picket 
line called Waldeyer's ring. They are also called adenoids. 

In Waldeyer's ring is a defensive line of filters, dotted around the field 
much after the fashion of the players on a football team when the opposing 
team kicks oif. One of these, called the lingual tonsil, is located on the back 
of the tongue. Two, called the eustachian tonsils, are located at the mouths of 
the tubes that run to the ears. One is at the back part of the roof of the nose, 
near the point where the air route turns down to cross the food route. This 
tonsil is usually called the pharyngeal tonsil. When we say that a child has 
adenoids, we generally mean that this tonsil is enlarged. 

This is a most important tonsil. It is frequently found large. When 
it is large, it shuts off the breathing space; the child becomes a mouth 
breather. Mouth breathers catch cold easily; they catch scarlet fever and 
diphtheria ; they are "catchers." 

In mouth breathers the roof of the mouth arches up; the nose space is 
lessened, and the teeth do not meet properly. 

These conditions are so important that it is good judgment to remove 
adenoids that swell and stay swollen. They are diseased, and, therefore, are 
not up to standard as filters. We know that a foul water filter increases the 
foulness of water that passes through it. The same filter, properly cleaned, 
cleans the water that passes through it. 

It is good judgment to remove adenoids that swell and stay swollen, be- 
cause they stop up the nose, befoul the mouth, increase infection, all by bring- 
ing about mouth breathing. 

The adenoid swells because it is doing an extra amount of filtering, 
which means that it is swelling because the nose is dirty. If the nose is kept 
clean and the air breathed is kept moist, tempered and clean, the adenoids 
will not enlarge. 

A large proportion of those enlarged would shrink up if the nose were 
cleaned and kept clean, and if the atmosphere of the schoolroom and home 
were made right. 

CLEAN MOUTHS AND INFECTION 

Physicians find that a large portion of the school children need to have 
their tonsils and adenoids removed. Nearly all the infections which children 
have, and most of those which adults have, get in through the mouth and 
nose. 

20 



CLEAN MOUTHS AND INFECTION" 



21 



Tonsils and adenoids are put in the nose, month, and throat because they 
are needed to keep infections from getting into the blood, brain, lungs, or 
other tissues, where they can do more harm than in the tonsils. 

Healthy tonsils and adenoids should not be removed. Those that are 
enlarged and swollen should be. Not one-half of the tonsils are removed 
which should be removed. 

Diphtheria infection may locate 
on the gums, the nose, or the tonsils, 
or in any one of several places. Diph- 
theria located on previously healthy 
tonsils requires less antitoxin, is more 
easily cured than diphtheria anywhere 
else. The reason is that tonsils help 
to protect the tissues which lie beyond. 




North Carolina Health Bulletin, Feb., 1913. 

Headquarters for Gossip and 
Germs. 



The point is that we should go back of 
the tonsils and thus try to keep them 
healthy. 

If the mouth, nose, teeth, and fold 
of the tonsils are kept clean the prob- 
lem is solved. The tonsils will not 
enlarge. 

The teeth should be picked, 
washed, and brushed several times each 
day. Periodically a dentist should 
give them a more thorough cleaning. FlG n 
The mouth and tongue should be 
washed as frequently and as thor- 
oughly as the hands. Periodically a physician should clean the tonsil crypts. 
There are those who systematically wash the nose. 

The human mouth is fearfully dirty. The wonder is that any tonsils 
escape enlarging. Is there any reason why we should have clean hands and 
faces and dirty mouths? 

Cause, Prevention and Treatment of Adenoids. — E. D. W. writes: 
"1. What causes adenoids in a child of 6 years? 2. What precautionary 
measures should he taken by parents to prevent the development of ade- 
noids in a child? 3. Will adenoids disappear in time, if they are let alone? 
J+. If an operation is deemed necessary in case of adenoids, is it such an 
important matter that an expert surgeon should be employed, or will any 
family physician be competent to remove them? 5. How are tubercular 
glands of the neck to be cured?'* 

Reply. — 1. Absorption of germs and their products, and of decomposing 
matter from the tonsils, teeth, mouth, and nose. 

2. Keep the mouth, teeth, tonsils, and nose clean from babyhood up. 
Keep the child in the open air. Keep him free from colds. ' Some children 
have an inherited tendency to lymph gland overgrowth. These must be 
better watched than the general run of children. 

3. Yes, many cases will. In most cases, however, the child is a con- 
firmed mouth breather, and his constitution is irretrievably gone before the 
adenoids go. 



22 ADENOIDS 

4. A nose and throat specialist is generally best. Some family physi- 
cians can operate successfully on such cases. 

5. Tuberculin tonics, open air, feeding, attention to the absorption areas 
— tonsils, teeth, mouth, nose. 

Dryness and Adenoids. — Reader writes: "Will you kindly inform me if 
it is unhealthy to live in a cement house that has waterproof coating on 
the outside? The house seems to be too dry, especially in winter. Can such 
a house be kept moist in any way? Can too dry a house cause adenoids in 
children f" 

Reply. — 1. The house you have in mind is not unhealthy because of the 
cement walls, but because, in heating it, you have fed heat and not water 
to the air. Whenever one feeds heat to air he must also feed moisture; 
otherwise there is trouble. If a cement wall house is unhealthy it is 
because the walls are snug and heat cannot readily pass out. 

2. Yes; evaporate enough water in connection with the heating system. 

3. Yes ; it is the most frequent cause. 

Removal of Adenoids. — G. S. E. writes that she has been told I do not 
advise the removal of adenoids and tonsils. Is this true? 

Reply. — My contention is that, if the mouth, teeth, and nose are kept 
properly clean from infancy up, tonsils and adenoids will seldom require 
removal. When the tonsils swell, sometimes the contents can be squeezed 
out of the small cavities, and removal is not necessary. When these stages 
have passed, there is nothing left but removal. Removal is not done in 
fully half the cases in which it should be. 

See Throat Specialist. — E. G. C. writes: "Kindly give me your advice 
in regard to the removal of adenoids. A little girl of four has adenoids. 
They do not trouble her, but she sleeps with her mouth open." 

Reply. — I am inclined to think a throat specialist will advise their 
removal. Sleeping with the mouth open is easily recognized. There are 
other results from mouth breathing not so easily recognized. 



SNORING 

When the currents of the air cause the soft palate to flutter, a snoring 
sound is made. This may happen when the mouth is closed. It is much 
more likely to happen when some of the breath is coming through the nose 
and some through the mouth. It may occur when the mouth is closed and 
nothing is the matter with the nasal passageway. 

The tendency to snoring, however, is increased by obstruction of the nasal 
airway. During sleep the muscles of the body are relaxed. For this reason, 
when one lies on the back while sleeping, the tendency is for the mouth to 
open. Therefore, grown-ups who sleep on their backs usually snore more or 
less. 

When one snores it is usually because the nasal airway is not large 
enough. There may be a crooked septum in the nose. There may be spurs of 
bony substances partially closing the nasal cavities. There may be enlarged 



SNORIXG . 23 

turbinates, diseased sinuses, polypi, or adenoids, which prevent free passage 
of air through the nasal openings. 

There may also be an undue smallness of the nares, or a tendency of the 
soft parts of the nostrils to collapse during inspiration. Too much fat along 
the air route, in the abdomen, or in the chest wall, may be the cause of the 
embarrassed breathing. 

The habit of snoring is difficult to cure. Abnormalities and diseased con- 
ditions of the nose and throat act as a contributing cause. They should be 
corrected. 

In many cases it is necessary to straighten a crooked septum, remove 
growths — adenoids, polypi, and spurs. It may be necessary to remove dis- 
eased tonsils. 

Inflammation involving accessory sinuses and tonsils must be cleared up 
before the habit of snoring can be easily overcome. 

Snorers should sleep on their sides. In this position the mouth is less 
likely to drop open. Various mechanical devices have been suggested for 
holding the lower jaw closed. A harness arrangement, extending about the 
head and under the jaw, has been advised. 

It has been suggested that holding pieces of muslin or cheesecloth be- 
tween the teeth and lips would assist in controlling the habit. The presence 
of foreign substances between the teeth would no doubt sufficiently impress 
the subconscious operation of one's mind to such an extent that he would keep 
his mouth closed. The presence of the foreign substance in the mouth keeps 
the mind on the substance even when asleep. The sleep in this case is as 
restful as when snoring. 

Cause of Snoring. — J. P. E. writes: "You will perhaps recall when 
Theodore Roosevelt was in a local hospital recuperating from the Milwau- 
kee shooting he snored so loudly that it was heard in the entire ward. Now 
T. B. is a 'physical marvel' and I wish to inquire if this snoring is pre- 
ventable or not. I know an open mouth has nothing to do with it. I have 
put a sealing plaster across my lips on retiring and found it intact in the 
morning, yet my wife said I snored just as badly." 

Reply. — Snoring does no harm. That is, it does you no harm; it may 
prevent the "missus" from sleeping. It is due to flapping of the palate. 
When two currents of air, one through the nose and one through the mouth, 
meet at the edge of the palate, this pliable curtain flaps back and forth. 
Occasionally a person will snore with his mouth closed. In that event little 
or no harm results. The harm of snoring results from the mouth breathing 
— the taking into the tubes of air not properly warmed and moistened. 
Mouth breathing in grown people makes them more liable to colds, and 
that is about all. It is more harmful in children. Snoring in grown 
people is of some consequence because it indicates that the breathing space 
is pretty near the limits of comfort and safety — the nose is not roomy 
enough or the individual is getting too fat. 




UZZLE 

the 

CROBE 




ANTICIPATE 

ysur SNEEZES, 

and help 

PREVENT DISEASES 

Ch/'c^o Department ct ' Health dttM.322 • Perfgaed fy Arthur M.Corww,AJl>MJb 

Fig. 12. 



24 



CHAPTER V 

Colds— Catarrh— Sore Throat 

COLDS 
COLDS A LUXURY, NOT A NECESSITY 

President Emeritus Eliot, in his address before the American Philo- 
sophical Association on "Benjamin Franklin as Printer and Philosopher," 
quotes that American scientist as saying : 

"People who live in the forest, in open barns, or with open windows do 
not catch cold, and the disease called 'a cold' is generally caused by impure air, 
lack of exercise, or from overeating. 

"I have long been satisfied from observation, people often catch cold from 
one another when shut up together in close rooms and coaches and when 
sitting near and conversing so as to breathe in each other's transpiration, 
the disorder being in a certain state." 

Says the naturalist, John Muir : "As long as I camp out in the moun- 
tains without tents or blankets, I get along very well, but the very minute I 
get into a house and have a warm bed and begin to live on fine food, I get 
into a draft and the first thing I know I am coughing and sneezing and threat- 
ened with pneumonia, and am altogether miserable." 

Says Irving Fisher: "Personally, I have known of scores of cases in 
which the tendency to catch cold has been almost completely overcome." 
After reciting some cases, he says that if outdoor life had been adopted simply 
as a preventive of colds, it would have prevented, originally, as it cured sub- 
sequently, their more serious disorders. 

Gulick is inclined to believe that something like nine-tenths of all the 
minor ailments that we have and which constitute the chief source of de- 
creasing our daily efficiency could be removed by careful attention. "With 
the removal of nine-tenths of our disabilities and the conservation and further 
development of our natural powers, the average person can increase his effi- 
ciency one hundred per cent, that is, he can be twice as effective." 

The things which need to be done are : 

1. Sleeping and living in cool, well ventilated rooms. 

2. Eating moderately. 

3. Keeping the secretory organs working properly. 

4. Building up resistance by cold baths, air and water, and exposures 
within reason. 

5. Keeping the mouth and nose clean. 

6. Keeping away from infectious people, sick and well. 

To do these six things perfectly means absolute freedom from colds. To 

25 



TttE DOUBLE CROSS 



If 



THAT THE WP0RE-A1R AND THE 1MPURE-F00& D15EA5E5 
GIVE CH1CAGOAN6. 

Monthly Death Bate5 Fpor^ Two 6couP5 of b»5EA5E$ 
That Are Indirectly Affected by Weather Conditions. 
1/^POPE.AlR Dl5F^E6- Pneumonia and Bronchitis- MlGH m Winter 
when people hou6e therr>6elvG6 ap and breathe the /but air of 
unVentWated room6 . LOW in Summer when people keep their doors 
and windows open; when people live more in the open air. 

IMPURE POOD bl6EA6E£- Diarrbea\ biseaSes-HlGrt in hot weather 
Chie/l^ because heal Spoili; or/lie6, dust, etc., contaminate the /ood wc 
eat — £6PEC!AUiy B^BYS POOD. 





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Fig. 13. 



Chicago Health Department. 



26 



COLDS 



27 



do some of them and not do others, reduces the number of colds, though the 
reduction can scarcety be put on an arithmetical basis. 

If it is possible to escape colds, then they are not a necessity. On the 
other hand, they are expensive enough to be termed a luxury. 



WHAT IS A COLD? 

A cold begins with a localized raw dryness at some point in the nose. 
There is some aching and a little fever. A few hours later a clear liquid 
begins to flow from the nose and the aching and general ill feeling persists. 
The uncomfortable area spreads until all of the upper breathing passages 
feel "raw." Frequently it spreads to the nerves, causing neuralgia of the 



AOJ 

Location of 
Adenoids 
shown x 

Adenoids 

cause mouth- 
breathing, 
freauenfcolds, 
catarrh, deafness, 
and deformity oi 
jaw and chest. 
They induce siupidiiy 
stunt mental and physical growth. 

DON'T LET TOUItCffllB 
BE 3>0 HANDICAPPE1D. 

Removal of Adenoids 
is a simple and brief operation. 

GIVE, YOUR. CHILD 
A CHANCE. TO BREATHE 




FlG. 14. 



Chicago Health Department. 



28 COLDS— CATARRH— SORE THROAT 

face and teeth. By this time the secretion from the nose begins to be thicker 
and whiter. 

The infection is now spreading down the larynx into the bronchial tubes 
and the cough is becoming prominent. The nose secretion changes from a 
clear water to whitish mucus, and finally to gray pus and mucus. And now 
the symptoms begin to subside. In a few days the soreness of the throat and 
nose passes away, but the nose secretion and the cough hold on for a few 
weeks. 

I have given these details because it is this type of cold that I have had 
in mind when advising people with colds to go to bed and send for a phy- 
sician. The bacteria are spreading along the surface from the nose to the 
bronchi, and what is of much more consequence, they are spreading from the 
surface to the underlying blood vessels, and, through them, are being scat- 
tered widely — proof that they are capable of infecting the host and those with 
whom he comes in contact. 

From the standpoint of the sick man this is the kind of a cold which 
demands care, since it results in pneumonia, heart and kidney disease, and 
rheumatism. 

I am also interested in that kind of a cold which is called "the cough 
which hangs on," since it is so frequently an early stage of consumption. 

The mild, temporary sore throats, the slight cold in the head, the little 
bronchial coughs, the minor colds without aches and without fever are of 
more consequence from the standpoint of the community than from that of 
the individual. 

Most germs that cause diseases, called pathogenic, cannot live outside the 
bodies of animals. Some of these would have perished had it not been that 
they were kept alive as mild, apparently harmless nose infections. In winter 
flies find warm places in which they keep barely alive, but from these places 
they go out to do a great deal of harm when the season is more favorable. 
For bacteria some noses serve the same purpose as warm places do for flies. 

CAUSE OF COLD 

Colds may be due to any one of several different bacteria. They are con- 
tagious, and should be treated accordingly. While not dangerous in them- 
selves, they become dangerous, because they spread or develop into other and 
more serious diseases — pneumonia, diphtheria, consumption, and Bright's dis- 
ease. 

Colds due to the presence of the pneumococcus, the germ of pneumonia, 
and those due to the presence of the germ that causes diphtheria are of the 
most importance. The reason for this is that these germs may produce a 
sore throat or inflammation of the mucous membrane of the nose, from which 
other people may catch diphtheria or pneumonia. While colds due to the 
other bacteria may not prove serious, they should never be treated lightly. 

A man may catch a cold from himself. He may catch a cold from an- 
other man. When one has a cold he should avoid crowds ; remain as far away 
from his fellow men as possible; avoid sneezing when in the presence of 
others, or sneeze or cough into a handkerchief held before the nose. 

Besides the germ which is the exciting cause of the cold there are con- 



COLDS 29 

tributing causes, such as sudden exposure to cold, exposrre to hot, stuffy air, 
overfeeding, underfeeding, failure of the organs of elimination (bowels and 
kidneys) to carry away all waste products, errors in clothing, and overindul- 
gence in alcoholic stimulants. 

Colds usually begin in the nose. This is especially true where there is a 
crooked septum, spur or bony growths, enlarged turbinates, or adenoids to 
interfere with the free passage of air. A blockaded nose does not drain well, 
and drainage is essential. 

In case of mouth breathers, or where there are diseased tonsils, the cold 
may begin in the throat. Such persons should exercise special care to keep 
the mouth clear by the free use of antiseptic washes morning and evening. 
The teeth should also be kept clean by brushing thoroughly after each meal. 

To avoid catching colds, deformities in the nose should be put and kept 
in order. The tonsils, if diseased, should be removed or cared for according 
to the advice of a physician who knows how they should be treated. 

Since lowered vitality has much to do with catching colds, body resistance 
should be kept up to efficiency by proper regard for body hygiene. 

"Cold catchers" should not overeat or undereat; they should avoid hot, 
stuffy, poorly ventilated halls and poorly ventilated rooms where people as- 
semble. They should live and sleep in the open air as much as possible, keep 
the organs of elimination normal, and cultivate a cheerful disposition. 

THE COST OF COLDS 

Last year (1915) a report issued from Boston said that an economic study 
of colds had been made there and that the estimated loss from this disorder 
should be capitalized at something over $20 a year per person. Sadler, in 
"The Cause and Cure of Colds," starting on the assumption that men lose on 
an average two days a year from "bad colds," "colds in the head," and "slight 
touches of the grip," calculates an annual direct money loss to wage earners 
of this country of $60,000,000. To this he adds $20,000,000 for money spent 
on patent medicines, "cold cures," and physicians' fees. He adds : 

"The estimate of loss in wages does not include the loss to the employer 
from the days of decreasing efficiency preceding the actual absence from work 
of the wage earner, nor does it take into account the days or even weeks of 
decreased efficiency which frequently follow cold infections. 7 ' 

Irving Fisher in Bulletin No. 30 quotes Dr. Charles H. Castle as esti- 
mating the average annual loss from minor ailments at three days per capita. 
The estimate of Dr. J. F. Morse is five days. Minor ailments include colds, 
headaches, toothaches, and some others. 

It cannot be doubted that the direct cost of colds runs into the millions 
in the United States. But at that, the direst cost is a small item as compared 
with the indirect. 

"Colds" is the term used to group many different kinds of infection. 
Among them are such important bacteria as those of consumption, pneumonia, 
diphtheria, meningitis, and the pus producers. 

Among those who are said to have colds are many who are keeping, har- 
boring, and "passing on" more violent diseases. Of importance are the nose 
and throat infections, which, of themselves, are of no consequence, but from 



30 COLDS— CATARRH— SORE THROAT 

which infection travels to joints, to be called acute rheumatism; to the heart, 
to be called, a year or so later, heart disease; to the kidneys, to he called 
Bright's disease. The portal of entry is somewhat harmed, but the main 
trouble shows itself elsewhere. It is as if a garbage wagon, driving into a 
private park, had scraped a gate post but then had gone on and dumped its 
load on a flower bed. Fisher says : 

"If what seem to be 'mere colds' were less commonly neglected, tubercu- 
losis would more often be caught in its incipiency and pneumonia and diph- 
theria would often be prevented." 

DRAFTS AND COLDS 

There are many who need to be set right on the relationship between 
colds and drafts. When a man sneezes he exclaims, "I am catching cold," and 
proceeds to find a draft on which to lay the blame. As a matter of fact many 
colds do first show themselves by sneezing, but sneezing is more frequently 
the result of other causes. Violent and continued sneezing is liable to come 
when one sits quietly in a warm room after having overeaten, or from breath- 
ing dust, or from other causes. 

In the second place colds are infections with bacteria, in which the germ 
is the most important element, and the condition of the man comes second 
but closely following. Lowering of the man's temperature, the too rapid ex- 
traction of heat, are items which influence him to catch cold in only a 
minor way. 

And thirdly, what is ordinarily called a draft is not a draft at all. What 
one means when he says he feels a draft on his feet is that his feet are being 
chilled. Heat is being abstracted faster than it is being furnished. 

As the skin temperature is over 90 and the air temperature is 70 or lower, 
much heat is given off by the body. The air next the skin is the warmest in 
the room and when currents move this aerial envelope away and replace it 
with cooler air, the skin may be cooled. Currents of cold air are more cooling 
than still air, but low temperature air may chill whether still or moving. 
What we call the "feel of drafts" is the feel of low temperature. 

Unquestionably, to be chilled beyond the reacting power helps to bring 
on infections. As the Bulletin of \he Pennsylvania Tuberculosis Society says: 
"To sleep cold brings on pains and assorted ills." But warm, flowing air is a 
draft just as much as cold, blowing air, and Leonard Hill, Fluegge, and all of 
the best authorities are of the opinion that health and comfort are impossible 
except where the air is kept in motion — drafts, if you please. 

If we must have drafts, and drafts at times do harm, what must we do? 
Why, regulate the drafts. Get good drafts rather than bad ones. 

The skin has a temperature of 96. The temperature of the room should 
be 68. Incoming air should not strike the body, and especially the extremities 
below the knees, at a temperature below 64. Incoming air should not strike 
the occupants at a velocity of more than 100 feet a minute, if the air is lower 
than 64. When the temperature of the room is 68 the leg zones should not 
be below 66. Young vigorous persons do not need such narrow limitations of 
temperature environment, but the average coddled clesk worker does require 
them. '■ ".:• "' ' i: \-..?.v :....:>• -.:;• .■.■■:::: : .::. : .:. .-: 



COLDS 31 

The fear of drafts is morbid and should end. The breezes of summer 
are drafts. When temperatures are regulated drafts are necessary for com- 
fort and health. When unregulated as to temperatures they are something of a 
factor in colds, but not much. 

SUGGESTION FOR PREVENTION OF COLDS 

"I sat in a draft and caught a cold" is an expression familiar as a 
household remark. It is partly correct, mostly incorrect. What did happen, 
perhaps, is this: You remained for too long a time in a stuffy, overheated, 
ill-ventilated room, overate, and otherwise disregarded bodily hygiene; then 
put yourself in a current of moving air. You caught cold, not because you 
were exposed to the breeze, but because of your indiscretions. They lowered 
your body vitality and body resistance. 

In other words, the sudden stress and strain to which you had exposed 
your body — the necessity for adjusting it to complex conditions — was greater 
than its machinery was equal to. This made it possible for the cold germs to 
enter the blood stream and cause such symptoms as the particular germ is ex- 
pected to produce. 

To keep from catching colds it is necessary to keep the body up to effi- 
ciency, and not subject it to too great a strain by overindulgence and lack of 
care. This can only be done by good habits of sleeping, eating, good body 
hygiene, and by taking plenty of exercise. These precautions are absolutely 
essential to health and freedom from colds. 

Another thing to take into consideration is the organs of elimination. 
That they carry away all the waste products is highly important, as, otherwise, 
the blood stream becomes vitiated, thereby lowering vital resistance. The most 
important of these organs is the bowels. By all means do not allow yourself to 
become constipated. 

If there is poor drainage in the air passages of the nose the cause is to 
be found and removed. Many times there are bony growths attached to the 
septum. There may be deflections of the septum. There may be enlarged 
turbinals. 

These abnormalities reduce the size of the air passageway and interfere 
with breathing as well as drainage. If for no other reason they should be re- 
moved. 

Where there are adenoids and polypi these should be removed, since they 
too interfere with free drainage and breathing. 

Lack of drainage in the above named structures favors congestion, thus 
making an ideal place for harboring and developing the germs of various 
diseases. It is the presence of these germs which frequently brings us down 
with some serious sickness, when, for some reason or other, body resistance 
and vitality have been suddenly and sufficiently lowered to enable the cold 
germs to produce only symptoms of a cold. 

Where the throat is unhealthy as a result of enlarged and diseased tonsils 
they should be removed. The germs of diphtheria and pneumonia have an 
especial liking for the fauces. They find a hiding place in and about the 
crypts of the tonsils. 

Here they lie in waiting for the presence of such physical condition as 



32 COLDS— CATARRH— SORE THROAT 

will enable them to cause the manifestation of such a train of symptoms as 
they are expected to produce. 

The necessity of early recognition of such a condition of the throat and a 
correction thereof becomes at once apparent. 

To Get Rid of Cold. — 8. J. writes : "I am 6^ years old and in excellent 
health. For the last two years I have not taken medicine of any kind. But 
once or twice a year I catch cold. It always takes me about a week to get 
rid of it, so I suppose I am not treating my cold right. I sleep with 
windows open all the year. Should I close the windows till I get well 
when I have a cold? What else can I do to get rid of a cold quickly? As 
a rule my cold seems to be in my head mostly/' 

Reply. — Do not close the window, but place a screen so that the air 
does not blow directly on you. Take one or two doses of aspirin and a 
purgative and let that suffice. To get rid of a cold in a week is doing well. 

Toilet of the Nose. — W. B. A. writes: "What in general is the cause of 
ozena? Is it usually cured by a series of treatments?" 

Reply. — Ozena is an after effect of neglected colds and chronic nose 
conditions. The dry nose secretions are infected and decomposing. Ex- 
perimenters are working hard on a cure now but they have not, as yet, 
much to offer. About the best that can be done is to maintain a proper 
toilet of the nose. 

Cold in the Head. — H. H. writes: "As soon as cold weather comes I 
am troubled with cold in the head, which is almost continuous during fall 
and winter. The inside of my nose is sore. My health otherwise is good. 
What is advisable for me to do?" 

Reply. — I judge you have a chronic infection somewhere about your 
nose. Keep in the open air, keep away from crowds, keep out of cold places. 
These procedures will help you, but you should go to a nose specialist and 
have him find the infected area and put it in better order. 

"Chronic Cold in the Head." — W. H. M. writes: "I am troubled con- 
stantly with what is called 'a cold in the head/ accompanied by constant, 
heavy discharge, smarting of the nasal cavity and forepart of forehead. 
If not attended to promptly and relieved in some way, it travels from there 
to the upper part of lungs and starts a cough. I am employed nights, in 
an office with about 100 others, and the windows are lowered from the top 
for ventilation. I seem to feel the effects of the draft therefrom the 
moment I sit down. I wear plenty of clothes, a sweater, a hat, and when 
draft is overly strong, a coat, but seem to keep taking fresh colds every 
night or two. This often incapacitates me for duty. Can you give me any 
information or suggestions to overcome this trouble?" 

Reply. — The probability is that you have a chronic infection of one of 
the sinuses leading from your nose. Every so often it travels to your nose 
and thence to your bronchial tubes. To "harden one's self" by cold baths, 
sleeping in a cold room, eating lightly, and keeping the bowels open makes 
one more resistant to these excursions of the cold germs from their lair. 
Ofttimes it is necessary in addition to have a throat and nose specialist 
find the lair and clean it out. 



COLDS 33 

Cause and Cure of Colds. — M. 0. writes: "1. Are aching bones and 

muscles, great weakness, and a dull headache symptoms of the grip? 

"2. What causes grip? 

"A young man, otherwise in good health, gets such an 'attach' three or 
four times a year. 

"3. How can he avoid it? 

'%. What course of home treatment will cure him of an 'attach'?" 

Reply. — 1. They are symptoms of a cold, frequently called grip. 

2. Colds are caused by germs. 

3. Eating lightly, hardening himself, keeping his nose clean, avoiding 
people with colds, keeping out of warm rooms and badly ventilated rooms. 

4. Purgatives. Going to bed. 

To Avoid Taking Cold. — 0. F. P. writes: "For years I have found 
myself a slave to a continual cold. As soon as the weather begins to get 
cool my cold sets in and will hold me in some way or other throughout the 
entire winter. I wish you would advise me as to what I should do to pro- 
tect myself during the winter, as I am engaged in outdoor worh the year 
around." 

Reply. — 1. Don't get overheated while indoors. The house temperature 
should be between 68 and 70 degrees (Fahrenheit), and the windows kept 
open to allow the constant changing of air. 

2. Sponge your chest with cold water every morning. 

3. Wear woolen socks. 

4. Throw away chest protectors. 

Treatment for Cold. — A. M. D. writes: "Will you please outline what 
treatment could be given at home for the dangerous sort of colds such as 
you described in the paper? There are many who would take the time and 
trouble to do the right thing if they hnew what it was, but who cannot 
afford a physicians attendance every time a cold is contracted. Can you 
tell me what causes the painful sensation in my nose when I exhale a deep 
breath or sneeze in cold weather? What sort of treatment could be given 
at home for catarrh of the nose?" 

Reply. — Go to bed, take a purge, drink an abundance of water. You 
must have a chronically infected area in your nose. Catarrh may be any 
one of several conditions. I think yours must be due to the inflamed sore 
spot. You should have your nose examined and treated. 

Cold Contagious. — C. L. R. writes: "When do you consider a cold con- 
tagious? For three days I have had a bad sore throat, and now my cold 
is in my head. Is it now contagious?" 

Reply. — Yes ; you are right at the time of maximum danger. 

Habits May Be Are Cause. — W. L. M. writes :"1. Please explain why 
cathartics do not relieve a chronic cold which lasts throughout every win- 
ter? 2. Does the fact that I travel through Illinois and Iowa constantly 
make this cold chronic? 3. Are Rochelle salts safe for a purge? k- Will a 
good purge, used frequently, stop the lodging of the refuse from the bowels 
at the rectum?" 

Reply. — 1. The use of cathartics will not benefit a chronic cold. 

2. No. Blame yourself and let Illinois and Iowa alone. See if some 



34 COLDS— CATARRH— SORE THROAT 

physician cannot tell you what is wrong with you or which of your habits 
needs to be changed. 

3. Yes. 

4. It is good judgment to take a purge to remedy some temporary symp- 
tom, for example a fresh cold, a headache, an attack of vertigo. To take 
purges regularly or frequently is the summit of folly. 

Complains of Colds. — Sufferer from Cold writes: "My wife insists that 
to get fresh air the windows and doors should he open. We seem hardly 
over one cold or cough before we get another, and I am sure it is caused by 
the drafts in our sleeping rooms, the windows and doors being open all the 
time. Every time I speak of this I am informed that you advise fresh 
air. If you will let us have a line or two on this subject, I am sure that 
many will thank you; I know I shall/' 

Reply. — Your sleeping room should have the window wide open. The 
temperature should be 40 to 50. A screen should keep strong wind from 
blowing across your bed. You should have enough cover to keep warm. 

If you "sleep cold" you will have neuralgia, cold, or something else. If 
you "sleep warm" in a cold room, you must look elsewhere for the cause of 
your colds. 

Is your office too hot or dry? Do you ride in crowded cars? Do you 
avoid breathing the breath and mists from other people ? Are your throat, 
nose, tonsils, and teeth in good clean condition? 

How to Prevent Colds. — Mrs. A. B. C. writes. "1. I have a cold in my 
head and I'm aching and sore below the breasts and around the ribs. My 
back is sore and aches. I have a slight cough. Does this mean my lungs 
are affected or is it pleurisy? 

"2. How can one who is subject to colds prevent them? Does chronic 
constipation have anything to do with it? This soreness in the ribs I have 
most of the time, even when I have no cold. My doctor says it's sore 



Refly. — 1. Your physician probably is right, since you have the pain 
in your chest most of the time. A cold accompanied by general aching 
pain around the ribs, and a little cough, all coming on as an acute attack, 
usually means pleurisy. 

2. By keeping the tonsils and teeth clean and the bowels open ; by eating 
moderately; by sleeping in a well-ventilated room and keeping out of hot, 
ill-ventilated, and especially crowded places; by taking cold air or cold 
water baths. 

Take Care of a Cold. — J. G. A. writes: "I notice in your article of 
'How to Live to a Happy Old Age' you speak of avoiding pneumonia by 
taking care of a mild cold, etc. Please tell us how to take care of a mild 
cold. 'Take care of a cold' or 'do not neglect a cold' means but one thing 
to the masses who read it, and that is to dose one's self with some of the 
various brands of cough syrup, a meaning which you and other physicians 
do not intend to convey." 

Reply. — To take care of a cold means: (1) to take a purge; (2) to eat 
lightly; (3) to go to bed and stay there until the fever and aching has 
ended. 



CATARRH 35 



CATARRH 

Colds are due to bacteria. These germs locate somewhere on the lining 
of the nose. They travel along the surface and find their way into the cavities 
that open off the nose. We might compare this process to an overflowing 
stream. 

When the acute infection subsides in the nose proper, a suppurating area 
is left behind, usually in some one of these cavities. When the overflow sub- 
sides everything drains off and dries out except certain low places that stay 
like malaria-breeding, snake-infested ponds. 

These sinuses, or cavities, discharging pus that drains into the nose 
periodically is what is called catarrh. From such pools are absorbed the 
poisons which cause the suffering of so-called catarrh. From them are ab- 
sorbed some of the germs which cause rheumatism and rheumatoid arthritis. 
They are responsible for various forms of neuralgia, some of which are not 
easily diagnosed. 

Inflammation of the nose caused by colds and grip may extend upward 
through the eustachian tube to the middle ear. When this occurs the lining 
of the tube often closes the passage through it so that fluids forming in the 
middle ear cannot escape into the throat. These conditions are sometimes 
present in such quantities that they break through the drumhead, and the 
fluids are discharged externally. 

Such conditions may cause severe pain (earache), which nearly always 
subsides with rupture of the drumhead and discharge of fluids and pus. 
When the matter reaches this stage it should be regarded as serious. 

If people would hear well when they are old, they should take good care 
of their ears in their younger days. To do this the nose and throat should be 
kept healthy, and earache or running ear properly treated early. 

Nose diseases are responsible not only for ear and other diseases; they 
are responsible for many eye disturbances. Hence, before having glasses fitted 
to your eyes, it is well to discover if there is some nose disease present. If so, 
this should be corrected, and then the eyes cared for. In many cases after the 
nose disease is cleared up eyeglasses are no longer needed. 

Chronic Catarrh. — Reader writes: "I am troubled with chronic catarrh. 
Is there a cure, climatic or medical?" 

Reply. — Chronic catarrh means nothing. There are about as many 
different conditions called chronic catarrh as there are kinds of men called 
Smith in a city directory. Find out from a throat and nose physician what 
your trouble is, and have done for it whatever is advised. "Shotgun" 
douching slops are useless. 

Catarrh. — H. M. I. writes: "If one has catarrh is it oeneficial to spray 
the nose and throat? If so, will you please tell me what preparation to use, 
and how often?" 

Reply. — It will help to keep the nose clean and, in this way, will be 
of some service. Use Seiler's or Dobell's Solution. Your druggist will 
furnish either. The proper policy for you is to go to a nose specialist, find 



36 COLDS— CATAEEH— SOKE THEOAT 

out what is the matter with you, and have the condition corrected. Catarrh 
is only a symptom. There is no such disease. 

Catarrh a Symptom. — L. E. writes : "You recently declared "catarrh is 
a symptom." As I am troubled with what is commonly called nasal catarrh, 
I would be interested in knowing what it is a symptom of." 

Eeply. — Catarrh is a symptom of any one of several conditions, such as 
enlarged turbinated bones, spurs on the septum, polyps, chronic infection of 
the nose, chronic infection of some cavity leading from the nose. Still oth- 
ers might be mentioned. Is it wise, when a disease is known by a catch-all 
name, to try to treat it as if it were one and the same condition in everybody 
who has it? 

Vaccine for Nasal Catarrh. — H. H. writes: "Will you please tell me 
if there is a cure for nasal catarrh? Is there a cure for a man who has 
been wearing glasses for the last six years, such that he will not have to 
wear them? Will nasal catarrh give a person weak eyes?" 

Eeply. — 1. Suppose you try a vaccine. Your physician will direct you. 

2. I don't think so. Nearsightedness starting in childhood is sometimes 
so corrected by the changes due to age as to make it possible to leave off 
glasses. I don't think you belong in that group. 

3. No. 

See a Physician. — C. D. F. writes: "What causes catarrh, and is there 
no cure for it? Do you think the advertised patent medicines for catarrh 
safe?" 

Eeply. — The advertised remedies are useless at best. Many are harm- 
ful. Have a physician find out just what is the disease in a case of so- 
called catarrh. Most nasal diseases are curable. Some are the effects of 
neglected conditions. These generally cannot be remedied. 

Catarrh of the Head. — Reader writes: "What do you consider the best 
cure for a catarrh of the head, especially ringing or buzzing of the ears? 
Are Glaubers salts helpful for constipation?" 

Eeply. — Catarrh of the head is a term used loosely to cover several dif- 
ferent conditions. Find out which you have and have that one treated by 
a competent physician. As to Glauber's salts, no. 

Treatment for Catarrh. — F. E. Z. writes: "Will you kindly inform me 
whether or not there is a cure for catarrh (chronic) ? A physician advised 
me that the only cure was a change of climate, and that not always a cure." 

Eeply. — Find out what is the condition in your nose. Many different 
conditions are called catarrh. Some are cured by operation, some by 
change of climate, and some in other ways. Many cases are of no con- 
sequence. Catarrh does not lead to consumption or any of the so-called 
catarrhal states played up in the advertisements. 

Offensive Breath and Catarrh. — M. E. C. writes: "Is there a cure for 
catarrh of the head, causing bad breath? I have taken patent medicine, 
but the catarrh returns/* 

Eeply. — The form of catarrh causing bad breath is known as atrophic 
rhinitis. In this form the mucous membrane has shriveled and its glands 






SORE THEOAT 37 

secrete but little moisture. Hard, dry scabs form and these decay, causing 
the odor. The National Association of Nose Specialists has a committee 
to find out what it can about this condition, what causes it, and what cures 
it. Some physicians recommend injecting paraffin under the membrane of 
the septum. Frequent and thorough washing keeps down the odors. Patent 
medicines and catarrh remedies will do you no good. 

SORE THROAT 

Grown persons as well as children suffer from sore throat. Dust, damp- 
ness, diphtheria, and other germs are the chief causes. Sudden chilling of 
bare feet, coddling, mouth breathing, overcrowded and overheated dwellings 
sometimes serve as the beginnings. 

The distinct germ infections, particularly diphtheritic sore throat, are the 
most serious. Children are attacked more frequently. Their close association 
at home, at school, and at play helps the disease to spread amongst them. 

Sore throat in young or old should not be neglected. The first principle 
of treatment is not to get it. Avoid overcrowded and overheated places, mouth 
breathing, and coddling. Avoid contact with people who have sore throat. 

Simple sore throat in healthy adults is not often serious unless it recurs 
frequently. Sore throat in children is always a serious proposition for the 
following reasons : 

1. They "catch" it easier. 

2. They cannot be depended upon to guard against it. 

3. It is more often diphtheritic. 

4. Some are too young and others don't know enough to complain of it. 

5. They are very apt to develop the form of sore throat known as 
"croup." 

6. Their resistance to disease is not so great. 

7. If they get diphtheria it often leads to very serious after results, hin- 
dering growth or permanently maiming. 

Sore throat in a child should be given immediate attention. Complaint of 
the child or the following symptoms should put you on guard : 

1. Fever ishness. 

2. Paleness. 

3. Difficulty in swallowing. 

4. Croupy cough. 

5. Hard breathing. 

6. Running of the nose. 

7. Swelling of the neck below the ears. 

If you notice any of these symptoms, call your doctor at once. Many 
mothers do not call a physician until they see white patches in the throat. 
Don't wait for that. That is giving the disease a good start and the child 
a possible bad finish. The membrane may be in the windpipe and not vis- 
ible. 

Castor oil, cloths about the neck, ham slices and turpentine, which 
mothers frequently use, do not cure sore throats. In diphtheria they are 
positively injurious on account of the loss of time occasioned by them in get- 
ting the proper treatment. 



38 COLDS— CATARRH— SORE THROAT 

If your child has a sore throat do not trifle with it, do not neglect it, do 
not attempt to "cure it up" or to cover it up. The best and only thing to do 
for the child with sore throat is to call in a physician. 

Hoarseness. — Mrs. G. R. H. writes: "I am a woman of 50. When 
younger I had a good voice, but now I grow hoarse after singing a few 
lines. Talking is difficult sometimes. 1. What causes it? 2. Can anything 
be done? 3. What causes a neuralgic condition of the bowels? The pain 
is mostly of a heavy, dull nature instead of sharp and cutting. If. Can 
anything be done to prevent it? I have been troubled with it at times for 
five years. 5. Is there any remedy?" 

Reply. — 1. You probably have nodes, cord nodes, or a chronic laryngitis. 

2. See a throat specialist, particularly one who has had experience in 
treating singers and speakers. Perhaps the condition can be remedied. 
Probably, however, it cannot be. In those cases where help is possible it 
means a good deal of trouble and expense. 

3. Pain in the abdomen may be due to different things, such as gall- 
stones, intestinal ulcers, appendicitis. Have a physician find out what is 
the cause of your pain. The answer to your other questions is dependent 
on the answer to the third. 

"Wash the Throat Daily. — A. L. F. asks: "1. Would the daily use of a 
throat wash be advisable? 2. If oxygen in air is good for us why not 
breathe oxygen out of a tank?" 

Reply. — 1. Yes. It is wise to wash the teeth, gums, tongue, and throat 
every day. 

2. Good pure air is 1 part oxygen, 4 parts nitrogen, a trace of carbonic 
acid, and a little moisture. Pure oxygen is not so good for a well man as 
pure air. There is such a condition as "too much of a good thing." Pure 
air contains about the best proportion of gases for human use. The harm 
that is done by bad air is due to the impurities in it rather than to a lack 
of oxygen. 

Trouble in Throat. — C. C. C. writes: "I have been troubled of late 
with a swollen throat; at times it is so bad I can hardly swallow. I am 
continually troubled with a cold, and have a large lump in my throat, and 
expectorate small lumps of a yellow, heavy substance. What are adenoids? 
Do you think my tonsils are affected? I have had medical examination 
several times, but have been advised that I had nothing but a cold, and 
was prescribed for accordingly. Do you think the bad atmosphere and poor 
ventilation of the office in which I work can have anything to do with the 
case? I am otherwise in perfect health, and am a hearty eater." 

Reply. — Adenoids are enlarged lymph glands in the back part of the 
throat, "behind the soft palate. As you tell me nothing about your tonsils, 
I cannot judge whether they are affected. It seems to me quite certain that 
you have some mild infection somewhere in your upper breathing appara- 
tus, and a poorly ventilated office is the most likely cause. 

Sore Throat. — M. C. G. writes: "I suffer with sore throat constantly, 
summer and winter. The crypts in my tonsils fill with white matter and 
I am told my throat is sore on account of being always infected. Is it a 



SOEE THROAT 39 

coincidence that I have a sore throat every time I get damp or chilled? Or 
has this something to do with the process of infection?" 

Reply. — Chilling or getting damp causes some of the bacteria in the 
crypts to infect you. You can be infected by bacteria in the crypts of 
your tonsils as readily as by those in the throats of other people. Have a 
physician empty the crypts at intervals or else have him remove your 
tonsils. 



CHAPTER VI 



Cough — Asthma 



COUGH 



Whenever there's a cough there's a reason. A cough means that some- 
thing is irritating the coughing center in the brain. The brain has a cough 
center just as it has a speech center. A brain center is like a telephone switch- 
board. It is a collecting place with incoming and outgoing wires. There may 
be trouble in central, whereupon the ability to cough is lost and the bronchial 
tubes fill up with secretion. The man may drown in his own secretions. 

The irritations capable of 
causing cough come over eight in- 
coming lines: 

1. From the brain covering — 
of no consequence. 

2. From the ear canal. No- 
tice the tendency to cough when 
you remove wax from the ears. 

3. From the upper back part, 
of the mouth and nose — a trunk 
line frequently used. 

4. From the back part of the 
tongue down the windpipe to the 
vocal cords. This trunk line keeps 
the windpipe clean. 

5. From the lower windpipe 
and lungs. This trunk line keeps 
the smaller air tubes clean and 
gives air a right of way. 

6. From the heart — a little 
used wire. 

7. From the esophagus — 
usually a dead wire. 

8. From the stomach — gener- 
ally a useless trouble maker. 

Any irritation along any of these lines may result in a cough. If the 
irritation comes in over Trunk Line 4 or 5 it means that somewhere in an air 
passage something has got in the tube and an effort is being made to clear it 
out. When the message comes in over Line 5 it means that the lungs are 
trying to help themselves. The lungs have but this one way to cry. They 
have but few ordinary nerves — nerves to register heat, or cold, or pain. 
When there is pain in the chest it is in the chest wall or pleura. 

40 




Fig. 15. — Looking Down the Windpipe from 
Above, Showing Vocal Cords. Glottis 
closed — half open — wide open. 



COUGH 



41 



If the small bronchials send in a complaint that there is pus and mucus 
in the way and that air is being kept out the coughing center sends down a 
muscle impulse. A cough results and the offending pus is moved out of the 
way. 

A cough that brings something up is helpful. We divide coughs, there- 
fore, into those that are helpful and those that are useless. Helpful coughs 
are to be encouraged; useless coughs are to be discouraged. 

Eight there is the keynote to the treatment of coughs. The old style 
plan was "to take something for a cough/' to take the same thing for every 
cough. That something usually was an opium mixture. Often this practice 
worked out this way : The lungs sent up a message, "Send me a cough to clear 
the airways." The answer was a dose of opium, which cut the telephone wires 
and left the lungs floundering. 



USELESS COUGHS 

A cough that does not clear out something is a useless cough. Useless 
coughs should be suppressed. The way to suppress the cough is by remedying 
the cause — if it can be done. 

Sometimes the cause is wax in the ear — remedy is easy. 

Sometimes it is eczema in the ear canal — remedy is more difficult. 

Soprano. 1024 



256 



m 



Cgatrafto> 



684 



EFGAB cdefigab c'd'e / .fg'a'b / 



t 1 , f 



r 



80 



c" d" e" £ " g" & \T € 



342 



m 



Tenor. 



512 



Fig. 16. — The Average Range of the Human Voice, c' to f is common to all voices. The 
'figures indicate the number of vibrations per second in the corresponding tones. (Landois 
and Stirling.) 

Sometimes it comes from smoking or dust — easy to suggest the remedy, 
but hard to get it carried out. 

Sometimes it is the result of other irritation in the upper air tubes. Il- 
lustrations of this group are elongated uvula, enlarged tonsils, large turbinate 
bones, polyps in the nose. The remedy is removal of the irritating tissue. 

Sometimes the irritation is due to causes operating indirectly on the nose 
and throat; for example, coughing spells when the skin is chilled or is over- 
heated. Of this group are the coughing spells that develop in the theater, 
those that come on in other warm, closed rooms, also those that develop as the 
temperature of the bedroom changes during the night. The remedy for this 
group is better temperature regulation. 

Sometimes a coughing spell starts when one lies down. Think of an 
elongated uvula as a probable cause. 



42 COUGH— ASTHMA 

If the coughing spell comes on as the result of exertion the cause may be 
heart disease or pressure on an air passage, from an aneurism or a tubercular 
gland attached to an artery wall in the chest. 

Finally there are the stomach coughs. Even when the cough is for the 
purpose of clearing mucus and pus (called sputum) out of the air tubes a 
good many of the coughing spells will bring nothing up. Those particular 
coughing spells have been useless. The irritated apparatus is temporarily 
set on hair trigger and it "goes off half cocked" about as often as otherwise. 

The offending mucus is gradually being worked from the air cells toward 
the larger tubes by tiny hairs called ciliae. After it has worked far enough up 
the lines the cough can catch up and carry it away. 

The movement by ciliae is slow, by cough fast. When one's coughing ap- 
paratus is on edge it keeps grabbing at the mucus before it gets in reach or 
before it can get a hold on it. 

Such coughing spells are useless. They are worse than that. They hurt 
the air tubes and air sacs ; they tire the muscles ; they use up energy. 

Where there is consumption, pneumonia, bronchitis, or colds, anything 
which results in mucus and pus in the tubes, such coughing as produces 
phlegm should be encouraged. Such as is unproductive should be discouraged. 

WHAT TO DO FOR A COUGH 

The first question to be answered is, Shall anything be done for a cough ? 
The old policy of taking medicine for a cough beyond question was harmful. 
It made dope fiends. In most cases nature went ahead and cured the cough 
in spite of the dosing with morphin-filled expectorants. The expectorants 
got the credit because nobody thought to try nature without expectorants, and 
therefore nobody was able to say which cured the quicker. 

The proper answer to the question depends on the cough and the cougher. 
Coughs are divided into useful and useless. Useless coughs should be discour- 
aged. How? If the cause can be removed, the way to discourage the cough 
is to remove the cause. If the cough is due to warm, bad air the proper pro- 
cedure is to get into fresh air — not to take cough drops. If you doubt this, 
go to any fresh air consumption hospital and listen for coughs. Fresh, cool 
air is a better cough allayer than paregoric. 

But not all of the freedom from coughs at a sanitarium is due to fresh 
air. The patients are trained not to cough uselessly. They learn to cough 
when they need to in order that the tubes may be cleared out. They also 
learn not to cough when there is no need for it. 

How do they tell ? Nobody can tell. But there is a little different "feel" 
when the something is in reach. Any one can speedily learn this "feel" — and 
then comes the effort to resist the impulse to cough when the "feel" is not 
present. Ofttimes the force of will is sufficient. When it is not there comes 
the question of cough medicine. There are times when the hair trigger state 
can be calmed down better by a dose of cough medicine than in any other way. 

There is a field for cough medicines. The mistake comes in promiscuous 
doping for coughs. There is even a field for cough medicines containing 
opium. But they do more harm than good if they are used longer than a few 
days, or habitually, or indiscriminately. The so-called consumption cure cough 



ASTHMA 43 

medicines are safer now than they were before the food and drugs act of 1906. 
The amount of opium, codein or heroin contained is printed on the label. 
Previous to the act some of them had more opium inside, but whether more or 
less none of them told on the label how much opium was contained or that 
any was present. 

The answer to what to do for a cough should include an answer to what 
to do with the sputum. The answer is to burn it or cook it regardless of the 
cause of the cough. 

Mild Climate Needed. — J. A. W. writes: "A lady, aged 70, has been 
troubled for three or more years with coughing spells at night and some- 
times during the day, raising a slimy mucus, which, when examined, indi- 
cated no consumption, the doctor stated. He calls it bronchitis. Will 
such affect the lungs? Can bronchitis be cured? If so, where? The 
same lady also has an inward goiter of small size. Would it produce 
coughing spells, as above? Can it be cured? If so, where? The coughing, 
when started, lasts quite a while and completely tires her out. It is more 
noticeable in winter than in summer. Please express your candid opinion." 

Reply. — Chronic bronchitis in an old woman may not be due to con- 
sumption. Such a bronchitis may bring on a bronchial asthma, make the 
person short-winded, or some other inconveniencing condition. If you 
can find a cause for the bronchitis and remove it, you will get well. If it 
is due to a change in heart or kidney, or blood vessels, due to age, you 
probably will not get well. A milder climate — the South or California — 
will help you if you can be comfortable and happy away. Goiter occasion- 
ally causes coughing through pressure. In a person of TO it is rarely 
advisable to be operated on for goiter. 

Chronic Cough. — J. H. writes: "I am continually suffering from a 
cough, and I am always coughing up gray pus. What is the cause of this?" 

Reply. — It is bronchitis. It may be a tubercular bronchitis, otherwise 
consumption. Get your sputum, the gray pus, examined right away. The 
examination will show whether it is a consumption bronchitis or some 
other sort. 

ASTHMA 

The object of breathing is to get oxygen into the blood and waste gases 
out of it. Whenever the breathing center in the brain feels the need of more 
oxygen and less carbonic acid and at the same time the passage of gas be- 
tween the lungs and the blood is interfered with, the condition is called asthma. 

In asthma the patient feels the need of air. So far as he can see there 
is no reason why his blood cannot take it up, but somehow or other it does not. 
And that is asthma — a yearning for air which somehow cannot be satisfied. 
It is just a symptom, not a disease at all. Therefore Stedman's dictionary 
gives eighteen kinds of asthma. 

Sometimes the trouble is with the kidneys, sometimes with the heart, 
sometimes with the thymus, nose, the sex organs, the tonsils, the nervous 
system, the bronchial tubes — anything that prevents a free play of gases be- 
tween the lungs and the blood and leaves the breathing centers on edge to 
help out. 



44 COUGH— ASTHMA 

Asthma comes in paroxysms. It may disappear entirely and for a long 
time or it may continue without inter mittence, getting better and worse. 
Spells generally come on at night. Bad weather may bring on an attack. So 
may any emotional disturbance or a bad cold. ' 

In a bad attack the patient has to stop everything else and work at the 
job of breathing. He sits up because that is the easiest breathing position. 
He may seek an open window. His face registers distress. His abdominal 
breathing is exaggerated; his chest breathing, strange to say, is below normal. 
He coughs. The mucus rattles in his bronchial tubes. 

The theory is that the reason asthma gets worse and better by spells is 
because the muscles surrounding the small bronchial tubes contract spas- 
modically and then relax. When they contract a paroxysm of asthma results. 
When they relax breathing becomes easy again. 

These small muscles are not at the end of the bronchial tubes. The end 
of the tube is an air sac, and that has no muscle in its wall. But when the 
muscles in the tube walls spasmodically close down the shape of the air sac is 
changed. It cannot do its work and the blood vessels cannot get oxygen from 
it or feed it carbonic acid, as is normal. 

All asthmatics have bronchitis a good part of the time and some of them 
have it all the time. Nevertheless, bronchitis is an attachment of asthma and 
not an essential. 

Being no one disease, asthma has no one treatment. What helps one 
asthmatic is of no service to the next. One man finds relief by having his 
nose treated. Another gets well by changing to a dry climate, where his 
bronchitis dries up. A third finds relief from changing to a vegetarian diet, 
eschewing meat, milk, eggs, and all other foods rich in the amino-acid, 
histidin. 

Because one man has been cured by a given procedure it does not follow 
that the next will be benefited by it. The proper plan is a careful study of the 
given case, and that, too, before the disease has run too long. Men get the 
asthma habit just as men get the fit habit in epilepsy, and after the habit has 
been well established the symptom may persist after the cause has been re- 
moved. 

Incipient Asthma. — A. B. L. writes: "Is asthma a form of tubercu- 
losis? What treatment can be given in incipient asthma to avoid its 
becoming chronic? If a patient sleeps with much air in the room will it 
bring on an attach? Could asthma symptoms be mistaken for symptoms 
of goiter?" 

Reply. — 1. Asthma is not a form of tuberculosis. 

2. To prevent incipient asthma from becoming chronic, avoid all irrita- 
tion that brings on an acute attack. 

3. Much air in the room will not bring on an attack if the current of 
air is directed so as not to strike the body directly. A slanted board put 
into the open portion of the window, so as to direct the current of air up- 
ward, or a cloth hung across the open space will do that. 

4. Asthma is not usually mistaken for goiter. The two conditions may 
be associated. 

5. Asthma is frequently a symptom of heart or kidney disease. Is it 
with you? 



ASTHMA 45 

Curability of Asthma. — W. T. H. writes: "Kindly let me know if 
there is any positive cure for asthma that you hnow of. I know it can be 
helped through medicine; also that a change of climate sometimes effects 
a cure." 

Eeply. — Some cases of asthma are due to heart disease, some to kidney- 
disease, some to bronchitis, some to polyps, etc. The question as to the 
curability must be answered for each case. 

Find Underlying Cause. — M. R. writes: "Is chronic bronchitis curable? 
If so, how? Life in New Mexico for more than a year has made the cough 
worse. Do you believe the more even temperature of southern California 
would be better, even if more moist?" 

Reply. — 1. The curability of chronic bronchitis is determined by what 
is back of it. Most cases are due to tuberculosis. Many are asthmatic; 
many are due to heart disease. What is to be done is to be determined by 
what underlies it. If tuberculosis, no climate will be so helpful as the one 
you are in. If asthma, try a vaccine. If heart disease, at whatever altitude 
your heart works best you will find the most ease. 

Bronchial Asthma. — R. N. D. W. writes: "Kindly give advice regard- 
ing bronchial asthma. If a man in the forties has had asthma only two 
years, it following a case of the grip, should he not get over it?" 

Reply. — Can't you get back of that diagnosis ? Many cases of bronchial 
asthma are in reality consumption. Some cases are due to heart disease, 
some to Bright's disease, some to growths in the nose. In a case of asthma 
the first thing to do is to find if there is a curable cause, and then to cure 
it. The case of asthma which cannot be cured is about as hard to do any- 
thing with as any disease I know. Climate helps more cases than any- 
thing else. 

May Be Asthma. — Mrs. E. R. writes: "My daughter is troubled with 
shortness of breath. Sometimes it is hard for her to breathe. What is 
this caused by? Is there any danger?" 

Reply. — I can do nothing more than guess. My guess is that she lias 
asthma. Her asthma may be due to heart disease or kidney disease, or it 
may be ordinary asthma, called bronchial asthma, or it may be due to other 
causes. Nobody is justified in allowing shortness of breath to run on. 
Always find out what lies behind it. It may mean a most dangerous 
condition or it may mean a disturbing but not a dangerous condition. 

Various Causes for Asthma. — J. R. L. asks what is the best cure for 
asthma and how to keep from getting asthma t 

Reply. — There is no "cure" for asthma. There 'is neart asthma, which 
can be partly relieved by treating the heart; kidney asthma to be treated 
by treating the kidney ; asthma due to reflexes from nose conditions, to be 
treated by treating the nose, and asthma associated with clironic bron- 
chitis, the cause of which is not yet worked out. Because one case of 
asthma has been relieved by a given remedy does not mean that the same 
treatment will help the next man. The so-called asthma cures seldom do 
good, and, taken indiscriminately, may do harm. Some of them lead to 
drug habits. 



CHAPTER VII 



Bronchitis — Hay Fever 



BRONCHITIS 



The bronchi are the tubes which carry the air to and from the air sacs. 
The first part of the air tube is the nose, the second part is the pharynx, the 
third is the larynx, and the fourth the trachea. 

After the tube has reached the root of the lungs it branches, sending one 
tube to each lung. From the point of branching on the air tubes are called 
the bronchi. 

It will be noted that the bronchi lie deep in the chest. Immediately 
after the division each bronchus enters the root of a lung and immediately 
divides. The constantly dividing tubes get smaller and smaller until the name 

bronchioles is applied to them. The air 
sacs open off the bronchioles. 

Bronchitis is inflammation of the 
bronchial tubes. Theoretically the in- 
flammations of the larynx are called 
laryngitis and those of the trachea are 
called tracheitis. In everyday life we are 
apt to call any inflammation of the air 
passages which results in cough bron- 
chitis. 

As the air 
chial tubes has 




which enters the bron- 
not been filtered of its 
bacteria, infections of the bronchi are fre- 
quent. In fact, bronchitis is a bacterial 
disease. Practically there is no cause of 
bronchitis except germs. Every case of 
acute bronchitis is a case of infection. 
The same may be said of chronic bron- 
chitis, for even in those cases when the 
first cause was not an infection infection 
soon occurs and remains thereafter the most prominent element in the case. 
The prominent symptom of bronchitis is cough. The cough is the result 
of irritation of the nerves of the bronchial tubes. Impulse to cough is fur- 
nished by these nerves. The force of cough is furnished by the muscles of 
the abdomen, the diaphragm, and the chest wall. 

The "soreness in the lungs" in bronchitis is not soreness in the lungs. 
The lungs do not have that kind of sensation. The soreness is in the muscles 

46 



LOWER BORDER? 
PLEURAL 



Fig. 17. — Location of the Lobes of 
the Lung and of the Diaphbag- 
matic pleuea. 



HAY FEVER 47 

overworked by the effort of coughing. If there is sputum in the bronchial 
tubes and a current of air can be got behind it it will be coughed up. The 
muscles of the chest or of the bronchial tubes do not directly expel the 
sputum; the force is the blasts of air which we call coughing. 

The above statement of facts is meant to be informing. Now let me add 
a practical point. Nine times out of ten a cough will do better without cough 
remedies than with. Cough remedies contain two types of medicine. One is 
a group called expectorants, such as carbonate of ammonia, muriate of am- 
monia, squills, tolu, etc. Careful experiments have shown that these medi- 
cines do not loosen the phlegm or cut it or affect the cough in any way. They 
do nothing but ruin the stomach. Therefore mark this, never take any cough 
medicine that contains any one of them or any other expectorant. 

The other group comprises the sedatives. The most frequently used of 
these are heroin, codein, and morphin. If a cough is dry, hacking, and per- 
sistent a dose of cough medicine containing a sedative will do good. 

The object of cough is to clean the tubes. If it does not do that it is 
doing some harm. Therefore one is justified in taking a sedative for a useless 
cough. 

However, forget not the harm which comes from overindulgence in 
heroin, codein, and morphin. Unless they are used judiciously the remedy is 
worse than the disease. 

Chronic Bronchitis. — M. R. P. writes: "What can I do for a child who 
has coughed most of the time since she was 9 months old? She is now 6V2 
years old. She coughs at night, at times two hours steadily, then again 
from 5 o'clock in the morning until she gets up in the morning. She has 
slept on the porch since last May. Would you advise sleeping indoors 
while coughing so hard? Have tried camphorated oil and almost every- 
thing without success." 

Reply. — I judge the child has a chronic bronchitis. This condition 
does not threaten life, but it is hard to do anything with. It is likely to 
keep hanging on. Is it possible to keep her in the dry region of the south- 
west for a while — say western Texas, Arizona, or New Mexico ? Wherever 
she is, she must lead the most hygienic out-of-door life possible. As to 
sleeping out, I would say make proper arrangements for her comfort and 
have her stay out. Keep her out much of the time during the day also. 
Feed her up well. These are the lines toward which to look for help rather 
than applications of oil and other things to the chest. 

HAY FEVER 

For a long time people scoffed at hay fever; said the sufferers were hys- 
terics, neurasthenics, and faddists; that everybody had summer colds; that 
the poor man called his sickness a cold and stayed at home; while the rich 
man called his hay fever and took a long vacation. There are still people who 
scoff, but they are not so aggressive as they were. 

Medical science has gone far enough to clear the hay fever sufferers of the 
charge of bad faith, without, however, having gone far enough to cure or pre- 
vent the disease with any degree of certainty. The science has worked out 
the basic, pathologic principle of the disease, has found a way to help some 



48 



BRONCHITIS— HAY FEVEK 



cases, but for the great majority it cannot do much more than tell them when 
to run and where to run to. 




Fig. 18. — Wormwood (artemesia absinthium). (Dr. William Scheppegrell.) 



For a long time it has been known that certain persons were capable of 
being violently poisoned by substances which were not in the least poisonous 
to the general run of people. For instance, while hay fever appears at any time 
of the year, two usual varieties are recognized — the spring and the fall. The 
hind that comes in the spring is attributed to the pollen of different hinds of 
grasses, hays, and sedges. 



HAY FEVER 49 

In addition a man having an idiosyncrasy toward horses would sneeze 
violently whenever he came near one. Another would eat a salad containing 
some lobster, and within a few hours would be badly broken out. 

A certain physician took anti-plague serum when he was working at the 
suppression of plague in California. For ten years thereafter, and perhaps 
even yet, he broke out in great wheals whenever he got into cold water. 

A term used to designate this peculiarity was idiosyncrasy. Some of 
these idiosyncrasies were scientifically studied with the result that a good deal 
was learned about a subgroup that was called anaphylaxis, or the condition 
opposite to prophylaxis. 

The idea of the scientist naming the condition was that, prophylaxis 
having to do with protection against a poison, anaphylaxis would be a proper 
term to use when, on the other hand, the body became exquisitely sensitive to 
a poison. 

The proof that hay fever is an anaphylaxis is not convincing. Neverthe- 
less it seems plausible that, in hay fever, the susceptibles are poisoned by vege- 
table irritants — pollens that are bland enough not to affect the general run of 
people. 

A person suffering from hay fever has the usual symptoms of a bad cold, 
plus some spasmodic symptoms. His illness has a greater tendency to hang 
on. An ordinary cold passes in two or three days through the dry stage, then 
the watery-eye, watery-nose stage, and later, into the stage of mucopurulent 
discharge. 

The hay fever subject weeps for weeks. An ordinary cold is prone to de- 
velop into pneumonia or rheumatism or something else serious. Hay fever 
seems to satisfy its ghoulish glee in just being hay fever. The disease differs 
in so many particulars from an ordinary cold that almost anybody can make 
the diagnosis. 

Elsewhere we have drawn the distinction between diseases whose harm is 
measured by the numbers killed and others by nonfatal illness caused. A good 
illustration of the latter group is malaria, with us a disease not important as 
a killer of men, but important as a destroyer of human efficiency. 

It is by the same yardstick that hay fever is to be measured. It does not 
kill, but for many men it shortens the working year from twelve months to ten. 

In addition, indulgence in hay fever draws on the storehouse of vitality. 
Every experience that wears and tears draws from the bank some of the capital 
stock with which life began, or from life's savings account, or both. 

Whenever a physician comes in contact with a hay fever patient he must 
start his consideration of the case by thinking of the patient himself; then 
he considers the patient's nose, and, last of all, he takes dust, pollen, and plant 
life into consideration. 

Generally speaking, hay fever subjects are neurotics and neurasthenics. 
This means that they are generally susceptible to irritants, they may be upset 
by various things which glide from the calmer man like water from a duck's 
back. 

When it comes to treating hay fever the physician must pay a little more 
attention to the way the patient looks at things — the psychology of the situa- 
tion — than with the usual run of men. 

Passing briefly to the second head, nasal spurs, enlarged turbinated bones. 



50 



BBONCHITIS— HAY FEVEK 




Fig. 19. — Ragweed (Ambrosiatrifida) . (Dr. William Scheppegrell.) 



deviated septums, infected accessory sinuses, abnormal conditions are of im- 
portance in many cases. 

Therefore, a physician consulted by a hay fever subject should study, 
first, the temperamental makeup of the patient, and, next, the condition of 
the nose and the cavities leading from it. Sometimes he should prescribe 
rest cure, psychotherapy, tonics, iron, arsenic; and proper cases will be bene- 



HAY FEVER 51 

fited thereby. Operations in the nose, from burning with a cautery anywhere, 
sometimes in the cavity (and one place to burn is as good as another) to 
the removal of polypus, will help greatly. 

Now let us briefly touch on washes, snuffs, and cures. Not any wash 
is better than no wash, and some are much worse. The nasal secretion is wash 
enough. But if the patient must have something, let him use some placebo, 
something with no effect at all except that from suggestion. 

Above everything, let him refuse to use cocain, morphin, and adrenalin, 
and every snuff, or wash, or cure that he does not know to be free from them. 

In the United States Hay Fever Association's leaflet for 1912 three pages 
are given over to "Sneezes and Snuffles, Joy and Gloom in 1911, Experiences 
of Members." Thirty-seven experiences are told. Some narrators were cured 
by this thing, some by that, and some by nothing. 

Hay fever illustrates well the folly of drawing conclusions from a single 
experience, especially a personal experience, the most misleading of all experi- 
ences. When there is a -multitude of cures, there is no cure. As Osier's 
"Modern Medicine" says: 

"Every patient who has tried the whole series of remedies is always con- 
vinced that there is no cure for hay fever." 

Having considered the temperamental basis of the disease, and then the 
relation of the nose, we come to the aggravating cause. This disease differs 
from an ordinary cold in that the exciting cause, instead of being a microscopic 
vegetable called a bacillus, or a germ, is a microscopic part of a vegetable, the 
part called the pollen. A cold may be caused by any one of several bacteria. 
Hay fever may be caused by any one of several pollens. 

In the present status of hay fever therapy interest centers in those things 
that relate to pollens. While hay fever may develop at any time of the year, 
most of the cases fall into the spring or the autumn group. 

In this country there is little spring hay fever. The disease of the spring- 
time is caused by all kinds of grass and hay pollens, by the pollens of different 
sorts of sedge, by that of lilies of the valley, of cabbage, thistles, and spinach. 

That of the fall comes from ragweed, golden rod, daisies, and a few 
other plants. It is pretty well accepted that eighty per cent of the August 
cases are due to ragweed, and practically all of the balance to golden rod. 

Accepting these statements as true, there are two things to do in the way 
of prophylaxis. The one is a community matter — to cut the weeds before 
pollen time. The other is an individual matter — to run away from the pollen 
which harms the individual case. 

In "Sneezelets," the bulletin of the Hay Fever Association, is the fol- 
lowing : 

"Anti-weed ordinances are on the books of most municipalities, but that 
is about all that can be said of them. Let every hay feverite write to the city 
board of health, calling attention to specific places where the sharp edge of 
a scythe will prevent the spread of pollen before the blooming period arrives. 
Enforcement of the ordinances will relieve the distress of many sufferers." 

In this connection we must remember that ragweed is a plant which 
depends on the wind for fertilization of its seed by pollen. Such plants must 
"paint with a comet's tail." There must be a wild extravagance of pollen, and 
no anti-weed campaign will accomplish anything unless it is fairly citywide. 



52 BRONCHITIS— HAY FEVER 

When is the time to run? Research indicates that the pollen poisoning 
begins with the first dose inhaled, increases a little day by day, until, after a 
few days, the flood gates break loose. 

Each hay feverite knows just about the date when his attack is due. 
He gains nothing by running from any pollen except that which poisons him. 
The season may be a little backward or a little early, and so he may modify 
his departure by the state of vegetation. 

Having determined to go away, the question is — where ? The answer is 
to go to a place where the harming weed does not exist or has already 
flowered. 

Many escape by remaining at sea until the season has passed. Some 
escape by going to sections where the ground is barren. Many go to Europe, 
where the flora is different. Some go south, where the disease is not prevalent, 
and others go north. 

The proper plan, in a general way, is to travel north or south, and to 
travel far, rather than to go east or west. Some writers claim that the disease 
does not exist at all in the South ; it is certain that it is not abundant there. 
In addition, the stage of vegetation there in the middle of August differs 
much from that of the North. 

For these reasons it seems to me that a visit to the gulf coast or some 
of the islands near by should be as good a preventive measure as one could find. 

FIGHTING HAY FEVER 

Many attempts have been made to vaccinate against hay fever. The 
German remedy, pollantin, is a preventive rather than a cure. So are the 
remedies made from bacteria. 

Last year we published the suggestion of Dr. Scheppegrell of New Orleans 
that hay fever subjects accustom their noses gradually and in advance, accord- 
ing to a method he proposed. 

The last number of the Journal of the American Medical Association 
contains a letter from Dr. Brown of Minneapolis, suggesting another way to 
vaccinate against hay fever. Dr. Brown's son is a hay fever subject. 

Dr. Brown collected some ragweed pollen. He ground up one dram of 
this in one ounce of glycerin. This was filtered and brought up to two ounces 
with water. To the mixture were added five drops of strong carbolic acid. 
He washed his son's arm with ether, placed a drop of the pollen solution on 
the skin, and made a vaccination scratch through it. This scratch healed 
promptly. Three days later the process was repeated. In a short while the 
skin around the wound looked like the hives. 

Dr. Brown suggests that people start with this solution diluted one 
to one million; that the vaccinations be done once or twice a week, and 
that the strength of the solution be increased as rapidly as possible without 
producing hive-like swelling. All of this is to be done before the attack is 
due. 

At the New York cancer hospital, Dr. Clowes has been working on the 
nature of hay fever. He found that hay fever subjects were exceedingly 
sensitive to pollen. Those who had fall attacks were sensitive to autumn 
blooming plants; those who had spring attacks were affected by the pollen 



HAY FEVER 53 

of spring blooming plants; while those who were subject to both spring and 
fall attacks were sensitive to both spring and fall pollens. 

Dr. Clowes vaccinated through the skin and also injected hypodermically. 
He got both local and constitutional symptoms somewhat as they are in hay 
fever. 

It seems positively proved that hay fever is not an imaginary disease 
and the sufferers have not always been justly treated. 

It seems also to be proved that the nose is not all important. Most people 
are affected through their noses. People with polyps, enlarged bones, infected 
cavities (the so-called catarrh) are more liable to infection than other people. 
To treat the nose will prevent some attacks and cure others. 

All of this is true, yet the nose is not all important. 

Hay fever can be caused by vaccination of the skin and by injection under 
the skin. If this information stops the use of cocain and morphin snuffs 
and washes for hay fever, it will have done enough good. 

Dr. Clowes is working on a vaccine to prevent the disease and a remedy 
to cure it. A few favorable results have been obtained, but no opinion on a 
remedy is of any value unless it is based upon a few hundred observations. 

Hay Fever Antitoxins Good. — H. W. Z. writes: "Consideration and 
reply to the following questions will be highly appreciated: 

"1. Is hay fever antitoxin efficacious, and to what degree? 

"2. From what is it derived? 

"3. How long before the 'regular season should it be administered? 

"k> Has it any noticeable effect on the nervous system when adminis- 
tered, and is there any element of danger therefrom? 

"5. Where can it be procured?" 

Reply. — 1. There are two or three hay fever vaccines. Some of them 
may be antitoxins, and that, I judge, you mean. The one made from 
pollen has been in use longest. Dunbar's statistics show a good degree 
of efficiency. Those made from bacteria are newer. Their advocates pub- 
lish favorable results. 

2. As indicated above, some are from plant pollens and others from 
bacteria. 

3. It is best to begin several months before and increase the dose 
gradually. However, they are used after the attack has begun. 

4. There is no harmful effect on the nervous system. Those of the 
remedies that consist of the serum of injected horses are dangerous when 
used in full strength on people who get asthma when around horses. There 
may be some danger in the use of bacterial vaccines. 

5. Your druggist. 

Causes of Hay Fever. — 0. R. S. writes: "What causes hay fever? Is 
it a sign of physical weakness? I go away every year for four or five 
weeks. I plan while gone where to go the next year. I weigh 200 pounds 
and am always able to eat and sleep well, but the thought of hay fever is 
constantly on my mind. Am I in any physical danger?" 

Reply. — Hay fever does not mean physical weakness. It occurs in 
nervous people. It is quite liable to occur in neurasthenics. The imme- 
diate cause is the pollen of some plant. You are in no more physical 
danger than if you did not have hay fever. 



54 BRONCHITIS— HAY FEVER 

Hay Fever Cures. — N. A. S. writes: "What causes hay fever, and is 
there any cure for it? Have been told that it sometimes develops into 
asthma. Is there any truth in that statement?" 

Reply. — 1. Hay fever results from infection with germs or with pollen. 
Certain types of nervous people are more susceptible than others. People 
with certain nose conditions are more susceptible than others. As to 
cures, yes, several — (a) the climate cure; (b) the serum cure, so called. 

2. Yes. 



CHAPTER VIII 

Pneumonia — Pleurisy 

TO AVOID GRIP AND PNEUMONIA 

The newspapers tell us that we are in the midst of an epidemic of grip 
and that everybody is sick. Bad colds, pneumonia, and grip prevail, according 
to the reports. The vital statistics report shows a considerable increase in 
deaths from all causes in Chicago. This is a fairly good sign of an epidemic 
of grip. When grip, pneumonia, or colds are bad the death rates from all 
sorts of seemingly unrelated diseases go up. 

Neither grip nor colds are reportable. Reporting pneumonia is not the 
custom, so the only signs by which to judge are the reports of general death 
rate and the newspaper stories. 

In 1891 there was a fearful epidemic of grip. At that time the grip 
bacillus was found in the sputum of most of the cases of colds, bronchitis, 
and pneumonia. Between 1907 and 1911 the Chicago Health Department 
rarely found the grip bacillus. I do not know whether the grip bacillus is now 
being found, but I am willing to venture the guess that it is not. It would 
be just as well to drop the term grip and to speak of this epidemic as one 
of colds and pneumonia. 

Assuming that the reports are correct, and we are in for a nation-wide 
epidemic, is there anything a person can do to protect himself? The answer 
is yes. 

The most important thing is to keep out of crowds. Whenever a man 
goes into a crowd there is a reasonably good chance that he will get close to 
somebody capable of infecting him. The person capable of infecting him may 
not be sick. As there is no way of knowing who is an infector, the safe 
policy is to avoid crowds. As a further factor a crowded place is very liable 
to be an ill-ventilated place. The air probably will be too hot, too dry, and too 
dusty. 

The second most important admonition is to keep away from people 
known to have colds. 

Next in importance is that colds be nursed. It is good judgment to go 
slowly when one has a cold. During the fever stage it is well to remain in bed. 
After the fever stage has passed, the better one guards against fatigue and 
exposure the less the danger of pneumonia and other complications. 

Ordinarily diseases do not run into each other, but there is reason for 
believing that neglected colds do run into pneumonia. Bacteriologists have 
shown how pneumonia cocci, at first incapable of getting into the blood, after 
a few days in the throat become changed so that they can enter the blood stream 
and be carried to different parts of the body. 

55 



56 PNEUMONIA— PLEURISY 

Next in importance is the injunction against drinking. Whisky and 
every other form of alcoholic drink is a pneumonia begetter. Alcohol lowers 
the fighting defenses of the human body against all forms of disease, but 
especially against pneumonia. This has been proven by careful scientific 
tests. It is a universally recognized clinical fact. This is one of the points on 
which the laboratory men and the practicing physicians are in full accord. If 
an ordinary man gets pneumonia the chances are three to one that he will get 
well. Whisky drinkers who gel: pneumonia do not have a three to one chance 
for life. 

The next admonition is against gorging with food. We hear every little 
while of some person who has eaten a very heavy meal and gone down with 
pneumonia less than a day afterward. 

Next in order is the oft-repeated advice to keep the air in the living rooms 
fresh, clean, and cold. At this point a friend came in and asked to add a 
word of advice. For many years he has taken a cold shower every morning, 
regardless of the temperature. He has not had a cold for forty years. His 
advice is that all who are strong enough to get up a good reaction should take 
a morning cold bath. 

PNEUMONIA 

While pneumonia outranks all diseases in the number of deaths which it 
causes, in point of importance it holds second position. Most people have it 
at least once during their lives. Many people have it more than once, and 
some more than twice. 

Men are far more susceptible to pneumonia than women, but the attacks 
are usually less severe and less fatal. Foreigners are more liable to the disease 
than natives, and negroes than whites. Negroes and foreigners are more 
liable, perhaps, by reason of their disregard for hygiene and on account of 
overcrowding and density of population. 

It is also noticeable that people living in country districts are less liable 
than city folk. Inasmuch as they spend most of their lives in outdoor work, 
it would seem but fair to conclude that poor sanitary conditions, overcrowding, 
and bad ventilation are more important factors to be reckoned with than 
climate. 

Pneumonia is the most widely spread disease in the world. It is less 
prevalent at the poles and the equator than in the intervening territory. In 
Chicago, for instance, it is an endemic at all seasons of the year. 

More than 50 per cent of the people in Chicago have pneumonia once 
"between the nursery and the grave; almost one-eighth of the people have 
tuberculosis. 

Pneumonia is, therefore, about four times as prevalent in Chicago as 
consumption. From an epidemiological and medical standpoint pneumonia 
would appear to be most important, while from a sociological standpoint con- 
sumption is most important. 

Pneumonia is no respecter of age. It attacks alike the babe in the arms 
of the mother and the octogenarian. In fact, it is during these extremes — 
childhood and old age — that the mortality from this disease is highest. 

Pneumonia seems to have an especial liking for the rich. This is due, 



PNEUMONIA 



57 



perhaps, to the fact that among the rich are to be found the idle, the obese, 
and the plethoric men and women. 

However, excesses in eating, drinking, and inactivity are somewhat offset 
by the splendid hygiene of their homes, when compared with the prevalence 
of the disease in the insanitary and unhygienic homes of the poor and less 
fortunate. 

Pneumonia is a preventable disease. It is also a contagious disease. 

It will be wise during the winter and early spring months to avoid 




Chicago Health Department. 



"SWiPR *SfLfcER.< 



Fig. 20. 



catching cold as much as possible, since colds are usually the first steps toward 
contracting the disease. 

One should avoid people who have colds and who do not have extraordi- 
nary regard for others when coughing, especially in large crowds and in 
crowded street cars and other inclosures that are ill-ventilated. 

If brought in contact with a person who is constantly coughing and 
sneezing it is just as well, when possible, to move to other quarters. These 
people many times throw off the germs that cause the cold. They may also 
throw off the germs of pneumonia. 

If one happens to be within the field of activity of these germs he becomes 
infected. He may catch only a cold. He may contract pneumonia. 

In either case a trouble has been negotiated that may be difficult of solu- 



58 PNEUMONIA— PLEURISY 

tion. This is a danger then that should be studiously avoided. If physical 
efficiency is high, one may escape both. 

A man may catch pneumonia from himself. In other words, we carry 
around with us constantly the germs which cause the disease. They are nearly 
always to be found lurking about in the mouth, nose, around the teeth, and 
in the throat. Hence the importance of avoiding colds. 

Keeping the mouth and throat clean by having proper regard for 
hygienic and sanitary conditions, then, becomes a means for lessening the 
chances of contracting pneumonia. By this means we maintain, as nearly 
as possible, a healthy condition of the mucous membrane which makes it 
more difficult for the germs to propagate their kind. 

Where there is an enfeebled condition of the system resulting from cold 
and many other diseases, such as indigestion, Bright's disease, diabetes, bron- 
chitis, or intestinal diseases, pneumonia is most likely to be a serious complica- 
tion. When brought down with any of these diseases, it not infrequently 
happens that pneumonia is the disease that comes along and puts in the final 
stroke toward placing our names upon the final roll call. 

It is particularly important to keep the bodily resistance up to a high 
point of physical efficiency if we would avoid contracting pneumonia. 

To accomplish this it will be necessary not to overeat, not to allow our- 
selves to become obstinately constipated, and to avoid as much as possible 
irritation of our nervous system by useless worry and loss of sleep. 

The use of stimulants to any great extent, of course, is positively inter- 
dicted. 

These warnings are especially true in cases of obesity, as the heart already 
has its full measure of work to do in pneumonia. It is the one organ that 
is excessively overworked by this disease. It is the one organ in the treatment 
of this disease that must be nursed to avoid a fatal termination. 

Most people have a rather clear and correct impression of the disease. 
As far back as the fifteenth century Fohne tells us that "the people of 
Switzerland referred to pneumonia as the stitch, Alpenstitch, malignant stitch., 
and putrid stitch ; that cases occurred almost every year at the melting of the 
snows, and particularly when the damp winds were blowing strong ; that these 
cases were sometimes sporadic and at other times small epidemics." 

The stabbing pain in the chest, the quick, rapid breathing, the cough, 
the rusty and blood-stained sputum are unmistakable evidences of this dis- 
ease of the lungs. Its curious onset with chill, pain in the side, followed by 
rapid rise in temperature and difficult breathing, mark it off sharply from all 
other diseases of the chest and lungs. 

Epidemics of pneumonia have occurred in all countries, according to the 
history of the disease, as chronicled by many writers. Italy, Germany, and 
England were visited by epidemics in 1564, according to Hirsch and others. 

Practically all countries of the habitable globe have suffered from epi- 
demics of this disease at different times and in different sections of the 
country. 

Illinois, for instance, has been visited by epidemic pneumonia, and be- 
cause of its viciousness business became paralyzed. Large numbers of people 
became sick, and the disease swept down upon family after family. 

While the germ is the exciting and active cause of pneumonia there are 



PNEUMONIA 59 

many contributing and predisposing causes. Statistics show that there are 
marked exacerbations during certain years, and that in countries where the 
twelve months of the year can be spent out of doors, there is an absence of the 
pneumonia. 

Fatigue, anxiety, poverty, and debility predispose to attacks during an 
epidemic. Insanitary and unhygienic conditions, especially where there is 
overcrowding, want of ventilation and accumulations of filth, act as predis- 
posing causes. 

In many extensive outbreaks it has been found that those sections suffered 
most where sanitary and hygienic conditions were worst. This is especially 
so in prisons, barracks, and on sailing vessels. 

The poorer classes usually suffer far more than the wealthy. Bad hygiene 
in the workhouse and factory, exposure to the inhalation of irritating dust, 
long and unavoidable fatigue, are contributing causes. 

Much has been written about the influence which climate, weather, and 
soil have in spreading pneumonia. One thing would seem sure — that the 
state of the weather would many times have much to do with physical 
efficiency, and physical efficiency surely has much to do with whether or not 
the pneumococcus is going to be able to find a lodging place in a particular 
person's lungs or circulation. 

Concerning the meteorological influences as a causative factor in pneu- 
monia, Anders has the following to say: 

"First, that the seasons exert a marked effect upon the prevalence of 
lobar pneumonia, the maximum mortality being observed during the winter 
and spring months. 

"Second, that insular climates probably manifest the greatest rise in 
pneumonia mortality in winter, while that of the continental climates coin- 
cides mainly with spring. 

"Third, that the mortality of the epidemic form of the disease is, to a 
less extent, influenced by the seasons, and that it may occur in the fourth 
and even third quarter of the year. 

"Fourth, that an apparently close relationship exists between periods of 
low temperature and the death rate from pneumonia. 

"Fifth, that the mortality rises and falls with the barometric pressure, 
the maximum being reached during periods of highest pressure and vice 
versa ; that the barometric pressure, however, is governed by the temperature, 
being inversely to the latter, is to be recollected. 

"Sixth, that the average velocity of the winds and the death rate from 
this disease would appear to stand to one another in relation of cause and 
effect (a provisional explanation of this fact being found in the controlling 
influence exerted by the winds upon temperature and barometric pressure). 

"Seventh, that the coincidence of existing low temperatures, high baro- 
metric pressure, the direction and velocity of the winds, and the maximum 
mortality from pneumonia is so uniformly constant as to merit serious con- 
sideration, and suggests a close and direct relation between their combined 
influence and the progress of mortality from pneumonia. 

"Eighth, that the mean relative humidity of the atmosphere shows equally 
decided variability during the periods of abeyance in the prevalence and 
fatality of the disease with that of the cold or annual pneumonia season. 



60 



PNEUMONIA— PLEURISY 



"Ninth, that the major influence exerted by the seasons, however, is 
probably not direct (e. g., by a lowering of the bodily resistance due to low 
temperatures, high barometric pressure, direction and velocity of the winds, 
etc.) but indirect, namely, by bringing about that effective element in the 
causation, concentration, and increased virulence of the specific poison in con- 
sequence of closed doors and windows and lack of free ventilation." 

PNEUMONIA AND DRINKERS 

Fat people and heavy drinkers are afraid of colds and pneumonia. On 
the one hand, they are more subject to infection, and, on the other, infection 
is more dangerous to them than to lean people or to those who are habitually 
temperate. Their fears are justified. There is more than one reason for the 
hypersusceptibility of these groups. 

Leading Causes of Death, Topeka, 1912. 
(Rates per 100,000 Population.) 



Tuberculosis 

Bright's disease 

Organic heart disease. 

Old age 

Pneumonia 



m 



•H 



't^^^^^^^^^^^^^ 



>immmsBm L 



- V)))WW)), 



Bronchopneumonia SS9S8T —. 

Paralysis wmmmmmm 

u. 
Respiratory diseases not specified . 



•EB! 



Nervous diseases not specified .... wmmmmtmmmmmmmmmm 

Diarrhea and enteritis under 2. . . . ppppppjp pppp— ■«; 

Diseases of early infancy ... ...g^ggggg^, 

General diseases not specified. . . .wmmammmmtm 

Typhoid fever mjmmmmammmt ? 

Homicide wmmmmmmmmm^ } 

Accidents mmjmmmmmuJ. + 

Cerebral hemorrhage — ^^m . i 

_,. . A ... V)})}}}}}/t77TrM )7 

Circulatory diseases not specified. — — — 

. . V/ ////////// '//Ait J 

Appendicitis 

Malformations 

Cancer 

Diphtheria 

Rheumatism 

Acute nephritis wmmtoi 

zzm 

Genito-urinary — not specified. . . .mmmt«i 

Peritonitis mmmt»t 

Diseases of the skin 

Diabetes 

Diseases — ill-defined 



' ^^^ T77///////////J9f f 
xamm 






■MBS ' 



X'tJO 



Uojy* 



mmmm Neervoj 



Fig. 21. — Russell Sage Foundation Report (By Schneider). 



The human animal at best has not a capacious nose. Its passages are 
large enough in healthy children, but, by the time adult life is reached, certain 
bones are larger and the airway is smaller. In fat people, this normally 
small space is further encroached on by fat. Not being able to get enough 
air through the nose they take in a good deal through the mouth. They are 
notorious snorers. Mouth breathers and partial mouth breathers are more 
subject to colds than nose breathers. 



PNEUMONIA 61 

Fat people and alcoholics are badly out of nutritional balance, hence they 
are unduly subject to colds and pneumonia. What frightens them more, 
these conditions go hard with them. When a person is fat his system is clut- 
tered with an excess of food which is stowed away under the skin, around 
the heart, anywhere to get rid of it. When food and alcohol are taken to- 
gether, the alcohol is burned and the food clogs the tissues just as the oil 
burns out of a lamp wick and leaves the wick nearly as it was. 

When the obese or drinking man, or the two in one, -finds himself with 
pneumonia, he is poisoned by the toxins of pneumonia plus an embarrassing 
amount of food and drink but partly changed into compounds ready to make 
tissue. Pneumonia at best is a hard fight. The fighting forces of the sick man 
hardly have a fair chance when they are further burdened by these incum- 
brances. 

If the muscle fibers of the heart are obstructed by fat they cannot work 
as advantageously as when they are clean. And finally, the man who has 
learned to lean on alcohol has not much in reserve for this trial of strength. 

Obese people and alcoholics do not have the same chance to recover from 
pneumonia as others. This does not mean that they stand no chance. It 
means that the proportion of recoveries to deaths, instead of being six to one, 
is only two to one. 

COLD AIR AND PNEUMONIA 

The pneumonic should be taken care of either in the open air or else 
in a cold room, according to the season of the year and the climate. He some- 
times objects mightily when his physician tells him to throw away poultices, 
flannel jackets, and steaming teakettles, to throw open the windows, and let the 
cold air blow right across the bed, when the room temperature is so cold that the 
nurses have to wear wraps; and yet in a room where the temperature is 45° 
to 50° and the air is fresh, the pneumonic finds the best chance in his fight. 

This plan has been in use long enough to have demonstrated its efficacy. 
The modified open-air treatment of pneumonia is as logical as the open-air 
treatment of consumption. The fresh-air treatment is not a complete treat- 
ment. Rather it is the basis on which treatment must be founded. Pneu- 
monia is a fight disease. There is an intense poisoning by bacteria and a 
violent fighting back by the human body. The fever, the cough, and the 
other symptoms are the smoke of battle. Fresh, cool air gives the human 
fighter vantage ground. The work of the physician is so to guide the patient 
that he is freed from any load which cumbers him in the fight. 

WHAT TO DO AFTER PNEUMONIA 

When a person has just recovered from pneumonia he wants to know what 
he shall do. During pneumonia the blood clots more readily than normal, 
hence the pneumonic patient must be moved with care that a blood clot may 
not break away and float off to an area where it would do great harm. He 
must exercise a similar precaution to prevent his very flabby, weak heart 
from stopping suddenly. 

The fever having gone down, the patient rapidly recovers unless there 
be an infection somewhere besides that in the lung. Clearly, the rapid improve- 



62 PNEUMONIA— PLEUKISY 

ment in the patient who is due to get well is because his system is making 
an anti-toxin which destroys the toxin of the coccus, or else it is making 
something which destroys the coccus itself. Nevertheless, sometimes a group 
of cocci in the heart or pleura or in a joint may go on doing harm after 
the crisis of pneumonia. 

The kidneys bear the brunt of pneumonia about as much as the heart 
does, and a fair part of the people having Bright's disease should date their 
trouble back to an attack of pneumonia. 

Generally speaking, convalescent pneumonia patients recover promptly. 
Their lungs are not weakened or changed in any way or any more susceptible 
to infection with consumption than if they had had no pneumonia. The late 
effects of pneumonia are to be looked for in the heart and kidneys. 

During the attack of pneumonia the sputum must be disinfected by 
burning. But it is much more important to know that, after recovery, pneu- 
mococci remain in the mouth secretions indefinitely. The convalescent should 
have his teeth cleaned; his tonsils put in sanitary condition, and in addition 
he should be careful about spitting, for probably in spite of everything he can 
do he will remain a pneumococcus carrier. Not infrequently he reinfects his 
own lungs months or years later. It is due to this rather than to crippled 
lungs that pneumonia frequently recurs. A man has been known to have it 
more than a dozen times. So far as we now know the way to stop such 
recurring attacks is to make the most thorough effort possible to clean up the 
mouth, teeth, and throat. 

PNEUMOCOCCI ELSEWHERE THAN IN THE LUNGS 

The idea is more or less general that, when pneumonia follows a cold, the 
disease has spread along the surface of the air passages from the nose to 
the throat, the larynx, and the lungs. As a matter of fact, when things get 
just right, the pneumococcus gets into the tissues and then into the blood, and 
from the blood it is carried to the lungs. It is easier to make the cultures 
of this germ from the blood than from the sputum. 

When the main effect of the pneumococcus is found in the lungs, the 
disease is called pneumonia. But the pneumonia germ can be carried to 
other parts of the body, and, locating there, cause disease. In some instances 
the coccus sets up changes in other organs at the same time as it does in the 
lungs. Sometimes infection of other organs follows infection of the lungs, 
and sometimes the germ locates in other organs and does not affect the lungs. 

The pneumococcus is one of the more frequent causes of heart disease. 
It causes 56 per cent of the pleurisies where there is pus; 17 per cent of 
those where the fluid which is drained away from the chest is a clear water. 
It causes a large part of the meningitis. A pneumococcus meningitis looks 
much like the epidemic form. 

A rather famous case of meningitis which came on in a girl who had 
been vaccinated was caused by a pneumococcus infection of her brain through 
her nose. Many of the inflammations of the joints called rheumatism are 
pneumococcus infections and it is these which are most liable to result in 
stiff joints. 

The diseases due to pneumococcus vary greatly in their severity. For 



PNEUMONIA 63 

instance, pneumococcus infection of the lungs is, next to tuberculosis, the 
most virulent of the usual infections of the lungs. Pneumococcus infections 
of the pleura are about the most curable kinds of pleurisy. 

We get a better idea of the pneumonia question by knowing of the other 
diseases which may be due to the germ of pneumonia and how the coccus varies 
in virulence in different parts of the same body — just as we have long known 
how it varies in different people. 

A POSSIBLE PNEUMONIA CURE 

For years physicians have been trying to find a cure for pneumonia. It 
was plain that digitalis, nux vomica, carbonate of ammonia, guiacol, whisky, 
and the old lot of cures were ready for the same scrap heap as bleeding. 
In fact, time has demonstrated that a certain group of pneumonia cases were 
helped by bleeding, and in consequence there has been some revival of bleed- 
ing. Eelief in some stages of some cases of pneumonia will result from the 
use of ammonium carbonate, guiacol, digitalis, or the other, but they are 
not cures in any proper sense. 

These latter-day studies have been on the pneumonia coccus. When this 
coccus was discovered it soon developed that it did not grow well on the 
foods for germs commonly used in the laboratories. After a few days of 
feeble growth it always died. In consequence study of the pneumococcus 
lagged. Laboratory men knew the consumption germ and the diphtheria germ 
like books, but the pneumonia germ was undiscovered country. 

In time a better food for this germ was found and the study of it began. 
Some facts were discovered that seemed to point a way to a remedy. It 
was found that when a mass of pneumococci were washed in weak salt water 
most of the poison was washed out of them. The washed germs had a slight 
power to produce fever and to harm the subject, but on the other hand they 
seemed to have great power to stir up the defensive forces of the body. 
Finally it was possible to get the cocci washed so clean that two teaspoonfuls 
of a suspension of them would not kill a guinea-pig when injected into its veins. 

For three pneumonia seasons Dr. Rosenow has been using this method of 
treating pneumonia. Of thirty patients treated this way by physicians in 
private practice three died — 10 per cent. In a hospital group of thirty-five 
cases in 1910, nine died — 25.7 per cent. In the next group were 294 cases 
treated in Cook county hospital. One hundred and forty-six received the 
injections — 148 did not. All other treatment and care was exactly the same. 
The cases were not selected. The death rate in the noninjected group was 
37.8 per cent (fifty-six deaths) ; the injected group, 23.3 per cent (thirty- 
four deaths). 

An injection of about 15,000,000,000 cocci was made the first day in 
the hospital. It was repeated each day. After the first injection there was a 
rise of fever of a degree or two, but after that the fever declined and it 
disappeared a few days earlier than is usual in pneumonia. 

It is most important that the treatment be begun early in the disease. 
The results are best when the injection is given the first day. Each day of 
delay lessens the chances of cure. 

In order to form a correct opinion of the value of any treatment it is 



64 PNEUMONIA— PLEURISY 

necessary to have a number of cases. Among young, healthy, clean people at 
least three out of every four ought to get well with any treatment. The only 
way to judge of whether a remedy is in the 40 per cent class or in the 20 
per cent class is to study enough cases. 

Dr. Rosenow does not yet know the value of this proposed remedy. In 
one of his articles he tells how to make it, what it contains, and how to 
use it. He thinks it will be especially valuable when given to nonalcoholics 
immediately after the pneumonia chill. 

He offers it free and has written about it prematurely in the Journal of 
the American Medical Association, because he wants family physicians to give 
it a trial and send in the records of the cases, that a better opinion of its 
value or lack of value may be had. 

Pneumonia and Air. — Inquirer writes: "It is said that hack drivers 
suffer more from pneumonia than any other class. If this be true why is 
pneumonia considered essentially a bad air disease? It is steadily increas- 
ing from year to year in the rural districts, as it is said to be in the cities" 

Reply. — 1. That pneumonia is an impure air disease is amply proved by 
its greatest occurrence during the months when houses are generally over- 
heated and a good many overcrowded. 

2. Pneumonia occurs with greater frequency in cities. 

I know of no proof that cab drivers suffer more from pneumonia than 
any other class. I do not think that they do. 



PLEURISY 

The pleura is slipped in between the lung substance and the chest wall. 
It is put there to prevent friction. It is the ball-bearing of the lung. It 
is a delicate structure, so delicate that it is not easy to see. When the lungs 
are removed and superficially noted the surface is smooth and glistening. 
There must be a membranous covering present. It is so delicate that the 
anatomists, before the days of the microscope, could not make it out well. 

When the inside of the chest wall is examined another smooth surface is 
noted. This pleura must have two layers, one covering the lung and the 
other lining the ribbed chest wall. 

The anatomist cannot outline it well without his microscope. It is not 
necessary to take the word of the anatomist for this. If you will try to strip 
off the shiny lining of a chicken's chest, or of a piece of rib pork, or of ribs of 
beef, you will find that this delicate layer is so thin that it will not strip. 

This pleura covers the lungs everywhere. Likewise it lines the chest 
everywhere. It lines the bony part of the chest wall and also the muscular 
wall, called the diaphragm, which divides the great body cavity into two — the 
abdomen and the chest. 

In this little more than microscopic membrane, the pleura, are located 
nerves, blood and lymph vessels. It is, in fact, provided with its own supply 
of these, separate and apart from the supplies on the one hand to the 
lungs and on the other to the chest wall. 

The reason is that this pleura is a buffer as well as a ball-bearing. Can- 
cer, consumption, and other enemies cannot shoot straight across from the 



PLEURISY 



65 




skin to the lungs, or vice versa. They do get across sometimes, in time, but 
they must stop at the pleural barriers and give the countersign. They must 
cool their heels in the antechambers. Most of them give up in disgust. 

We may say then that the pleura has two jobs — the ball-bearing job and 
the buffer job. 

I understand that cable, telegraph and telephone companies have instru- 
ments with which they can accurately locate trouble on the lines. A cable 
operator can hitch an instrument on a cable line and tell that the trouble is 
2,037 miles out. A telephone operator can hitch in a locater and find out just 
where the trouble is located. 

The nerves are exact duplicates of cable, telegraph, and telephone lines. 
The ordinary nerves correspond to insulated cables; 
the sympathetic nerves to ordinary exposed unin- 
sulated wires. Some of the nerves are well trained 
to local impulses; some of them are poorly trained. 

The best trained are in the palms of the hands 
and especially those of the tips of the fingers. If the 
tip of the finger is touched by two pin points the 
finger registers two points, even when the pin points 
are close together. 

On the back of the hand the two pin pricks are 
registered as one, even though the points pricked are 
half an inch apart. On parts of the body the nerves 
are so poorly trained that they cannot distinguish 
two pricks even when the two points are held inches 
apart. 

You can learn something by trying the training 
of your nerves in different locations on your skin. 
The nerves of the skin at that are much the best trained nerves of the body. 

The nerves to the pleura are so poorly trained that the hurt never 
shows just where the trouble is. This is especially true when the affected part 
of the pleura is some place on the diaphragm. Some men with diaphragmatic 
pleurisy will feel their pain in the appendix ; others in the gall-bladder ; others 
in the kidney, and others in the stomach. 

Ordinarily it is pain in the ribs that makes a man think he has pleurisy. 
This catch in his side may be due to muscular rheumatism in the muscles 
of the chest wall, to neuralgia of the nerves that run between the ribs, or to 
inflammation of the pleura. 

The ordinary treatment is to put on a porous plaster and to let it go at 
that. That is the way the ordinary man has worked it out, and that is about 
the best way. 

With some kinds of pleurisy, where there is no cough, no fever, and no 
effusion, this treatment is as good as any, provided there is free purgation. 
This is also true of the neuralgic pains and the muscular-rheumatism pleurisy 
pain. 

The porous plaster makers generally put some drug in the plaster. 
They do that so they can call it capsicum plaster or belladonna plaster; or 
maybe they will even put in some hot stuff and call it an electric plaster. 

The object of this is the same as the object in putting pepsin in chewing 



Fig. 22. — Pleurisy with 
Effusion. A consider- 
able quantity of fluid is 
pressing the lung up- 
ward and forward. 



66 



PNEUMONIA— PLEURISY 



gum. It does no harm; it does no good, but it makes a fine talking point in 
the advertisement. 

The plaster straps the side; holds the movement down, and in this way 
helps to cure. Meanwhile the mind is at ease ; something is being done. That 
also helps the cure. 

These mild cases of pleurisy that the doctor is accustomed to dismissing 
lightly, calling them intercostal neuralgias, or muscular rheumatisms, tend 

to heal quickly, and leave no 
after effect. They are not worth 
much trouble. 

There are forms of pleurisy 
that are of great importance and 
that are frequently overlooked. 
I think doctors are agreed that 
there are more mistakes in diag- 
noses in pleurisy than in any 
other disease. 

Are there any signs by pay- 
ing heed to which we can escape 
these mistakes? 

When the pleura inflames, 
fluid is poured out of the blood 
into the tissues. As there is so 
little space in that delicate mem- 
brane the serum exudes from the 
pleura as water oozes out of wet 
ground. 

As the serum accumulates in 

the pleural cavity the lung is 

pushed away from the chest; 

pleural friction is lessened; the 

chest wall moves less, and the 

lung is partially collapsed. 

In consequence the pain with which the attack may have started stops 

or nearly stops. As a matter of fact, in the pleural cavity there may be a 

gallon of clear, straw-colored serum. 

Is there anything to make a patient suspect? It is not my part to 
describe how the doctor would examine with the stethoscope and hammer. 
My part is to tell the man walking around the street with a gallon of serum 
in his chest what should make him suspect, and acting upon that have a 
diagnosis made. 

He will notice that since the pleurisy pain he has been short-winded. He 
was not sick enough to be short-winded. He knows of no cause for being 
short-winded. 

He strips the clothes from his chest. By careful observation he notes that 
the two sides of his chest do not move evenly. One side moves much less 
than the other. If it were not hooked up in the same ribbed wall it would not 
move at all. The space between the ribs does not fall in the same way on the 
two sides. In fact, on the affected side the spaces may even bulge. 




Fig. 23. — Diagram Showing a Bronchus Branch- 
ing to End in Air Sacs. At the upper left are 
two large cavities. Sputum at the points in the 
bronchus at the left causes coarse dark rales. 



PLEUEISY 67 

Of course, if a man is exceedingly fat this point cannot be noted. If he 
is thin he may note that the heart beat does not show just below the left 
nipple, but does show to the right or left of where it belongs. 

Finally he has a sense that something is wrong in his chest. Something 
feels tight inside one chest or the other. 

This form of pleurisy is called pleurisy with effusion. The French call 
is pleuresie a frads, or pleurisy with a chill. 

It is a sneaking disease. So far as the pleurisy part of it is concerned 
it is of no great consequence. The significant feature is that consumption 
so frequently starts that way. 

Of the pleurisies with a clear, straw-colored effusion, these sneaking 
pleurisies, more than half are due to tuberculosis. Straus says 56 per cent 
of them; Landouzy says 75 per cent of them; Kelsch and Yaillard say 82 
per cent of them. 

The Bowditches of Boston have been prominent physicians there for a 
long time. The fathers hand down the families in their practice to the sons. 

One of the Bowditches looked over the histories of their patients, espe- 
cially of those families whom they had continuously cared for since 1849, and 
he reported that most of those who had had pleurisy with effusion subsequently 
showed consumption. 

Osier says : "I confess that the more carefully I have studied the ques- 
tion the larger does the proportion appear to be of primary pleurisies of 
tuberculous origin." 

Sometimes the pleura fills up with fluid during the course of consump- 
tion. Sometimes consumption starts with the pleural effusion. But the 
rule is to have the person who has had this kind of pleurisy get well and ap- 
pear to be well for a year or two, and then begin to show signs of consump- 
tion. 

The extremely important reason for finding out that one's pleura, is full 
of fluid is that consumption is then present. In all probability it will not be 
exceedingly active for a year or more, and the disease is easily curable. 

The method of cure is to change one's method of living. Two years later 
the disease may be so far advanced as to put the cost of cure so high that the 
sick man cannot reach it. By cost I mean cost in time, in rest, in money, and 
in those things that money can buy. 

A group of cases often overlooked, though more easily diagnosed, is that 
in which there is fever, general aching, pains in the chest and a dry cough. 

The above description reads much like an ordinary hard cold. There 
is but one way to tell these cases from a hard cold, and that is when the 
physician listening to the chest sounds with his stethoscope on the skin hears 
a friction sound if pleurisy is present. 

If he listens to a chest covered by clothes the friction sound given will be 
due to the shirt rubbing on the undershirt. A physician who listens to chest 
sounds through the clothes obtains money under false pretenses. Some day 
the state's attorney will charge the grand jury to that effect. 

The chance of getting well with or without medical care is fine. Much 
depends upon the germ which causes the pleurisy. Many of these are due to 
the tubercle bacilli. Those cases will get well if the patients will get busy; 
not otherwise. 



68 PNEUMONIA— PLEUKISY 

The cases due to infection with pneumonia germs will stand a little 
better chance to get well than the cases of pneumonia, in which latter con- 
dition the germs have been deposited by the blood in the lungs. 

The pleurisies due to the staphylococcus will probably get well. The 
chance is not so good for those due to the other pus cocci. 

A better way to tell what the outcome will be is to put in a needle and 
draw off fifteen or twenty drops of fluid. If this fluid is of a clear straw color 
the germ is generally the tubercle bacillus. If it is a little cloudy, or is pus, 
the germ is probably a pneumococcus, or an ordinary pus coccus. 

If the pleurisy has followed pneumonia, or has been left by pneumonia, 
the germ is pneumococcus. The people who convalesce slowly after pneu- 
monia, who "don't get their strength back," who have a nagging afternoon 
fever, who sweat, or have night sweats, will, if carefully examined, usually be 
found with a pleura full of pus. 

In a child this is not an extremely serious condition. Children with sup- 
purative pleurisies, following pneumonia, generally get well. The pus may 
open into a bronchial tube and be coughed up, or it may be drawn off with a 
needle, or it may absorb. The condition is much less grave than with a 
grown person. 

When the pleura of a grown person is found full of pus the condition is 
one of gravity. If the pus is white and creamy it will be found that the 
pneumococcus is the most frequent cause. The chance of cure of that group 
is better than that of the next. If the pus is ordinary the chance is that 
streptococcus is the cause. 

Curing up a suppurative pleurisy is a most difficult process. It is easy to 
understand the reason. 

When a boil is lanced the pus flows out and the walls fall in. This col- 
lapsing of the walls is what makes the cure easy. 

When the boil is in a bone the walls cannot collapse. The suppuration 
goes on and on. Witness how white swelling holds on. 

The chest wall is composed of bony ribs. It cannot fall in or collapse. 
When the pus is emptied out a cavity is left. Cavities cannot remain. This 
one fills up with pus again. 

These cases must be cared for by the surgeon. What the surgeon does is to 
open up the chest and cut away the ribs. The stiff bones being out of the 
way the muscles cave and the pleurisy heals up, as would any other boil. 

When ribs have been cut away they have a great tendency to grow back. 
In fact, when but little has been cut away the rib may grow back so fast as 
to prevent the proper healing of the cavity. If a rib was taken from Adam to 
be used as a basis for Eve the chance is that before the season was over Adam 
was around with a full supply of ribs. 

Fowler's and Godlee's book contains an illustration showing how a drain- 
age tube, left in the pleura for a few months, was found encircled by newly 
grown ribs like the tombstone-eating trees in the old cemetery at James- 
town, Ya. 

Empyema of Pleura. — J. V. C. writes: "Please advise me regarding a 
disease called empyema. What is its nature? How is it contracted? How 
avoided? Is it difficult to cure? Is it contagious or infectious?" 



PLEURISY 69 

Reply. — Empyema means pus m a cavity. Generally the name specifies 
the location of the pus — e. g. : empyema of the gall-bladder. If you mean 
empyema of the pleura (or chest) the following are the answers to your 
questions : 

1. It is a suppurative inflammation of the covering of the lung. It 
may be due to ordinary pus cocci, to pneumococci, to tubercle bacilli, or 
some other bacteria. 

2. The bacteria may spread to the pleura from the lung. They may 
be carried by the blood. It is frequently secondary to pneumonia, con- 
sumption, or lung abscess. 

3. By living a hygienic life. 

4. It depends. Generally speaking, it is difficult to cure. Pneumococcus 
pyemia in children is cured rather easily. Pneumococcus pyemia in adults 
is harder to cure. Pus cocci pyemias are more difficult to cure than those 
due to pneumococci. 

5. Practically, no. 



CHAPTER IX 

Consumption 

PACTS ABOUT TUBERCULOSIS 

The consumption situation is improving. Careful students are of the 
opinion that the disease is milder now than it was a century ago. When we 
come to the last twenty years the figures are accurate enough to permit of 
dependable judgment. The cities that began fighting consumption first have 
only half as much as when they began. Chicago began fighting it about ten 
years ago, and has only three-quarters as much. 

CONSUMPTION CAN BE CURED 

l«l. I> .) ■linn. ii in in hi "~ "" linn m i ii — — "■■ i I i op».vaMawv>— »» 

if treated in time. Most consumptives do not know 
they have it until too late. You may have it. Have 
your doctor find out NOW with a tuberculin test or 
otherwise before too late. The thousands of hopeless 
cases are due to neglect. 

Fresh air prevents consumption and pneumonia* 
Ventilate all the time—winter and summer—day and 
night "Too much fresh air is just enough." 

DEPARTMENT OF HEALTH 

Chicago Health Department, Jan. 8., 1910. 
Fig. 24. 

The national census office tells us there is a general improvement down 
the line, the older cities showing great improvement, the younger cities show- 
ing some improvement, the country districts showing a little loss, but not 
enough to neutralize the gain. 

The death rate from consumption in Chicago is less than was the typhoid 
rate twenty years ago. The typhoid rate is not one-twentieth of the rate 
twenty years ago. Within the next twenty years the consumption rate will 
be chopped to pieces. People generally see that, and therefore they want to 
know everything they can about consumption. 

The Relation of Inheritance to Consumption. — A few children have 
been born tuberculous. The child when born contained tubercle bacilli in its 
tissues. The tubercle bacilli were passed from an infected mother into the 
body of the unborn child. Such are cases of inherited tuberculosis. These 
cases are rare, so rare as to be medical curiosities. That is all there is to 
inherited tuberculosis. 

70 



FACTS ABOUT TUBERCULOSIS 



71 




As we go through life, we are attacked by tubercle bacilli from time to 
time. Therefore the ability to throw off tubercle bacilli is a highly important 
question. People have this ability in varying degrees. Some are extremely 
resistant ; others are but little so. 

Resistance is modified in different ways. We strengthen resistance by 
breathing fresh air, eating good food, and exercising. 

The life insurance tables show that fat people have a lower tuberculosis 
rate than thin ones. This means that people who for one reason or another 
are more liable to tuberculosis than the average will lessen their chances of 
having the disease by keeping somewhat overweight. 

Some inherit a lowered resistance 
to tuberculosis. If more than one- 
twelfth of the members of a family die 
of consumption the family is a con- 
sumptive family. Of course, in order 
to draw any conclusion at all, it is 
necessary to get the cause of death of 
at least 100. 

Statisticians, after carefully study- 
ing family histories, have concluded 
that consumption does run in families. 
This does not mean that consumption 
never develops outside of these con- 
sumption families. What it means is 
that if a member of a consumptive 
family gets infected with consump- 
tion he does not have the average 
chance of throwing off the infection 
before getting sick or of getting well after the disease has developed. 

Williams studied 1,000 cases of consumption and found that 488 of 
them belonged to consumptive families. Walsham found that the proportion 
was 320 out of 1,000. After we make allowance for the danger that members 
of a family catch the disease from one another, we see that much more than 
half the consumptives do not belong to consumptive families. 

Walsham tells us what every physician knows : "A man starting life with 
a constitution favorable to the growth of the tubercle bacillus can,, by his 
habits and environment, over which he generally holds some control, to a 
large extent alter his tissue resistance to his advantage." 

In other words, a man, by carrying out the laws of personal hygiene, can 
be reasonably safe from consumption. If he is of a consumptive family he 
should be doubly careful in living. He must live right to be safe, and living 
right, he will be safe. 

The Relation of Heart Disease to Tuberculosis. — As a general proposi- 
tion those people who tend to heart disease, apoplexy, and Bright's disease 
do not tend to consumption. As rheumatism lies at the base of a good deal 
of the apoplexy and heart disease, we may also say that the rheumatics have 
a slightly better chance not to become tubercular than have the average. 

However, if a man concludes that because he is in less danger than the 
average man he is in no danger, he will be in error. 



£E£ • A • GOOD • DOCTOR- • 

North Carolina Health Bulletin. 
Fig. 25. 



72 



CONSUMPTION 



Again, the heart is really four pumps set side by side, and disease of one 
part may have just the opposite effect from disease of another. 

A learned Austrian of the latter part of the last century, Eokitansky, 
wrote : 

"Persons laboring under enlargement of the heart do not contract tuber- 
culosis." 

Eokitansky's opinion carried so much weight that for a long time it was 
accepted blindly. Further analysis has shown that certain kinds of heart 
disease protect against tuberculosis and other kinds help to produce it. 

About the most important of the valves of the heart is one known as the 
mitral. Sometimes this valve is diseased in such a way that the blood cannot 
pass easily from a cavity called the left auricle to another called the left 
ventricle. The condition is called mitral stenosis. Mitral stenosis offers 
protection against consumption. 



IN CASE OF CONSUMPTION, LOOK TO THESE FOR CURE 




THE DOCTOR. 




SUNLIGHT. OUT-DOOR AIR. GOOD FOOD. 

NEW YORH STATE DEPARTMENT OF HEALTH. 



REST. 



Fig. 26. 



There is a valve located where the important artery, the pulmonary, starts 
from the right ventricle to run to the lungs. When this valve is stenosed, 
infection of the lungs with tubercle bacilli is apt to occur. 

The Relation of Diabetes to Tuberculosis. — Diabetes is a symptom. 
Any one of several conditions may be responsible for this symptom. Speak- 
ing generally there is little danger of diabetes directly causing death. 

However, diabetics are more liable to become infected than is the average 
run of men, and infections in diabetics are especially liable to be severe. 

Ordinarily, boils and carbuncles are not dangerous. In diabetics car- 
buncles and boils are quite dangerous. A pneumonia in a diabetic is much 
more dangerous than in a nondiabetic. 

Diabetics are prone to consumption. A young person with diabetes stands 
about an even chance of getting consumption. 

Consumption in a diabetic runs a rapidly fatal course. In a diabetic 
tissue is burned much more rapidly than in a normal person. In a consump- 
tive the same is true, though in a lesser measure. 

When diabetes and consumption are combined in one patient the fires 
burn out the body rapidly, as a furnace in which wood and paper are burned 
melts out the grate bars and blisters the boilers. 

The Relation of Pregnancy to Tuberculosis. — The idea is general 
among medical men that pregnancy occurring in a tubercular woman would 
cause the disease to become highly active. Walsham gives it as his opinion that 
"pregnancy does not predispose a woman to tuberculosis, and even when preg- 



FACTS ABOUT TUBERCULOSIS 



73 



nancy does occur in a tubercular woman the complication is not a serious one, 
although, of course, it is a complication we would rather be without." 

I have observed a number of pregnancies in tubercular women. If the 
women have had good care they have gone through the period without a flare- 
up in the disease; good healthy babies have been born, and the disease has 
not progressed rapidly immediately after the confinement. 

I have known of cases where the baby, born in the spring or early sum- 
mer, has been left at the breast until the cool weather of autumn without 
harm. The baby born to a tubercular mother probably will be free from 
tuberculosis and otherwise healthy and strong. 





//n\ x 

SUNLIGHT. OUT-DOOR AIR. 



Fig. 27. — To Cure Consumption. 



Michigan Public Health. 



A careful mother can prevent her baby at the breast from becoming 
infected. The weaning of the baby is for the purpose of saving the mother's 
strength. 

The Relation of Alcohol to Tuberculosis. — Walsham tells us that "a 
large section of the public believe that alcohol protects the body from the at- 
tack of the tubercle bacillus. This belief is due to the teaching of the older 
physicians, as the medical opinions of the public of today are generally those 
of the last generation of physicians. There can be no question that physicians 
in the middle of the last century did not consider that alcohol predisposed the 
organism to tubercle. They even considered it beneficial and gave it to 
phthisical patients in large quantities." 

At the present time up-to-date physicians do not give alcoholic beverages 
to consumptives. Furthermore, statistics convince them that users of alco- 
holic drinks have more than the average amount of consumption. Addiction 
to drink predisposes to tuberculosis. 

In addition, as Kelynack says: "There can be no doubt that the non- 
hygienic surroundings of many chronic alcoholics afford important conditions 
suitable to tuberculosis invasion." 

Some years ago at Dunning, 111., we noted that consumptive women who, 



74 CONSUMPTION 

prior to contracting consumption, had been drinkers or who had been notori- 
ously immoral succumbed rapidly to the disease. 

The Relation of Chest Development to Consumption.— Many observ- 
ers have noticed that stoop-shouldered, narrow, deep-chested people were prone 
to develop consumption. People whose chests are shoulder bound do not 
expand the upper part of their chests well. Sometimes those upper ribs get 
so ossified that they can move but little, and in breathing the upper part of 
the chest moves only slightly. Freund thinks this lessened movability of the 
upper chest is largely responsible for consumption. 

The Relation of Age to Consumption. —Infants in arms are fairly sub- 
ject to the tubercular infection. When the tubercle bacillus enters their bodies 
it is apt to locate in the lungs. Such children have ordinary lung consump- 
tion as grown people do. With them the disease runs a rapid course. 

Children past the age of infancy are prone to have scrofula, glandular 
tuberculosis, and bone tuberculosis. In them tuberculosis is quite mild and 
tends to get well. 

Young men and women, say from 15 to kO, are apt to have lung infec- 
tions. In them the disease tends to progress rapidly. 

In older people the disease is slower; the lungs are apt to harden up 
and the overgrowing fibrous tissue either cures the disease or makes it take 
on a chronic form. 

The Influence of Race on Consumption.— The negro race is exceedingly 
liable to become infected with consumption. Consumption in a negro is liable 
to progress rapidly. The lungs are usually moist and much sputum is raised. 

Occupation in Relation to Consumption.— There is the widest varia- 
tion in the amount of consumption among the different groups of workers. 
The dusty trades are the worst sufferers. At the head of the list are those 
who work in metal and stone dust. In some lists stone cutters stand at the 
head; in others, metal polishers. There is not a great amount of difference. 

The printer and compositor are near the top. There is not so much dust 
in their working place, but what is there is kicked up from a dusty floor, and 
there are always likely to be consumption germs in floor dust. The printer 
works in an ill-ventilated room, which makes a little dust as harmful as a 
larger amount would otherwise be. 

The cigarmakers are usually fourth on the lists as printed. Janitors 
stand near the top. 

In Pittsburgh they claim that coal smoke makes for pneumonia but that 
it makes against infection by consumption. They say the solid particles of 
unburned coal fill up the lymph spaces in the lungs so that consumption germs 
cannot get in. 

WAR AGAINST CONSUMPTION 

In the United States the consumption death rate is falling in a dozen 
or more cities, but in the country at large it is not falling. New York and 
Boston have cut their consumption rates in half. Many other cities have done 
well, but not so well as the cities named ; and the rate in the rural districts is 
increasing slowly. 

In Germany, prior to the insurance period, the consumptive rate was 



WAR AGAINST CONSUMPTION 



75 



stationary. Soon after insurance was begun the rate began to fall. The rate 
for all Germany has fallen from 3.25 per 1,000 to 1.65. The rate for German 
cities fell from 3.1 to 2.2 in 1897, when the anti-consumption crusade of the 
pension boards began. Since then the fall has continued until now the cities' 
rate is lower than the rural rate. 

Dawson quotes Professor Kayserling of Berlin and Professor Frankel, 
who rank among the highest German authorities upon the subject, as attrib- 
uting the progress made "more to the industrial insurance laws than to any 
other cause, owing to the fact that these laws have placed within the reach 
of the working classes sources of healing which were never dreamt of before. 
. . . There is little room for doubt that, before many years have passed, this 
scourge of the race will be robbed of its terrors and take its place as one of 
the minor afflictions of mankind." 




GOOD FOOD. REST 



Michigan Public Health. 
Fig. 28. — To Cure Consumption. 



Michigan Public Health. 
Fig. 29. — To Cure Consumption. 



Professor Kayserling also says: "We will conquer this disease by [a] 
recognition of the fact that we have to deal with a specific infectious disease 
caused by the tubercle bacillus, and by [b] the largest possible development 
of treating tuberculosis by means of the machinery of industrial insur- 
ance." 

Nor is the effect of these measures limited to tuberculosis. "It seems 
impossible to deny to insurance legislation some credit for the fact that, 
during the last twenty-five years, the rate of mortality for the whole empire 
has fallen from 25.4 per 1,000 to 19 for the last ten-year period and 16.2 
for 1910. 

"In Germany the contention is general that the effect of the insurance 
legislation and of the various activities to which it has given rise has been 
marked improvement in the physical, mental, and moral condition not only 
of the insured but of the poorer section of the population, and this improve- 
ment is reflected in a higher standard of civilization and of economic effi- 
ciency/' 

The authorities seem agreed that an improvement in the efficiency of 
men has been one of the noticeable consequences of the better housing and 
better public health resulting from these laws. 



76 



CONSUMPTION 



EARLY DIAGNOSIS NECESSARY 

Early diagnosis is the heart of the consumption question. Consumption, 
diagnosed in the early stages, is curable in nearly every case, and, what is 
just as important, cure can be brought about with the expenditure of so little 
time and money that it is within the reach of nearly every one. 

On the other hand, late consumption is not often cured. Part of this is 
because the disease in that stage is hard to cure, and part of it is because 
the time and money required put the cure beyond the reach of most people. 

The cure of consumption by fresh air, rest, and feeding, while the best 
cure we have, is far from being perfect. When scientists have discovered a 
better cure there will no longer be so great a premium on early diagnosis. 
After that, men can go along foolishly saying, "There is nothing the matter/' 
saying, "Thinking consumption makes consumption," trying in every way to 
deceive themselves, and still be cured. 



WHEN TO SUSPECT CONSUMPTION 



The earliest sign of consumption is unwarranted tire. This is always 
very suggestive of consumption, but it is also suggestive of many other condi- 




COUGHS, SPITS AND 
SNEEZES INTO 
PAPER OR CLOTH,- 

Michigan Public Health. 

Fig. 30. — A Careful Consumptive. 



BURNS OR BOIU 
BEFORE IT DRIES, — 



tions. This symptom would have qualified Napoleon Jackson, "who was 
marked for rest." It would qualify those who suffer from hookworm, to say 
nothing of a good many other ills, some of which are of no particular im- 
portance, while others are. 

If the person who suspects he has the disease will take his temperature 
four times a day for a week or more, he will find a morning drop to a little 
below 98 J and an afternoon rise to a little over 99. The range of temperature 
is not conclusive proof of the disease. It is suggestive only, but it is a more 
reliable sign than the rundown feeling. 

Both of these symptoms come before the cough appears, and, of course, 



WHAT CAN CONSUMPTIVE DO TO BE SAFE TO OTHERS? 77 

weeks before bacilli can be found in the sputum. They bespeak an easily 
curable stage of the disease. 

Cough follows a little after the onset of the infection in the nose and 
throat. The consumption cough is much more liable to sneak in without 
aches and pains. This symptom, too, is suggestive only. There are other 
causes for a slowly developing, persisting, mild cough. By the time the 
cough comes the disease has progressed far enough for a fairly good diagnos- 
tician to find evidence of it in the chest by a physical examination. 

There is another suggestive circumstance that is of great importance. 
That is a history of having been thrown in close contact with consumptives. 

If a member of one's family has recently had an open tuberculosis, spit- 
ting tubercle bacilli or having a wound or sore throat discharging them ; if one 
has worked recently by the side of a spitting consumptive; if one has been 
drinking milk from cows proved to have had consumption — such a personal 
history is just as suggestive as the feeling of tire, or a little range of tempera- 
ture, or a little cough. Any one of the four suggestions brings two bits of 
advice: the first that, whatever in the method of living is insanitary or un- 
hygienic be changed; the second, that effort be made to get a diagnosis. 




CONTENTS 

0p <A*»OUCACH 
T °EACHQ<JAf r 



£ 



f 



WHAT CAN THE CONSUMPTIVE DO TO BE SAFE TO OTHERS? 

The consumptive starts out with an infection located in one part of one 
lung. If he is not to harm himself he must not infect other parts of his 

own body. He starts out as the only case in 
his home and his office. If he is not to harm 
his fellow man he must not infect his sur- 
roundings. How can he earn security for 
himself? How can he earn security for his 
fellows ? 

In order to prevent infection of other 
parts of the infected lung and of the other 
lung it is necessary that sputum should be 
cleared out of the lungs just as soon as it 
comes in coughing reach. But coughing 
which does not produce sputum jerks the 
lungs and thus harms them and forces bacilli 
into new areas in them. Therefore, there 
should be enough coughing to empty the lungs, 
but no more than is needed for this purpose. 
The throat must not become infected. 
The cough must keep the vocal cords clean, 
but it must not be hard enough to hurt them. 
The mouth must be kept scrupulously clean. So must the teeth, the tongue, 
the tonsils. Sputum must not be swallowed, because tubercular ulcers in the 
intestines very nearly end all possibility of cure. 

Pneumonia and common colds must be avoided by keeping in the open 
air and avoiding people who have colds. 

The man must not infect his family or his work fellows. First of all, 
he must not cough or sneeze without holding a napkin or handkerchief in 




¥ 



or puts it into 
a disinfectant:- 

Michigan Public Health. 
Fig. 31. — A Careful Consumptive. 
(See Fig. 30). 



78 



CONSUMPTION 



front of his face, so that no mist may be thrown into the air. He must not 
spit either the sputum or ordinary spit on the floor, the wall, the bed, or any- 
where except into a napkin or some receptacle, which in turn must have 

proper care. He must 
not kiss those suscepti- 
ble to the disease. He 
must have his own eat- 
ing and drinking uten- 
sils. He must not han- 
dle the food of others. 
He must be careful that 
he does not stay long in 
badly ventilated places, 
nor in places where sun- 
light does not reach. 

It is difficult to in- 
fect a well-ventilated, 
sunlit room. He must 
not luork at a dusty 
trade. 

Following these few 
simple rules, he is a 
good neighbor and a 
good fellow workman. 
As an associate he is 
safe and he should be 
allowed an opportunity 
to work and to enjoy 
himself. On the other 
hand, a reckless con- 
sumptive should have 
fewer rights than any 
other man. He is an 
enemy to his fellow 
man. Perhaps more of 
charity and humanity 
would decrease the 
number of community 
enemies. How often a 
consumptive gets careless and reckless, bitter and vindictive, because he 
believes that consumption is a sin of society and that he is being made to 
suffer unjustly. He grows resentful and strikes right and left, or maybe, 
tired and worn, he ceases to care for men because he thinks that no man 
cares for him. 




Fig. 32. — Look Out for Consumption. 



WHAT IS THE CONSUMPTIVE TO DO FOR HIMSELF? 

There is no cure for consumption in the sense that diphtheria antitoxin 
is a cure for diphtheria, or even in the sense that quinin is a cure for malaria. 



HEADING OFF CONSUMPTION 



79 




When antitoxin is injected it searches out the diptheria toxin, neutralizes it, 
and leaves the tissues of the body untouched. When quinin is taken for malaria 
every tissue in the body is poisoned, but the malaria organisms are poisoned so 
much more than any other cell that the result, in a certain sense, is specific. 

For tuberculosis we have tuberculin. This carefully used over a long 
time builds up the resistance of the body to the toxin of the tubercle bacillus, 
but not to the bacillus itself. Certainly there is none of the magic effect seen 
after diphtheria antitoxin is used. 

The present consumption cure consists in building up the resisting forces. 
They then fight back in a general sort of way and as the tubercular process is the 
most evident force at which to strike, 
the quickened resistance strikes at it. 

It is as if a sleeping giant had 
been half awakened to a sense of dan- 
ger, and, simultaneously, to a desire 
to fight back. The monster lunges 
out against whatever is at hand. It 
may fight against the enemy. It may 
waste its force in a futile struggle. 
The elements of cure are rest, food, 
and fresh air. 

One of the best books on curing 
consumption is "My Personal Experi- 
ence with Consumption/' by Eoss. In 
an article in the October number of 
the Journal of Outdoor Life, Eoss says : 

"The day's work should consist of rest; rest should be the only business 
on hand. . . . The error that many fall into is in confusing rest with some 
of the many forms of recreation. Hence, it is necessary that we 'standardize' 
our meaning of rest to fit the case of the person suffering with tuberculosis. 
The matter is an important one, equally as vital as the proper regulation of 
the other requisites of the cure, for it has been very clearly demonstrated that 
the cure depends not on any single one of the major necessities, i fresh air, 
wholesome food, and rest/ but on all of them, sensibly applied and regulated." 

As a matter of fact, the need is that the patient be told just how much 
to rest, just how to rest, and just what is rest. In his book Eoss says : 

"Besting is a severe test upon one's patience. It will be taxed to the ut- 
most again and again. The real battle is taking place at this point. Getting 
well requires the exercise of many of one's powers, and foremost of these is 
patience and restraint. The development of these two faculties will save much 
energy, every ounce of which is needed. A large percentage of those who have 
not been cured might have been had they learned to rest in the proper manner 
during the curative period." 



WASHES HER HANDS 
BEFORE AND AFTER EATING* 

Michigan Public Health. 

Fig. 33. — A Careful Consumptive. 



HEADING OFF CONSUMPTION 



Whenever close association with a consumptive, or lassitude, or fever, or 
cough has made one suspect that he has consumption, the proper course for 



80 



CONSUMPTION 



him to follow is to find out if he has the disease and if so to adjust his life 
so as to fight it successfully, and, if he has not, to dismiss the subject from his 
mind. 

Nothing could be more asinine than a policy of dread of the disease so 
great that one is afraid to investigate and inquire, afraid to know the truth. 
Such a policy means a foolish drifting into breakers from which there is no 
escape. 

The most searching and thorough test for tuberculosis is the tuberculin 
test. The principle of the tuberculin test is that when tuberculin — a secretion 
of the tubercle bacilli — is put in the body it will search out the tubercle 




AlWflfS USES THE SAME 
DISHES AND BOILS THEM 
IN WATER BEFORE WASHING 
WITH OTHER DISHES,— 

Michigan Public Health. 
Fig. 34. — A Careful Consumptive. 




AND SLEEPS ALONE 



Fig. 35. — A Careful Consumptive. 



bacillus and, if any are found, the two of them working together will cause a 
reaction. The lock fits the key, the key fits the lock, and put together they 
bring results. Tuberculin applied when there are no tubercle bacilli in the 
body is without any effect. 

Tuberculin is sometimes dropped in the eye, sometimes injected into the 
skin, sometimes vaccinated into the skin, and sometimes injected under the 
skin. The latter is the method generally employed, and in my opinion the best 
method. Its disadvantage is that it gives the person with tuberculosis an un- 
comfortable day. 

There are those who believe it sometimes causes the disease to flare up and 
spread more rapidly. In a disease whose natural course is alternately to flare 
up and settle down, it is difficult for anyone to decide the cause of any flareup. 
Allowing that these men are right in their supposition that the use of tuber- 
culin has sometimes caused the disease to flare up, the fact remains that the 
enormous good from the early, exact, certain information given is of over- 
shadowing advantage. 

The trouble with the tuberculin test is that it is too searching to fit in 
with other tests. It finds tubercular lesions that are not of much consequence 
as well as those that are. The proper plan in one of these conditions that 
suggest tuberculosis is to have a tuberculin test. If there is no reaction, all 
thought of the disease can be dismissed from one's mind. If there is a reac- 



HOW TO HAVE CONSUMPTION" 



81 



tion, searching physical examination should be made to determine whether the 
infection is of any clinical importance. 

Bacilli in the sputum is an infallible sign, but the trouble about it is that 
it is a late sign. A man with consumption ought to know of his disease and 
change his method of living before that sign develops. 



HOW TO HAVE CONSUMPTION 

Much is to be said in favor of optimism. It buoys one over the rough 
places. As an antidote to worry and the habit of anticipating ills it is about 
the best medicine ever taken. It is much better than medicine poured out of 
a bottle. 

On the other hand, optimism has taken the lives of many thousand con- 
sumptives. Men cheerily, smilingly saying that all is well, and, acting on this 






Fig. 36. — A. Chest in Rickets 
Badly Deformed. 



B. Deep Narrow Chest Prone to 
Consumption. 



assumption, have drifted from good health into early consumption or from 
early consumption into the incurable stages. Proper effort based on common 
sense would have kept them on good ground or pulled them out of tight 
places. 

As between a pessimistic consumptive, self-centered and selfish, and one 
who is optimistic, who bathes himself in sunshine and radiates hope, every man 
would choose the optimist. But those who have had experience with con- 
sumptives know that there is a frame of mind preferable to optimism. It is 
the facing of the situation with frankness and intellectual honesty backed by a 
quiet courage and persisting determination. 

There is no hope for the pessimistic consumptive. There is little for the 
optimistic. The reward of recovered health does not always come to those 
of the third group. ISTevertheless, they can reasonably expect it. The others 
cannot. 

The first element in the right way to have consumption is the right frame 
of mind. 

Rest is necessary for a cure. A man is a machine daily engaged in eating 
food and converting it into energy — assets. He does work. Let us call this — - 



82 



CONSUMPTION 



liabilities. Normally he maintains a balance between these. When tubercu- 
losis is added to his liabilities the load becomes too heavy. It is necessary to 
readjust by increasing food and decreasing labor. Eest is necessary for a 
cure. 

Worry is a form of mental labor. It uses up energy needed to fight the 
disease and it brings no proper return of any kind. The consumptive must 
not worry. 

And another detail well worth while is that he must not use up energy 




•EXEQCISE-IN-OPETi-AIR.- 

North Carolina Public Health. 

Fig. 37. — To Avoid Consumption. 




•RE-ST-WflEN-TIB&D' 

North Carolina Public Health. 

Fig. 38. — To Avoid Consumption. 



by needless coughing. A certain amount of coughing is necessary to keep the 
bronchial tubes clean. Any coughing in excess of this wastes energy and in- 
jures the lungs. Needless coughing must be controlled by will power. Medi- 
cines should not be used. 

A man can fight his consumption in a reasonable or in an unreasonable 
way. Proceeding with reason and common sense he gives his fighting forces 
the most favorable ground from which to win. 



HOW IS A CONSUMPTIVE TO KNOW? 



It is easy to tell late consumption, but then no good comes to the sick 
person from knowing what his disease is, because cure is beyond his reach. 
Even the few who are cured have lungs so badly crippled that they have no en- 
durance. 

It is difficult to discover early consumption, but so much is gained by 
early diagnosis that it is all important. Very early consumption will get well 
after tivo to three months of rest, air, and feeding. Early consumption will 
get well in six months. A diagnosis that is not made in one of those two 
stages is not worth much to the patient of average means. The average man 
can find a way to rest for six months, but any need in excess of that is beyond 
him. Who should suspect that he is tubercular ? 



HOW IS A CONSUMPTIVE TO KNOW? 



83 



1. Any person who has been in contact, within a year, with a consumptive 
or a cougher should consider himself under suspicion. 

2. Any person who catches one cold on top of another should suspect himself. 

3. Any person who has a cough which holds on without cause. 

4. Any person who does not feel vigorous, especially those who feel de- 
pressed before 8 in the morning and after 3 in the afternoon should take the 
morning and afternoon temperature. If the morning temperature is under 98 
and the afternoon is over 99 he should consider himself under suspicion. 

5. Any person losing weight without apparent cause. 

Any person belonging to any of these groups should have his condition 
carefully looked into. This means a careful examination of the chest, a de- 




•5LE.EP • WITH* WINDOWS-OPCM* 

North Carolina Health Bulletin. 

Fig. 39. — To Avoid Consumption. 




-DVST*COHT&\nS * GERflS' 

North Carolina Health Bulletin. 

Fig. 40. — To Avoid Consumption. 



tailed inquiry into the history, and such other procedures as may be necessary. 
A good physician will probably want to watch the patient a while before he 
makes a diagnosis. 

The procedures which are valuable in these early cases are : 

1. Careful, painstaking examination of the chest. 

2. Careful consideration of the history. 

3. The use of tuberculin in the average case, and in the hands of the aver- 
age physician is the most valuable of all. It is most reliable in the early cases 
which offer so much hope. 

4. Examination of the sputum by the microscope, a procedure of great 
service in the late cases but which does not help much in the early ones. It is 
desirable to have the diagnosis established before tubercle bacilli appear in the 
sputum. The cases which have fever, sweats, coughing, and spitting are late 
cases and easily diagnosed. 

To know, and to know early, is an absolute necessity if the consumptive is 
to get well. For knowing early there are two requisites : , First, to become 
suspicious just as soon as there is reasonable ground for it ; a sense of mental 
security not based on physical facts is a delusion which inevitably leads into 
situations from which there are no escapes. Second, a careful, comprehensive 
examination. 



84 



CONSUMPTION 



HOW CAN A CONSUMPTIVE JUDGE OF PROGRESS? 



The signposts are temperature, pulse, weight, cough, and expectoration. 
The morning temperature is generally below 98, the afternoon temperature is 
above 99. When the temperature stays below 99 things are usually going 
nicely. When it goes over 100 the poisoning is getting beyond the system's 
carrying capacity and the patient's work must be lessened, his food and air 
increased. 

After a certain fashion the pulse indicates the progress of tuberculosis. 
The number of beats will mount up rather faster than does temperature. A 
patient who has fever and a rapid pulse can bring his temperature to normal 
much more easily than he can cause his pulse to slow up. A fast pulse will 
persist for weeks after temperature has become normal. 

When a person who is eating well 
and not worrying loses weight con- 
sumption is to be thought of, particu- 
larly if there is a cough which hangs 
•on. In the early stages of consump- 
tion if work is lessened and food in- 
creased properly the patient always 
gains in weight. If he is of the lean 
kind he will gain more slowly; if he 
is a good feeder he will gain more 
rapidly. The uniformity with which 
early stage consumptives gain flesh 
when properly fed is proof that any 
healthy person can get fat if he wants 
to. Of course thinking he wants to 
does not get him anywhere. 

When a consumptive gets to the 
point where he will not fatten even 
though he rests and feeds he is not doing well. In some cases the patient fat- 
tens even though his disease is progressing. In other cases the patients gain 
fat faster than their lungs improve. Nevertheless fattening and wasting are 
signs which indicate how the battle is going. 

Cough and expectoration are signs of value. Consumptives soon learn to 
cough little. A visitor to a consumptive hospital does not hear one-tenth the 
coughing that he does in a theater. The amount of expectoration is a more 
valuable sign than the cough. In measuring the sputum an average must be 
struck. A temporary nose cold or a temporary ordinary bronchitis will tempo- 
rarily increase the amount of sputum. 

Sweats, pallor, emaciation, diarrhea, indigestion mean that the fight is 
running strongly against the patient. 

Signs which the patient can notice in his chest are not of much service 
in determining how his disease is progressing. He should tell his physician 
of such sounds, pains, and unnatural feelings as he has observed, in order that 
the physician may interpret them. The results of physical examination of 




•5D0NT- GET -"RUM 'DOWr* • 

North Carolina Health Bulletin. 

Fig. 41. — To Avoid Consumption. 



WHAT THE CONSUMPTIVE SHOULD DO 85 

the lungs by the physician are not of the value in indicating progress of the 
disease that people generally believe. 

And, finally, conclusions must not be drawn from observations of but a 
few days. Consumption is a disease which goes by "fits and starts." Each 
case calls for careful, close study. Each case needs to lean on a master mind. 



WHAT THE CONSUMPTIVE SHOULD DO 

It is most important that he should eat enough food. It should be of the 
proper kinds. A standard day's ration should consist of : 

Meat 6 ounces 

Milk 4 pints 

Eggs 2 

Cereal 1 plateful 

Bread 8 ounces 

Butter 2 ounces 

Potatoes 4 ounces 

Pudding 1 helping 

Apples or oranges 2 

Lemon, or juice of 1 

Spinach, cauliflower, lentils, peas, and beans may take the place of po- 
tatoes. Nuts may take the place of some of the butter. Honey and sugar may 
be taken freely, providing these articles do not disturb the digestion. 

Some people can profitably increase the above quantities about 50 per 
cent. A few people can double them. Some will do better if they decrease 
them 20 per cent. 

The winter diet should have more fats than that of summer. There 
should be four meals a day. The food should be eaten slowly and be well 
chewed. The mouth and teeth should be cleaned before and after eating. 

He should sleep at least nine hours of the twenty-four. He should sleep 
on a sleeping porch properly protected against rain and snow. If he sleeps in 
a room the temperature must not go higher than 45°. The window must be 
wide open, for it is more difficult to get air into a cold room than into a 
warm one. 

In order to keep warm he must have a paper blanket between the mat- 
tresses and another between the quilts which cover him. He must have a 
woolen nightcap, woolen mitts, a long woolen bathrobe, and slippers made of 
soft sheepskin tanned with the wool on them. 

Under no circumstances must he work over six hours a day. A fair 
number of cases can work four hours a day, many can work two hours, many 
must sit out in the sunshine and air all day without working. No whisky 
or other stimulants should be used. No cough medicine nor any other medi- 
cine should be taken except as a physician directs. 

No case should be without medical direction. The proper way, in con- 
sumption, is to have a physician call at stated intervals, study the history, 
and direct the method of living. A detailed history of the case and the house- 
hold happenings should be kept by a trained nurse or by a member of the 



86 



CONSUMPTION 



family. When a case is being cared for by the family, a nurse should call in 

at intervals. 

In Chicago it is estimated that there are 15,000 people with tuberculosis. 

In 10,000 of them the disease has progressed far enough so that they know 

they are tubercular. Less than 1,000 are in hospitals and sanitariums. 

There are 9,000 people in this 
community who have a close per- 
sonal interest in knowing what to 
do at home. From these 9,000 about 
5,000 persons contract the disease 
each year. They, too, are interested. 
This makes a total of 14,000 per- 
sons who have a direct personal in- 
terest in knowing what a consump- 
tive should do in the way of eating, 
sleeping, and resting. These are 
about one one-hundred-and-sixtieth 
of the total population. 

Sanitariums and hospitals do 
magnificent work, but the great ma- 
jority of consumptives are cared for 
in homes, are nursed in the main by 
members of their families, and cared 
for by family physicians. 

There is a general agreement 
that the treatment of a consumptive 
must not stop with the arrest of the 
disease. The patient must be got 
back into social and industrial life. 
Cabot tells us that men live by work 
in more senses than one; that a 

sanitarium that does not lead back into life is a blind pocket; its statistics 

of cures do not stand when the cases are looked up ten years after they have 

left the institution. The report of the social service department of Indiana 

university says: 

"Once interest a patient in his own condition and problem and give him 

hope, and he will go further than anyone else, according to his ability, toward 

solving that problem." 




Fig. 



42. — Cut of Window Tent Showing 
Ventilation. 



CHASING THE CURE IN THE CLOUDS 



In the cure of consumption, climate counts for 15 per cent. If we take 
two men with the same degree of infection, having about the same capacity 
for resisting the disease, having about the same amount of money to provide 
rest and open air treatment, submitting themselves to the same degree of con- 
trol, the man who is in Colorado will stand a 15 per cent better chance than 
the man in Illinois. 

If the one goes to Colorado without money and takes his chances in the 



CHASING THE CURE IN THE CLOUDS 



87 



catch as catch can of what is called ranching it, he will lose more than 15 per 
cent of his chance, and therefore Colorado will net a loss for him. 

As so many of the people who chase the cure in the West plunge foolishly 
into the venture it is probable that the real value of climate is under 15 per 
cent rather than over 15 per cent. 

How does climate work the cure? Probably some part of it is due to 
sunny days, low air humidity, dry soil, and slow winds. Each of these agencies 




—.Of •" — 



-i*f Sps-i/cc *>#". 



rX^mrrnrpr^ 








'•'-» 




1; 


i! 

i!' 




i! 

1! 


1 1 


ll 

— t ■*' ij 

;i 


\ 








!i! 


-Ji- 




i 


_ ..! i , 


-41 — 






L 




M 


-.»•-♦-= — 


-j&. — 






• *-°>" — ■# 




Fig. 43. — Building Plan for Sleeping Porch 



of good have been written about until everybody knows of them. Recently 
scientists have been trying to discover whether altitude of itself is of advan- 
tage, and if so, how. 

In 1911 some scientists from Oxford, England, and one from Yale con- 
ducted some studies on mountain sickness on Pike's Peak. Incidentally they 
discovered that at high altitudes the blood is richer than at sea level, and that 
a certain blood cell called the lymphocyte is increased in numbers. 

Before Metchnikoff began to study men he was known as a great zoologist. 
He was especially learned in the ways of animalculae, the microscopic animals 
which the boil-the-water film at the moving-picture shows as crossing the cur- 
tain and eating up everything within reach. 

When Metchnikoff took up the study of men he found in his blood small 
cells called leukocytes. Most of these leukocytes are called polynuclears, be- 



88 CONSUMPTION 

cause they have several nuclei. These polynuclear leukocytes move around like 
the animalculae at the picture show and eat up all the germs in reach. 

Among these active, rustling, hungry polynuclears are certain quiet leuko- 
cytes with but a single nucleus. These were called lymphocytes. 

The tubercle bacillus is an armored knight, as truly armored as the 
knights of the middle ages. Its armor is wax. But wax to a polynuclear leuko- 
cyte is as impenetrable as iron. 

Therefore, although in pneumonia, appendicitis, and many other kinds of 
infection the white cells jump from the normal 5,000 to 20,000 or more, and 
the polynuclears jump from the normal, 60 per cent about, to 80 per cent 
about, in consumption there is no considerable increase in the number of leuko- 
cytes, and the polynuclears actually decrease in percentage. 

However, it has been found that the quieter mononuclear leukocytes called 
lymphocytes can eat the wax out of the consumptive germ, and then proceed 
to kill it. The investigators above referred to found that at high altitudes 
the percentage of lymphocytes was increased. 

Bunting at Madison, Wisconsin, found that the sturdy students of Wis- 
consin university had 42 per cent of lymphocytes among their leukocytes. 
Harvard students had 37, and Colorado college 52. Webb at Colorado Springs 
found that children had 60 per cent and adults 14. 

The visiting scientists found that each cubic centimeter of blood normally 
had 2,200 lymphocytes, and that on Pike's peak this rose rapidly to 4,100, and 
then settled back to 3,300, where it remained. 

In plainer words, altitude increases the number of those blood cells which 
are the best fighters of the consumption germ We have — an additional factor in 
that 15 per cent. 

CURE OP TUBERCULOSIS 

Our present cure of tuberculosis is a four-legged stool. One leg is rest, the 
second control, the third food, and the fourth fresh air. 

The object of rest is that all of the energies of the body may be available 
for combat with the disease. a 

The need of control rests on many factors. The fight is to be trying. 
Backbone will be required. Nobody gets well except the fighting men. Op- 
timism is needed — optimism savored with sanity. Quiet courage is needed. 
Persistent, dogged determination is a requisite. Earely does any man alone 
and of himself measure up to these demands. The control must help to make 
backbone. And then the waters are beset with rocks and skilled piloting is 
required. 

The need of an excess of food is that resistance may be heightened. In 
addition, tuberculosis bears a peculiar relation to nutrition. The neglected 
consumptive falls off out of all proportion to the disturbance of his digestion. 

Fat people have always had a partial immunity towards it. Since the 
start of things man has somehow sensed the idea that oils and fats were helpful 
in curing the disease. In addition to the general increase of resistance from 
full eating consumption seems peculiarly responsive to a good food intake. 

The need of air comes from the gain of breathing pure air as compared 
with the breathing of foul air. We would expect neither a sick nor a well 



WHERE SHALL THE CONSUMPTIVE GO? 89 

man to thrive on sewage as a drink. Neither can we expect men to thrive on 
sewer air, even though they have been trying to get accustomed to it for a long 
time. A further gain comes from the power of fresh cold air to absorb heat 
from the body. 

When all this volume of food is being burned into energy and resistance 
an excess of heat is made. It must waste. If there is plenty of cold air in 
contact with the body it can be wasted to the air. If the air of the room is 
warm the chance to waste surplus heat disappears, the excess of food cannot be 
taken and resistance cannot be built up. 

Such are our only elements of cure. The whole makes up the only cure. 
The advertised cures — the patent medicines — are the rankest fakes and frauds. 
The wrappers and testimonials in the old days were tissues of falsehoods. The 
Shirley Law, passed on August 20, 1912, may force them to quit lying. Many 
of them depend upon opium and alcohol for the only effects which the patient 
could feel. They were, therefore, not only dopes but they were habit-breeding 
dopes. They were robbers, for they took the money of poor unfortunates on 
pretext of doing for them what they could not possibly do. 

One of the arguments in favor of the national insurance plan in operation 
in some parts of Europe is that it pulls the teeth of these fakes. The source of 
much of the abuse of Wiley and of the American Medical Association is that, 
in protecting the people by exposing these frauds, they have put a crimp in the 
gains of certain people. 



WHERE SHALL THE CONSUMPTIVE GO? 

So far as the average consumptive is concerned, he will have to stay at 
home. There is no other place for him. Ten years ago, someone, Osier, I 
think, said that 98 per cent of the consumptives must stay at home. Change 
of climate was available for only 2 per cent. The situation has improved in 
the last few years. 

Nearly every fraternal order now has a well regulated, well run sana- 
torium. One old line life insurance company, the Metropolitan, is building a 
consumption sanatorium, and before long the old line companies will follow 
the lead of the fraternals. Many of the trades are now doing relief work for 
their tuberculous members, and some part of the relief consists in organized 
machinery for caring for their consumptives who are chasing the cure. The 
printers have their own home and, I dare say, other trades also have equipped 
homes. The Y. M. C. A. has its tuberculosis camp at Denver and the Jews 
have their hospitals. 

An organization of medical men in the West has expressed violent objec- 
tion to having that section made a dumping ground for consumptives without 
strength to work and without resources to sustain them without work. The 
Rocky Mountain Public Health Association recently estimated that 11,000 of 
the 12,775 consumptives in Colorado were citizens of other states. Therefore, 
133-134ths of the financial burden on Colorado for consumption is properly 
chargeable to other states. From the standpoint of the individual, it is the 
height of folly for a consumptive to go away from home unless he has resources 
enough to curry him without work in his new home, 



90 



CONSUMPTION 



In changing climate the individual must be studied from every stand- 
point. People from northern Europe and the northern United States, accord- 
ing to Knopf, do best in Colorado. The people who come from the sunny 
parts of America and Europe do best in New Mexico, Arizona, California, and 
North Carolina. Observers have noticed that Europeans generally do best 
when they go back home — e. g., the Irish to Ireland. Bone tuberculosis, gland 
tuberculosis, and tuberculosis in children generally do best at or near the sea 
shore. Lung tuberculosis does best in the mountains. Moist tuberculosis — ■ 





MEAN RAINFALL (in inckes & by seasons) FOR 
DIFFERENT PARTS OF THE UNITED STATES. 


• • place: • 


•WINTER 


■ SPRING 


•SUMMER- 


•FALL.- 


SARANAC LAKE, NY 


J4" 


7.8" 


11 b' 


3.8" 


PHILADELPHIA, PA. 


_q.?_ 


1.5" 


11. V 


«LS" 


ASHEVILLE, N.C. 


JjJ__ 


,U * 


ia.c" 


S_2.'^_ 




AIKEN, S.C. 


JLV 


■H^^a 


155 


JOS" 


COLORADO SPRINCS.COL 


0.8" 


4.5" 


7.0" 


2.0' 


ALBUQUERQUE, N.M. 


1 0" 

■ 


13" 

■ 


3.4" 


IS' 

m 


SANTEFE, N.M. 


2.0" 


k. 


fe I' 


3.3" 


PRESCOTT, N.M. 


4.5* 
Em 


2 8" 

in 


5.3" 


3.0* 


PHOENIX, ARIZ. 


2.2" 


F~ 


JP" 


i 7 " 


YUMA, ARIZ. 


I 


,0 4- 


0.4* 


O.fc* 

■ 


LOS ANGELES , CAL. 


_8_q" 


4.5" 


o.r 


Z.J" 


SAN DIEGO, CAL. 


5.4" 


2 4' 


3" 


L3" 

I 







Fig. 44. 



tuberculosis with sputum — does best in a dry climate, one, however, where 
there is not too much wind and dust. 

If a patient is sanguine, cheerful, and bright he will stand a change of 
climate well. If he is morose and Irypochondriacal or given to homesickness, 
he will not stand going away well. Generally, patients with heart trouble or 
great nervous tension or tendency to hemorrhage do not stand elevations well. 
Less than 7,000 feet does not seem to make any difference. 



CLIMATE AND CONSUMPTION 



The climate of Colorado, western Texas, New Mexico, and Arizona is 
without equal for tuberculosis. The weather reports for the last twenty years 
show that San Antonio has a yearly average of 99 cloudy days; El Paso, 36, 



CLIMATE AND CONSUMPTION 91 

and New Mexican points about the same number. The daily mean humidity 
at San Antonio is 67.5 ; that at El Paso, 40, and that at some points in New 
Mexico and Arizona lower still. The average rainfall at San Antonio is 
twenty-six inches ; at El Paso, nine inches, and at Albuquerque, eight inches. 

However, the trouble about the matter is that the average man does not 
know what climate can and what it cannot do for a consumptive. More than 
half the consumptives who travel to these resort regions would have been 
better off, more comfortable, more contented, and would have had a better 
chance to live had they stayed at home. 

Dr. Sweet of the Public Health Service estimates that there are 30,000 
consumptives in western Texas alone and that there are 27,000 in New Mexico. 
Many of these are entirely well. Many are on the road to recovery. But, un- 
fortunately, a large number are there without funds or income wandering 
around from place to place. 

Ten years ago more than 50 per cent of the consumptives dying in El 
Paso, Texas, had been in the region less than six months, and 20 per cent had 
been there less than a month. In 1913 the figures were 22 per cent and 8 
per cent respectively. In Albuquerque, New Mexico, in 1913 the figures were 
still 42 per cent and 13 per cent respectively. 

In El Paso the length of residence there of the 2,791 consumptives who 
had died there during ten years was divided as follows: Under thirty days, 
11.5 per cent; thirty days to six months, 19 per cent; six to twelve months, 
8.3 per cent; one to two years, 7.9 per cent; two to five years, 12 per cent; five 
to ten years, 5.6 per cent. The percentages for Albuquerque were similar. 

Of 1,775 bodies of consumptives shipped out of western Texas, 225 went 
to Illinois; 217, to Missouri; 131, to Ohio, 32 per cent of the whole. Add to 
these the numbers from Kentucky, New York, Tennessee, and Mississippi and 
we get more than 900 — over 50 per cent of the whole. 

The normal consumption death rate of a well regulated community is 
around 140 per 100,000. The mean death rate of Albuquerque from consump- 
tion for ten years past has been 1,404.6 — about ten times the normal; that of 
El Paso, 788.7; Asheville, North Carolina, 672.9; Colorado Springs, 607.6; 
San Antonio, 449 ; Denver, 372 ; San Diego, 324, and Los Angeles, 299.8. 

The reason for these high rates is because each year Albuquerque receives 
something over 2,000 consumptives from outside its state; El Paso, nearly 
3,000, and San Antonio, 3,500. But 7.8 per cent of the consumptives dying in 
Albuquerque were born in New Mexico. But 12.1 per cent of the consumptives 
dying in El Paso were born in Texas. 

Furthermore, a very large proportion of those traveling about in trains in 
the health resort region are in the last stages of the disease, and a fair pro- 
portion of those on the through trains entering the resort region are very far 
advanced cases. 

The lessons are two. First, very advanced cases should stay at home. 
The chance of cure is very slight. The chance of accidents on the road is not 
to be overlooked. The sick must see that going away is bad judgment. 

The second lesson is that the climate cannot cure unless it has a fair 
chance. Wandering around from place to place does not help. Restlessness is 
a serious handicap. The best chance lies in settling down in one place, getting 
into the hands of well-equipped physicians and nurses and obeying orders. 



92 



CONSUMPTION 



CARE OF CONSUMPTIVES 




Fig. 45. — Sputum Cup. 



Custodial care of consumptives is better than no care at all ; curative care 
is, of course, better ; and best of all is prevention. So much for the standpoint 
of the sick person. From the standpoint of the community, custodial care is 
best. 

Consumption is generally contracted through continuous, close, personal 
contact. Air infection and milk infection are of consequence, but continuous 
contact infection leads all the rest. It is in the home that the conditions of 

close, continuous, personal contact are most fre- 
quently found. Therefore the most important 
consideration is to get consumptives from their 
families into the hospitals, where they will have 
custodial care. 

A French physician has recently investi- 
gated 500 consumptives, with a view of discover- 
ing whether susceptibility to the disease is in- 
herited. The conclusion at which he arrived is 
that a case in the family increases the tendency 
to the disease to at least the second generation. 
Communities should have hospitals for late 
cases. Many of them have seen this need; 
many of them have not acted on this need be- 
cause, somehow or other, such hospitals are usually filled up with tramps, 
hobos, homeless men, casual workers, aliens, and such people. The family 
man or woman, the home man, the steady worker, the people who made up 
the steady, day in and day out citizenship, would not go to such hospitals. 
The home, the family, and the factory took care of the citizen until pretty 
near the end. In the meanwhile he was endangering his children and his 
*benchmates. In the light of what the Frenchman quoted above tells us, it 
is, above all, necessary to protect the parents. The homeless men and women 
are rarely parents. 

The remedy? To provide care in the hospital for late cases so humane 
and comfortable that the man with a home will voluntarily go there and stay 
there. To equip consumption hospitals as well as general hospitals are 
equipped with nurses, physicians, instruments, and laboratories. To provide 
open air treatment for suitable cases. To furnish good food and enough of 
heat for comfort. To locate them in the city and reachable within one hour 
and by a 5-cent fare from the homes that they draw from. In a word, to draw 
patients from their homes because they are more comfortable, happier, and 
more hopeful in the hospital than elsewhere. By persuasion rather than by 
compulsion will the family be protected against its dangerous members. 



NIGHT CAMPS FOR CONSUMPTIVES 



An interesting report on the work of the New York Night Camp has 
been made to the New York State Medical Society. 



TUBEKOULOSIS DAY 93 

A night camp is a place where a consumptive, still able to work, can get 
his dinner, his lodging, and his breakfast. The food furnished is even better 
and more abundant than that of a consumptive sanitarium. He sleeps out of 
doors on a sleeping porch or in a room where out-of-doors conditions prevail. 
In a word, a right-at-home sanitarium. 

The people who need night camps are early stage consumptives who must 
keep at work, who cannot go away, and who cannot get proper food, sleeping 
arrangements, ventilation, or nursing in their homes. As they are working 
during the day, they cannot make use of a night camp unless it is conveni- 
ently located. 

The night camp idea has been tried before. It must have been eight 
years ago that Miss Addams tried to interest someone to give about $2,000 to 
inaugurate such a camp to be maintained particularly for working women 
living in the neighborhood of Hull House. She did not succeed. Perhaps the 
time was not ripe. Our minds were then running on sanitariums located off 
somewhere. At any rate, Chicago lost its chance to be early in the field. 



TUBERCULOSIS DAY 

The custom of setting aside certain days as saints' days is older than our 
country and much broader. On such days everybody who can, stops work 
and gives over the day to the customary observance. The money cost of these 
days is enormous, and yet willingly we pay the cost. 

Tuberculosis day is a new sort of a day. On the other days we do honor 
to the memory of some dead and gone servant of the common good. Tubercu- 
losis day is the season when we pledge ourselves anew to a growing movement 
— the movement to end consumption. 

Consumption is decreasing — that much is certain. The figures show the 
disease to be on the decrease. It is plain, though there is no way to show, 
that the decrease is in those parts of the country where the interest in the fight 
is most general. Furthermore, the decrease is in proportion to the interest. 
In those places where the people think they have no consumption problem and 
where they are not joining in the crusade, the disease is on the increase. 

Consumption slipped up on us while we were not watching. While we 
were busy with the work of everyday life it was quietly eating away like a 
moth in a chest. The remedy is to get busy. It is not the custom for 
90,000,000 people to get busy in a hurry. We must first talk about it. 

The first year you talk about it a few see the point and get busy. The 
crusade is begun. The next Tuberculosis Day starts a few more. After a 
while the employers of labor see where they are putting the moth in the chest, 
and they get busy. 

The next year the woman who keeps the windows nailed down and the 
children sewed up from fall until spring sees where she has put the moth in 
the chest and gets busy. Maybe the next year it's the taxpayer who sees that 
caring for consumptives is the cheapest way, and he gets busy. Maybe next 
year it's the spitter, and he gets busy by being careful. 

The consumption fight is being won. The number of deaths from the 
disease in the active centers of the fight is less than the number ten years ago. 



94 CONSUMPTION 

It takes three years for results to show. Our only way of judging is by vital 
statistics. The disease lasts nearly three years. Therefore, judge your 1914 
and 1915 activities by your 1916 consumption death rate. 

The fight is being won. Tuberculosis Day is helping to win it. A day 
that is contributed to giving battle is worth while. No feast day, national 
birthday, or great battle anniversary celebration is better worth while. 



CAPTAIN RAOUL'S EXAMPLE 

. For many years Captain W. G. Eaoul was president of a railroad in 
Mexico. When the railroads of the republic were taken over by a new com- 
bination Captain Eaoul returned to his old home in Georgia. 

The captain found himself in a position in which many most capable 
men have found themselves, and many others will find themselves. He was too 
old for the aggressive work of managing a great corporation. The competitive 
basis of that work did not fit this man, well on toward the evening of life. 

He might have returned to the home of his early years and led a life of 
ease, but he preferred to take another course. He had a few more fights in 
him. 

The fight against consumption was to his liking. He was no longer a 
two minute horse, but the tuberculosis fight is in the three minute class, and 
he felt able to hold his own in that class. He became an officer in the tubercu- 
losis organization and fought for a sanitarium. The sanitarium secured, he 
became one of its officers. Instead of rustfng out he worked to overcome con- 
sumption until he died. 

I do not know why he became interested. He may have had some per- 
sonal interest in consumption, or his interest may have been on the grounds of 
general welfare. Whatever was the cause the example was of the best. 

Why will not that group of men who are too much worn out for the hard 
strife of the severest competition give to great philanthropic and economic 
enterprises out of the abundance of their trained judgment and executive 
ability ? 

When Captain EaouFs will was read it was found that he had left $50,000 
for anti-tuberculosis work in Georgia. The first expenditure of the income 
from this bequest has been used for a state tuberculosis survey. 

It is usually difficult for legislatures to decide what to do because of lack 
of information. The idea prevails rather generally that consumption is a dis- 
ease of cities only. Many people think because not everybody has consumption 
that nobody has it. 

When we say that the consumption death rate is 170 for each 100,000 
people it does not mean anything to a man who lives in a sparsely settled 
country and never saw two hundred people assembled. 

Tuberculosis surveys are just as necessary for community life as taking 
stock is for a merchant. The Illinois Federation of Women's Clubs has com- 
pleted a tuberculosis survey of Illinois. Wisconsin has been making surveys 
through its State Tuberculosis Society for several years. Most states are in 
the dark as to tuberculosis conditions among their people. Perhaps here, too, 
Captain EaouFs excellent example will be followed. 



THE CONSUMPTIVE NURSE 



95 



THE CONSUMPTIVE NURSE 

Is it safe to have a tuberculous nurse care for your baby? Is it safe to 
liave your baby cared for by a nurse that you do not know to be free from 
contagion ? 

One year a New York infant asylum employed a nurse in May. She had 




Chicago State Board of Health. 

Fig. 46. — To Fold a Paper Drinking Cup. 



been in a tuberculosis sanitarium during the previous winter, but the asylum 
authorities did not know it. 

In June they noticed that the nurse was sick with a cold. About July first 
they found that she had tuberculosis, whereupon they removed her. 

She had cared for ten children for six weeks. During this time many of 
these children had had some digestive trouble, and, in consequence, the nurse 
had given extra attention to the bottles and nipples. 

In this asylum all the children are fed on pasteurized milk. These chil- 



CONSUMPTION 



dren came in contact with no outside people. It was possible to eliminate 
every source of infection except the nurse. 

Now, what were the results of these exposures ? 

In April all of the children were tested for tuberculosis by the skin 
tuberculin test. Three reacted. In July they were all tested again. The 
same three reacted ; the others did not. 

In October they were tested again and all reacted. In January of this 
year all of them reacted. The nurse had infected the seven previously unin- 
fected children. 

In the meanwhile the other children in the asylum did not develop 
tuberculosis. Those that showed reaction when 
they first came continued to show it, but no new 
cases reacted. None developed the disease ex- 
cept the babies cared for by this nurse. None of 
the children was extremely sick. Apparently 
each of them will completely encapsulate his 
tubercular focus, and these foci may break out 
in later life, or they may be permanently walled 
off. 

Had this nurse cared for these babies for 
six months instead of six weeks, the story might 
have been different. The dose of tubercle bacilli 
might have been so large as to have caused an 
acute, progressive infection instead of the walled 
off patches, such as they clearly have. 

This thing of resisting the disease does not 
seem to mean that we can prevent it from get- 
ting a foothold. Every one of the exposed babies 
was infected. What it means is that the re- 
sistant person will be able to wall it off with a 
fair chance that it will stay walled off. 

Of course, it is unfortunate that this experience occurred, but if it will 
make mothers more careful of the health of the nurses to whom they intrust 
their babies it will do more than enough good to compensate. 




Fig. 



47. — Pocket 
Cup. 



Sputum 



Tuberculosis. — T. H. G. writes: "1. Why is it that tuberculosis so 
often follows typhoid fever? 2. Isn't it a fact that more people are attached 
with tuberculosis between the ages of 25 and 30 than at any other period? 
3. Why is it that the tubercle bacilli hover so conveniently and success- 
fully near people of that age? -4- Why is it that in proportion to the popu- 
lation there is as much tuberculosis in the country as in the city?" 

Reply. — 1. It does not. Nearly always, when consumption is supposed 
to follow typhoid, the case was consumption from the start. There are a 
few exceptions. Consumption after typhoid is rare. 

2. Yes. 

3. The health between 20 and 30 averages the very best. There is 
almost no death rate from any disease except consumption in those years. 
Susceptibility to disease in general in those years is at its lowest. 

4. The city consumption rate is higher than that in the country because 
of more consumption contagion, poorer houses, and poorer hygiene. The 



THE CONSUMPTIVE NURSE 97 

city rate is falling and the country rate is not. Before many years, the 
statement on which you base your fourth question may be true. 

Tuberculosis of the Spine. — G. D. F. writes: "Please tell me the symp- 
toms of tuberculosis of the spine and how it affects the patient. Also the 
cause and how it should be treated/" 

Reply. — The most prominent symptom is pain. The pain being due to 
the pressure on the nerves, it may be felt some distance away, down the 
leg, where it may be called sciatica, or in the abdomen, for instance. The 
muscles near the affected bones are held rigid. As jarring increases the 
pain, the muscles try to protect the sore bone. Later the spine twists. It 
may show a knuckle over the affected vertebra. There may be fever. 
X-ray shows the diseased bone, the deformity, and the abscess, when there 
is one. A keen diagnostician catches the disease before there is much 
deformity. A careless one treats the disease as rheumatism or sciatica for 
a long time. The cause is infection with the tubercle bacillus — frequently 
through milk. The treatment is rest in bed for a while; then proper 
braces, tonics, forced feeding, out-of-door life, tuberculin. 

Curvature of the Spine. — I. M. writes: "I have a daughter 15V2 years 
old, whose spine has become crooked in the last two years, the right side 
bulging out under the arm, and the reverse on the left side. I have been 
sending her to a gymnasium, but without result, and it is becoming worse. 
A year ago she weighed lOlf- pounds and now but ninety-five pounds, and I 
fear she is becoming tubercular. Where in Chicago could I get a free, 
reliable diagnosis of her case, as our financial circumstances prohibit a 
specialist? 

"Do you consider the wearing of appliances beneficial for crooked 
spines, or will it cramp other organs so as to do more harm than good?" 

Reply. — Your child has been tuberculous for more than two years. The 
disease was breaking down some part of a bone in her spinal column before 
her back began to bend. She probably got it from tuberculous milk which 
she drank about three years ago. She probably will have to go to bed for 
a while and then she can put on proper appliances. These appliances will 
straighten out some of the curve and in that way lessen the "cramping of 
the other organs." A crooked back cramps organs. Go to any orthopedic 
clinic. Find out what days the clinic is running and then bring her in. 
They will find a place in a hospital for her. 

Curvature of Spine Causes. — G. A. writes: "I am a man 25 years of 
age. Kindly advise me of the cause of curvature of the spine. I have never 
been able to find out the cause of the deformity." 

Reply. — There are several causes. 

1. A frequent cause is tuberculosis of one or more bones of the spine. 
The bacilli are taken in with the food — usually milk. 

2. Old infections outside the bones of the spine, but producing heavy 
scar tissue which pulls the spine out of line ; for instance, an old pleurisy. 

3. Habits, position of body while at work or at the school desk. 

4. Infection of the joints between the bones of the spine; for example, 
rheumatoid arthritis. 

Curvature of the Spine. — A. J. writes: "I am a woman about 28 years 
old. I have curvature of the spine, caused by a fall when I was 6 years old, 
but have never been sick a day from it. 1. Wont it be wrong for me to 



98 CONSUMPTION 

marry f 2. Would my children necessarily have curvature? 3. Is there 
danger of me getting tuberculosis?" 

Reply. — 1. That is a matter for you and your affianced to decide. A 
physician can tell you whether your curvature would prevent you from 
bearing living children. 

2. No. Practically, they would be as liable to tuberculosis of the spine 
(the cause of curvature) as other children and no more so. 

3. You are about in the same average danger as women of 28. Intrin- 
sically your danger is a little above the average but, being apprehensive, 
you lead an above-the-average hygienic life. 

Ill Not Transmissible. — Constant Reader writes: "I am a young man 
not 27 years old. I think a great deal of a young woman of 20, but she has 
a curvature of the spine, so that one shoulder is quite prominent and her 
chest also somewhat out of position. Will it be safe for me to marry her? 
Would our children be normal?" 

Reply. — If the deformity is considerable it is probably due to tubercu- 
losis, caused by drinking milk from tuberculous cows. If so, it is not 
transmissible; her children will not inherit it. 

If the deformity is slight it may be due to sitting habitually in a 
cramped position. If so, it is not transmissible; her children will not 
inherit it. 

If the curvature is limited to the region of the chest it will not inter- 
fere with child bearing. Frequently, however, a curve high up is accom- 
panied by a countercurve lower down. Would the young woman be willing 
to have her physician pass on these points ? 

Consumption in Diabetes. — 0. 0. A. writes: "I have read quite a num- 
ber of your articles on the subject of tuberculosis. The only thing ever 
mentioned as incurable is the third stage. Nothing is ever said as regards 
tuberculosis following diabetes and the hopelessness of such a case, or the 
following of tuberculosis after any other serious illness and what might 
be done. It is true people who have only tuberculosis, if action be taken 
early, can be helped a great deal and perhaps cured. But what of the 
patient who has diabetes or one who has had pneumonia, and tuberculosis 
begins to set in? What care should he have? Why not have this informa- 
tion published as well as the other? What is to be said of the patient who 
has fistulas?" 

Reply. — I am sorry that you have not found what you want in the 
articles. As I understand it, you seek answers to three questions : 

1. What is the outlook when a diabetic contracts consumption ? A. — It 
is exceedingly bad. 

2. What is the outlook of the man who has pneumonia and later de- 
velops consumption, and what should be done for him ? A. — If his supposed 
case of pneumonia be pneumonia, he has the same chance as a man who 
develops consumption in the ordinary way. Many cases of pneumonia that 
"run into consumption" are really cases of acute or galloping consumption 
from the start. The outlook for these cases is poor. They must go to 
bed, preferably in an institution, and take even stricter rest, open air, and 
feeding than the other consumptives. 

3. The consumptive who has fistula is practically in about the same 
position as other consumptives. His fistula should be cared for. It adds 
a little to the gravity of his case. 



THE CONSUMPTIVE NURSE 



99 



Tuberculosis in Animals. — J. K. H. writes: "You said recently that 
tuberculosis in the lower animals — cows, pigs, etc. — resembles that disease 
in man. The treatment prescribed for tuberculosis is in the main fresh 
air. Now, why do animals have this disease, when they live out of doors 
all the time?" 

Reply. — Cows that are on the range do not have tuberculosis to any 
appreciable extent. They have it in proportion as they are housed. Pigs 
have tuberculosis contracted through food. Most of their tuberculosis 
conies from drinking tubercular milk or eating tubercular germs from cows. 



Will you please tell me 



Symptoms of Consumption. — A. F. writes: " 
what are the symptoms of consumption?" 

Reply. 

A. Very early: 

1. Low temperature in the morning. 

2. Slight fever in the afternoon. 

3. Loss of weight. 

4. Slight cough, persisting. 

5. History of exposure to person with consump- 
tion. 

6. Reaction to tuberculin. 

B. Early : 

1. Low temperature in the morning. 

2. Fever in the afternoon. 

3. Loss of weight. 

4. Persisting cough and sputum. 

5. Sometimes tubercle bacilli in sputum. 

6. Signs on physical examination. 

7. Reaction to tuberculin. 

C. Later : 

1. Fever. 

2. Cough. 

3. Sputum containing bacilli. 

4. Physical signs. 

5. Loss in weight. 

Diagnosis should always be made before bacilli appear in the sputum. 
Late diagnosis makes cure impossible for any except the better-to-do. 

Consumption and Cough. — J. P. S. writes: "Is it possible for one to 
have consumption without a cough. What is the difference between 
tuberculosis and consumption, or is there none?" 

Reply. — When the tubercle bacillus locates in the body it sets up a 
disease called tuberculosis. If it has located in the lungs the disease is 
called lung tuberculosis or pulmonary tuberculosis, or by the shorter term, 
consumption. 

When the tubercle bacillus locates in the lung small tumors begin to 
grow. When these nodules are small there is no cough. When they have 
grown large enough to press on the bronchial tubes cough starts. At first 
the cough is a slight hack. Nothing is coughed up. After a few days 
coughing raises a little. Some weeks or perhaps some months later it raises 
sputum containing bacilli. 

You see it is possible to have consumption a short while before the 
cough starts, but only for a short while. 




Fig. 48. — Respirator. 



100 CONSUMPTION 

Not Tuberculous Cough. — F. W. writes : "I have had a sort of chronic 
cough for the last year. I went to a prominent doctor and he told me as 
soon as the hot weather would arrive I should get rid of it by perspiring. 
I am perfectly well, weigh 215 pounds, and am gaining all the time. I 
sleep well, eat well — in fact, feel better now than I ever did before. Please 
advise me." 

Reply. — There are many causes for coughs. Tubercle infection is one. 
If you are gaining in weight, are feeling well, and your physician cannot 
find tuberculosis, put that cause out of your mind. 

Looks Like Tuberculosis. — E. R. S. writes: "Last spring I had my 
tonsils removed. I caught a heavy cold and doctored it myself. Now I 
cough slightly. The lymph glands were much swollen, but are ordinary 
now. But I have a swelling of the thyroid gland. My temperature rises 
in the afternoon. I lose my voice also. My doctor says there is no con- 
sumption. I have leukorrhea. Do you think that weakness causes other 
faults?" 

Reply. — An afternoon fever, a slight cough, and some disposition to 
loss of voice suggests tuberculosis. Have at least one more examination 
for tuberculosis. 

The physician examining will advise you about your thyroid. Not 
much can be done to prevent the thyroid from swelling. 

Leukorrhea is not a source of weakness, nor does it result from weakness. 
It is the result of a local infection with any one of several bacteria. This 
infection usually is innocently acquired. It must be treated locally or by 
vaccines. Keep this clear: This condition does not cause constitutional 
weakness nor does it arise from constitutional weakness. 

Pains, Sputum, and Cure of Tuberculosis. — H. A. L. writes: "1. Bo 
tuberculosis pains of the lungs come in the back? 2. Is black sputum at 
times a sign of tuberculosis? 3. Is there any certain cure for tubercu- 
losis?" 

Reply. — 1. Pain as a sign of consumption is not of any value. People 
who think they have consumption because of pains in the chest are gen- 
erally mistaken in their diagnosis. 

2. The black color of some sputum is due to soot and dirt. People who 
think they have consumption because of black sputum are generally 
mistaken. 

3. No. Nothing is certain but death and taxes. If 100 people in the 
early stages of consumption change their methods of living and live right, 
75 will get well. If 100 people in the late stages of consumption change 
their methods of living and live right, eight or ten will get well. 

Preventing Consumption. — J. L. B. writes: "I wish you would tell us 
a few ways of prevention of consumption, such as exercise, foods, and 
tonic." 

Reply. — 1. Keep away from careless consumptives. 

2. Keep away from dusty working places. 

3. Keep out of ill-ventilated rooms. 

4. Do not neglect colds. 

5. Keep in the open air as much as possible. 

Many other preventive measures could be suggested, but these are the 
most important. 



THE CONSUMPTIVE NURSE 101 

Needs Medical Advice. — Inquirer writes: "I wish to know if a slow 
form of tuberculosis is curable. Should one have the lungs examined 
every three or four months? I am short of breath and seem to get choked 
up, so I have to take deep breaths to get air. I cough a kind of a short 
bronchial cough quite often and my limbs have a tired ache almost all 
the time. I am nervous and am troubled with insomnia sometimes. I have 
been told it is useless to go to a physician for examination, as there is 




Fig. 49. — Frame for Attached Sleeping Porch. (Carrington's " Fresh Air and 

How to Use It.") 

nothing to do but live in the air and sunshine and eat nourishing food. 
Please advise me what to do." 

Reply. — A fair percentage of cases of advanced tuberculosis get well. 
The person who told you that you did not need medical supervision gave 
you bad advice. You need advice as to how to live out of doors, what to 
eat and what not to eat, how to get sleep, how much or how little to 
exercise. 

Where one has a disease like malaria, he may cure himself by a course 
of quinin and may need no medical guidance. Where one has a disease such 
as tuberculosis, for which no specific is known, he must have a pilot. 

Enlargement of Glands. — Reader writes: "What treatment would you 
advise for children threatened with tuberculosis of the glands of the back 
of the neck? Is it contagious? We sleep with the windows open, but 
the children are in school, thus preventing them from being out. Do you 
think it necessary to give them any medicine aside from cream, milk, olive 
oil, and the necessary foods?" 



102 



CONSUMPTION 



Reply. — Enlargement of the glands of the neck may be due to tubercle 
bacilli or may be due to other bacteria. Unless they continue to absorb 
bacilli the enlargement can be expected to disappear. The condition is 
not contagious. The condition may be due to (1) dry, hot air in the school- 
room, (2) tubercular milk, (3) enlarged tonsils, (4) adenoids, (5) bad 
teeth, or several of these combined. 

The remedy is to pasteurize the milk, see that the schoolroom air 
is cooler or moister or else take the children out of school, put them 




In Hip Joint Disease the knee is drawn up when the back is straight. 




In Hip Joint Disease the back bows when the leg is straightened. 
Fig. 50. — Hip Joint Disease. 



in an open window school, see that the tonsils and teeth are put in 
good condition, see that the children play out of doors, give them 
meat, bread, vegetables, fruit, and milk in abundance. Olive oil has no 
advantage over milk and butter and probably they do not care for it. 

Tuberculosis of the Knee. — M. M. R. asks if any cases of tuberculosis 
in the knee joint have been cured without causing permanent stiffness. 
His trouble is of seven years' duration, and for three years he has been 
wearing a cast which keeps the limb from bending. The result is that 
there is little motion left. When it is no longer sore and weak he asks if 
it can be "broken" to produce a good range of motion. 

Reply. — If tuberculosis in the joint is discovered early there is a pos- 
sibility that it can be cured without permanent stiffness. After the disease 
has subsided, surgeons will be able to repair the injured joint and give a 
good range of motion. 

Tuberculous Sores. — Mrs. A. G. writes: "Kindly let me know if lupus 
of the nose of seven years' standing can be cured? Can a tuberculous sore 
of five years' standing on the face be cured?" 

Reply. — Lupus and tuberculous sores on the skin can be cured rather 
readily. Skin tuberculosis is about the mildest form of tuberculosis. If 
you will persist in proper care of your case under the direction of a com- 
petent physician, you will be cured. 

Advice to a Consumptive. — R. C. L. writes: "In the first stages of 
tuberculosis, where the patient has gained ten pounds weight and coughs 
very little, would it be advisable to come to Chicago in April, after spend- 
ing the winter in western Texas?" 

Reply. — No. 



THE CONSUMPTIVE NUESE 



103 



Menace to Neighbors. — Subscriber writes: "We have in our neighbor- 
hood a man who has had tuberculosis of the lungs for a year and a half. 
He has had several hemorrhages, yet he goes about the yards and gardens, 
his own and his neighbors', expectorating where he will, as well as all the 
way from his home to the station. Is not this a menace to the neighbor- 
hood? He also uses his handkerchief to expectorate into when in company 
indoors. These are sent out to be laundered. Is this right? After his 
eating at one's house 
should his dishes, etc., I . 1 S 3 

be boiled separately? 
If he persists in these 
things would it not be 
wise to cease visits, or 
is the risk not great?" 

Eeply. — 1. Yes, he 
is much of a menace 
to his family and 
something of a menace 
to the community. 

2. No; it unneces- 
sarily endangers those 
who work in the laun- 
dry. 

3. Yes. 

4. It would. 



Should Protect 
Girls.— H. F. W. 

writes: "In a home a 
block from my house 
lives a woman badly 
afflicted with tubercu- 
losis of the lungs. 




X" 

Fig. 51. — Window Ventilation: Lower Sash Raised, 
Upper Sash Lowered. Shade roller is placed several 
inches below top of window. Space between roller 
and top of window is covered by wire screening. (Car- 
rington's " Fresh Air and How to Use It.") 



There are several girls in the home. My 13-year-old boy is frequently in 
the home and often sits in the hammock with the girls. Is there any 
danger?" 

Eeply. — If the girls are well, no. If the girls are tuberculous, yes. 
Someone should see that proper effort is made to protect these girls. The 
chances are more than even that several of them will be found to be tuber- 
cular within two years from now. 

Night Sweats.— E. L. M. writes: "I have been having night sweats 
for the last two weeks. I had them about seven years ago. I do not drink 
liquor. I eat and sleep well. I have lost about ten pounds in the last two 
weeks. What would you advise me to do?" 

Eeply. — I should say, if you have lost ten pounds in two weeks, and 
are having night sweats, you should have a physician discover the cause. 
Night sweat by itself is of no special consequence, but taken in conjunction 
with rapid loss of flesh is suspicious. 

Consumption Cures. — G. E. 8. writes: "There are thousands of poor 
souls in the southwest, just hanging on to life in the hope that someone 
will find a cure for their terrible disease." He mentions a newspaper 



104 



CONSUMPTION 



article, which said that a man in England claimed a cure by inhaling the 
odor of putrid meat. He asks about a cure which consists of an injection 
into the veins. He says the same man has a cure for pneumonia, which 
consists of injecting something hypodermically. 

Reply. — We know nothing of this cure for consumption. If there is 
anything in it that fact will be demonstrated. This seems slow to those 
poor souls who are waiting for a cure, yet it is the way which experience 
has shown to be the only way. 

As a general proposition it can be stated that consumption cures are all 
worthless. Rest, feeding, and fresh air will cure all the early cases, about 
half of the moderately advanced cases, and a few of the late cases. The 
dry climate of the West will cure about 15 per cent of the cases which 




Fig. 52. — Rustic House for Sleeping Out. (Carrington's 

How to Use It.") 



Fresh Air and 



cannot be cured in this climate (Chicago), provided the cases are properly 
directed. Cases without money will do better at home than in the West. 

Tuberculin, properly used, adds about 25 per cent to the chance of 
getting the disease arrested and keeping it from recurring. Properly used 
it requires about six months to a year. Improperly used, it does more 
harm than good. 

The hospitals, sanitaria, and laboratories are filled with men who are 
working to find a cure for the late cases — those with cavities. In the 
meantime advertised cures are worse than useless. They do harm. Many 
of them contain opium. They prevent people from taking air, rest, and 
feeding. 

Tuberculin as a Cure for Consumption. — J. K. writes: "So much has 
teen written about vaccination against smallpox and typhoid that I think 
it about time to bring in the idea of the tuberculin vaccine or injection 
as it is properly called. 

"Now it is an understood fact that medicine taken into the stomach 
never cured tuberculosis; then we know that what a doctor prescribes is 
merely a tonic so as to build up the system and overcome the germs. 

"Now then the modern treatment of injection is to immunize the ailing 
hody to further attack and thus give the patient a chance to recover. Does 
this injection wear off in time? What chance has a person to recover 
from the disease? Is there a better treatment?" 



THE CONSUMPTIVE NURSE 105 

Reply. — Open air treatment of tuberculosis is the proper treatment, and 
you should not get the idea that tuberculin or any other serum will take its 
place. However, it is quite generally believed that tuberculin is a valuable 
aid to open air, and that by its use in connection with the open air treat- 
ment the chances of cure are materially improved. Trudeau has found 
that there is a further gain from using tuberculin in connection with the 
open air treatment, in that the people who have had their disease arrested 
are much more liable to remain well. The danger of a recurrence is greatly 
lessened. The estimate of the value of tuberculin is that it improves the 
chances of permanent cure about 18 to 25 per cent. It is not possible to 
get much advantage from the open air treatment without having good 
nursing and good medical supervision, and this is also true of the use of 
tuberculin. 

I am not able to answer your question as to how long the effect of 
immunizing with tuberculin lasts. It was found in the case of vaccination 
of calves that it was not permanent. 

The chance of a person recovering from consumption would depend 
upon several things. The most important thing is how early is his case. 
Early cases nearly all get well. As time goes on the chance of getting 
well decreases rapidly. 

Treatment of Tuberculosis. — H. A. J. writes: "What is the proper 
course of treatment, diet, etc., for pulmonary tuberculosis in an early 
stage?" 

Reply. — The three important factors in the treatment of tuberculosis 
are food, rest, and fresh air. Meat, eggs, and milk in generous quantities 
are the staple articles. Cream, butter, fish, bread, vegetables, and fruits are 
added. Raw lean meat, soaked in water for two hours and finely chopped, 
may be given. The process of overfeeding must be carefully watched and 
indigestion prevented. Rest is very important. Fresh air and plenty of 
sunshine are essential. Cases that require such treatment need careful 
medical supervision. 

Tuberculin Is of Value. — J. W. writes: "I am very much worried 
about my neck, which has been operated on seven times for tubercular 
glands. These operations occurred in the last six years. Now they are 
growing again on both sides. 

"I thought I would ask you if there is anything else which might 
help me. 

"Is tuberculin of any use in such a case, or would change of climate 
help? Otherwise my health is very good." 

Reply. — Tuberculin is of value. Change of climate is of value. But 
my suggestion is that you have your physician see if he cannot find where 
the bacilli get into your tissues — probably in your throat, possibly in your 
nose or mouth there is a place through which bacilli are entering to be 
stopped by the glands of your neck. You may say that the glands of your 
neck are the second gate. Cannot the first gate be found and attended to ? 
Do you drink nothing but boiled milk? 

Sun Better Than Sulphur. — Anxious Contributor writes: "Is there any 
danger of infection in sleeping on a spring and mattress that was used 
by a tubercular patient, if disinfected with ordinary sulphur candles?" 



10G CONSUMPTION 

Reply. — If the articles were properly disinfected there is no danger. 
In addition to the disinfection, sun them for several days. Several days' 
sunning will be as efficacious as steam disinfection and more so than 
sulphur. 

Medicines No Use. — A. F. T. writes: "What is the condition of a per- 
sons lungs described as fibroid? Does it mean the person has consump- 
tion? What ought he to do?" 

Reply. — The frame-work — the scaffolding of the body — is called fibrous 
tissue. Whenever the proper tissue of a part wears out this scaffold tissue 
replaces it. The organ in which there is too much fibrous tissue is said 
to be fibroid. 

A fibroid lung may result from slow, chronic consumption, one that 
has lasted five years or more. It may result from an old asthma or an old 
bronchitis. It is found in coal miners and others who breathe a great deal 
of dust. 

When you are told that your lungs are fibroid ask whether it is tuber- 
cular. If the condition is due to tuberculosis, it is advisable to move to a 
drier climate. If it is due to coal dust, change occupation. Medicines 
will not be of service. 

Why Consumptives Go West. — W. J. M. writes: "Is it not a fact that 
the Arabs of the Sahara Desert are among the most virile and longest- 
lived people in the ivorld? Is it not also true that mountaineers in all 
parts of the earth are exceptionally healthful? Now, we know that desert 
air is extremely dry, and that the air at high altitudes is much less humid 
on the average than it is at sea level. You recommend consumptives to 
seek high altitudes, 'preferably from 5,000 to 8,000 feet,' on account, as I 
suppose, of the low relative humidity. 

"What puzzles me is how you square these facts with your oft-repeated 
warning as to the injurious effects of dry air. Is it not possible that the 
bad physical conditions sometimes observed in persons who live in hot 
rooms in which the air is very dry may be caused solely by the heat and 
the lack of ventilation rather than by the dryness of the air? 

"I lived for many years in a house which was heated by hot air, the 
temperature being maintained constantly, night and day, throughout the 
winter, at 68 degrees. The air supply was direct from out of doors, no 
water was evaporated, and the humidity was always far below normal. 
Under these conditions my health and that of all the other members of my 
family was excellent. The supposed injurious effects of living in a dry 
atmosphere certainly failed to materialize in our case. How about it?" 

Reply. — Arizona atmospheric air does not have as low a humidity by 
odds as house air in Chicago in winter. When you live in Chicago in 
winter, part of the day you are outside, where the humidity is, say, 90, and 
part you are inside, where the humidity is 25. In Arizona the humidity is 
rather evenly near 50. Consumptives go West for: 

1. Humidity around 50. 

2. Maximum sunshine. 

3. Low precipitation. 

4. Clean air. 

5. Air low in bacteria, especially those which produce putrefaction. 

6. Elevation. 

7. Maximum possibility of being comfortable out of doors all of every 
day and night. 



:• \ 






Fig. 53. — Exercises Which Develop the Muscles or the Shoulders, Chest, Back and 

Abdomen. 



107 



108 CONSUMPTION 

The climate of the West is good for consumption; it is bad for other 
diseases and conditions. Low humidity is not the only benefit. In indoor 
air low humidity is not the only harmful quality. Not all people who 
breathe improper air die or get sick. If they did, Chicago would have been 
handed back to the Indians a long time ago. 

Advice on a Cure for Tuberculosis. — F. C. C. writes : "Kindly give me 
your opinion of the efficacy of the newly discovered 'deoraden in the treat- 
ment of tuberculosis." 

Reply. — You had better let it be tried on the other fellow. Consump- 
tion gets well so frequently under rest, food, and air, that many remedies 
claim to cure that do not. No treatment can be judged of fairly until it 
has been used on enough people to satisfy the law of averages. 

Going Away Question. — J. K. writes: "Some months ago I had a 
hemorrhage. I took twelve treatments of tuberculin, and am now contem- 
plating going to northwestern Texas or farther south into New Mexico, 
where the climate is milder and the altitude greater. I have had no hemor- 
rhages since the first and have increased twelve pounds in weight. My 
occupation is that of bookkeeper. An examination previous to taking the 
treatment showed bacilli. Would a warmer climate of the same altitude 
be better than one subject to 'northers,' as Amarillo, Texas? If sputum 
shows bacilli at this time how soon should I take the second treatment of 
tuberculin? If I remain in Texas or New Mexico until May next could I 
with safety return to Chicago if I am of usual weight and apparently 
cured? Does the fact that I have regained my usual weight indicate that 
I have no tubercular germs?" 

Reply. — 1. Amarillo, Texas, is a good place for a consumptive, but 
Arizona, or New Mexico, or Colorado is somewhat better. Do not try for 
a warm climate. Avoid places subject to "northers." 

2. The presence or absence of tubercle bacilli does not determine the 
question. The proper method of treatment is to give it in slowly increasing 
doses about once a week, or at most twice, and to keep it up until about 
five drops of straight tuberculin cause no reaction. 

3. If you have had bacilli in your sputum for several months, there is 
no probability that you can return to the city by spring. In fact, this third 
question is the key to the situation. I feel quite certain you are making a 
mistake in going away. He who goes away counting the months until he 
can return is not liable to return alive. There is some advantage in going 
to a better climate, but it is only for those who have money enough to 
sustain themselves without work for a year or more, for those who will not 
become homesick, for those who will go into a sanitarium or under the best 
of control. 

4. No. 

May Be Curable Consumption. — V. L. writes : "Kindly tell me whether 
a morning temperature of 97.1). to 98 degrees is unusual. The afternoon 
temperature is about 98 degrees, but has times of running to 99.k or 
99.6 degrees. The person has a good color and seems well. She is free 
from heavy colds, but seems to have a slight cold constantly, and is subject 
to headaches that sometimes last three weeks. She is rather chilly in the 
morning and very suddenly becomes extremely tired toward the end of 
the afternoon. She is 5 feet W2 inches tall and weighs 120 pounds." 



THE CONSUMPTIVE NURSE 109 

Reply. — This reads like a history of early curable consumption. She 
should have an expert examination without delay. 

Reason for Varying Advice. — C. 8. asks why some patients suffering 
from consumption are sent to one place and others to another. 

Reply. — Whether a patient is to go to one place or another is depend- 
ent on : 

1. Personal considerations. 

2. Social considerations. 

3. Sanitarium considerations. 

4. Climatic considerations. 

Patients go to Denver because they have friends there or hope to get 
some work, want city life, or sanitaria, as well as on account of the climate. 
It is highly desirable that the patient should be satisfied and happy. 

Many patients are sent to places where there is a good sanitarium in 
which they will be controlled and closely studied. The physician sending 
patients away is wise if he gives great weight to sanitarium facilities. 

Climate is the prime consideration in the advice given many patients. 
Here, too, the individuality of the patient must be taken into consideration. 
Generally speaking the requisites are: 

1. Low relative atmospheric humidity. 

2. High percentage cloudless days. 

3. Low rain and dew precipitation. 

4. Freedom from winds of velocity of more than twenty miles an hour. 

5. Freedom from dust. 

6. Elevation 1,000 to 8,000 feet, preferably 5,000 to 8,000. 

Many physicians advise their patients to keep away from states and 
cities which have no laws regulating tuberculosis, or laws which are 
worthless. 

Sanitaria About Denver. — M. writes: "I wish you would let me know 
of any camp or tent colony at Denver for tuberculous patients. There 
is a hoy, 18 years old, a printer by trade, who has just started for Denver. 
I imagine, from what he has told me, that the disease has advanced pretty 
far, as he says he has had four or five hemorrhages. The boy has little 
money, probably $100 in all, and, if there is a colony where he could live 
for two or three months at a nominal sum each week, I ivish to write to 
him of it as soon as possible." 

Reply. — If the boy is a member of the International Typographical 
Union and has been for five years, he is entitled to free care in the Union 
Printers' Home at Colorado Springs. The tuberculosis directory gives the 
following list of sanitaria in or near Denver: 

Agnes Memorial, Association Health Farm, the Home, Mrs. Fare's Tent 
Sanitarium, National Jewish Hospital, Jewish Consumptive Relief, Sun- 
light, Swedish National, Evangelical Lutheran, Fern Hill. 

It is most unfortunate that cases of this class go to Denver or elsewhere 
searching for a climate cure. With the little money at his command he 
stands but a slim chance of improving. He probably will shortly be penni- 
less and helpless among strange people. His chances would have been 
better at home. 

Breathing and Consumption. — Dr. A. W. Foreman of White Hall, Illi- 
nois, says that for thirty years he has sent his tubercular patients to the 



110 CONSUMPTION 

Rocky Mountains with excellent results. The altitude he has found test is 
5,000 feet. His explanation is that the air is poorer in oxygen, and the 
breathing must be deep in order to have the blood get enough oxygen. This 
brings into play all the air sacs. Lazy breathing is not possible. He has 
seen patients increase their chest measurements in this way three to four 
inches. 

Reply. — The reasons consumptives do well in the Rocky Mountains are 
several. Elevation is one of them, and not the most important. In certain 
stages of the disease the lungs heal better when kept as quiet as possible; 
in others they get on better when breathing is deeper. So, deep breathing 
may do good or do harm. 

Arizona Better Place. — B. E. 8. writes: "Do you consider the climate 
of Florida, say Tampa, or near there, a healthful place for one who has 
tuberculosis? If the rainfall there is between fifty and sixty inches, would 
that not be too damp? Is malaria prevalent there? Would the climate of 
Arizona be more beneficial?'" 

Reply. — 1. No. 

2. Yes. 

3. Yes. In the summer and fall; not in the winter and early spring. 

4. Yes. 



CHAPTEK X 

The Eye 



PREVENTABLE BLINDNESS 

The last edition of the Encyclopedia Britannica says: "The data fur- 
nished in various countries by the census in 1901 showed generally a decrease 
in blindness, due to the progress in medical science, use of antiseptics, better 



CORNEA 




CONJUNCTIVA 
ANTERIOR- 
CHAMBER 



CILIARY 
MUSCLE 



RETINA 



OPTIC NERVE 



Fig. 54. — During accommodation the lens becomes more convex through contraction of the 
ciliary muscle, as shown in the left of the diagram, while to the right is shown the position 
of the lens at rest. 

sanitation, control of infectious diseases, and better protection in shops and 
factories." 

That blindness is on the decrease is much more apparent in recent years. 
This fact is a reason for still greater endeavor. We are winning a fight. The 
fact that we are winning calls on us for renewed, redoubled endeavor, that the 
enemy may be wholly routed. 

The control of preventable blindness is a battle. The enemies are enumer- 
ated in the above opening quotation. We are making a winning fight. The 
statistics from England and Wales show that in 1851 there was one blind 
person for every 979 with sight, 1,021 blind for each 1,000,000 of the popula- 
tion. This fell during each decade. In 1901 there was one blind person to 

111 



112 



THE EYE 



every 1,285 able to see, 778 per 1,000,000 of the population. The decrease in 
blindness in the other countries of the world is at about the same rate. 

However, much remains to be done. According to the census of 1900, 
there were 85,662 blind in the United States, 1,125 per 1,000,000. 

The low blindness rate countries are Holland, 5,414 ; Denmark, 427 ; and 
Belgium, 487. 

The high blindness rate lands are Eussia, 2,000; Finland, 1,191; Italy, 
1,175, and the United States, 1,125. 

Dr. Alexander Graham Bell was appointed a special expert of the census 



There are 60,000 blind per6on5 in the United States, 
/\t le^st Z0,000 o^ these sad ca^es 

were Preventable ! 



IF CHICAGO 

WILL ENFORCE 

THE USE OF 

-THIS- 



Si 

w 

THE DROPS 



THE 
MEDICINE 
DROPPER 



IT WILL COST 

-THIS- 



FIVE CENTS 



AND 
PREVENT 

-THIS- 




To Lose ones 5IGHT -is LiKe Losiscj LIFE rrseLF. 

SAVE YOUR BABYS SIGHT 



gfelCArfb TWAffmenr «t r H^ALTK-> gducAtlon*L -Series <Ve-91 



Wl.fi. 



Fig. 55. 



office to inquire into blindness in the United States. He investigated about 
65,000 blind, making some interesting observations. Of this 65,000, 2,300 
were under 10 years of age. 

Some children under 10 years of age are blind by reason of accident, but 
the very important cause of blindness in this group is what is known as oph- 
thalmia neonatorum. This term means infection of the eyes occurring during 
birth or within the first few days thereafter. 

This form of blindness is preventable. The methods of prevention are 
known. They have been tried. They work. 



PREVENTABLE BLINDNESS 



113 




Now the question is: Will the mothers see that the approved measures 
are carried out ? 

The method was devised by Crede, and goes by his name. It consists in 
dropping a drop of 2 per cent nitrate of silver solution into each eye of the 
newly born child immediately after the face has been carefully washed. 

The cloths, grease, water, and soap used to cleanse the balance of the 
baby's body should not be used on his head. A separate lot of cloths and 
cleansing material should be used for the head. 

To cleanse the eyelids, absorbent cotton should be used. The pledget 
used for one eye should not be used for the other. To wash the corners of the 
eyes and the margin of the lids, a little saturated 
solution of boracic acid should be employed. 

The pledget of cotton saturated with boracic 
acid solution used on one eye should be thrown away 
at once, and not returned to the solution, lest an 
infection of one eye be carried to the other. 

Next a drop of silver solution is put into each 
eye, followed a moment after by a few drops of 2 per 
cent salt solution. 

If the eyes seem to be at all inflamed the doctor 
must be told without delay. This form of eye in- 
fection works very rapidly. If neglected for a few 
days, no doctor, however skillful, can save the sight. 

Before Crede began the use of his method at 
the Leipsic Hospital, one in every eleven babies born 
in that hospital speedily lost its sight from this one 
type of infection. Within a short while the use of 
this method had reduced the blindness to one in 
every 1,000. 

Harmon's book on preventable blindness tells us that, of 25,317 blind in- 
vestigated in England and Wales in the census of 1901, 489 were children 
under 5 years of age. According to Dr. Tivnen, of the blind treated in the 
Illinois Charitable Eye and Ear Infirmary in 1909 and 1910, 13 per cent 
were blind as the result of infection at birth. 

Some other percentages also noted by Dr. Tivnen are as follows : Massa- 
chusetts Eye and Ear Infirmary, 1.04 ; Manhattan Eye and Ear Infirmary, .03 ; 
New York Eye and Ear Infirmary, .08. [Magnus' table for Germany, 10.8; 
Troussean's for France, 4.6 ; Oppenheimer's for the United States, 3.1.] 

Anyone who thoughtlessly reads the above figures is liable to get an 
erroneous opinion. People go to infirmaries to be treated for conditions 
which can be relieved. It is only a small percentage of the blind people 
blind from birth who find their way to infirmaries. 

Harmon says that an investigation of the causes of blindness among 
London school children showed that 25 per cent were so as the result of con- 
genital defects, 36 per cent because of infections of the eyes at birth, and the 
remainder as the result of miscellaneous causes. 

The percentage of ophthalmia neonatorum blindness to total blindness in 
children of school age for Berlin, Breslau, and Paris is around forty. 

In ten state schools for the blind classified by Tivnen, the percentage 



Fig. 56. — Astigmatism 
Chart. — Test one eye at 
a time. If all the lines 
appear of the same shade 
astigmatism is not pres- 
ent. If any lines look 
darker or less clear than 
others, astigmatism is 
present. 



114 THE EYE 

of birth caused blindness to total blindness ranged from 12.5 for the Con- 
necticut school at Hartford in 1907 to 44 for the Pennsylvania school in 
1909. 

However, these figures are too high to be accepted as general averages. 

Among the school children, and especially among the school for the blind 
children, the number of afflicted as a result of birth accident is disproportion- 
ately high. Much nearer a true figure are the following estimates: 

The New York Association for the Blind goes on record as thinking that 
10 per cent of the blindness is the result of this infection. 

Then let us say that about one in each twenty of the blind people are 
blind because of neglect of their eyes at the time of birth and for a few days 
thereafter. 

O F 

Can you read these letters at the distance of forty feet? 

P H E 

Can you read these letters at the distance of thirty feet? 

Z P L R D F 

Can you read these letters at the distance of twenty feet? 

A F E T B X V 

Can you read these letters at the distance of fifteen feet? 

V B S H O K HE D A 

Can you read these letters at the distance of ten feet? 
If so you are neither nearsighted nor farsighted. 



The situation is serious enough to warrant effort. The percentage is 
decreasing; the fight is a winning one, and that is the second reason which 
warrants effort. 

Dr. Parke Lewis thinks the state and city governments should pass laws 
making this infection of the eyes reportable. Many states and some cities now 
have such laws, but it has not been found easy to enforce them. Since nitrate 
of silver solution is unstable, uneven, and rather undependable, he would have 
the solution furnished, dated and ready for use, by the government. This is 
the practice in many states. He especially advocates measures for the educa- 
tion of the public. 



PREVENTABLE BLINDNESS 



115 



Dr. Tivnen advocates education of the public and particularly of indi- 
viduals. He would labor to secure the cooperation of medical societies, 
mothers' clubs, nurses, and individuals with the health departments to bring 
about the education. 

In the meanwhile why not let each mother individually do her part ? She 
can see to it that her baby does not go blind. 

First, every mother should enter labor as free from infection as possible. 
But there is a way to guarantee the sight of the child even when the ideal 
condition of the mother is unattainable. She can understand the method. 



SUPERIOR RECTUS 




CHOROID 



^ OPTIC NERVE 



CHOROID 



INFERIOR RECTUS 



Fig. 57. — Diagrammatic Section of the Eyeball. 



There is little to it, and she can see that it is carried out in the case of her 
child. 

Another cause of preventable blindness is trachoma. Trachoma is said 
to have come from Egypt. 

Napoleon went to Egypt with an army for the purpose of capturing a 
pyramid or some other white elephant. He got trachoma. Nearly every 
soldier of his 32,000 got trachoma. When he returned to Europe this modern 
Cleopatra refused to be left at home. 

From the armies it spread to the people. From the European peoples it 
spread to the L T nited States. 

Not only is it to be found everywhere in the congested quarters of our 
great cities, but it has penetrated to the most inaccessible of our mountain 
populations. One of the great fights being made by McCormack in Kentucky 
is against trachoma among the pure-blooded Americans of the Blue Ridge 
Mountains. 



116 



THE EYE 




Fig. 58. — Showing For- 
eign Body on Surface 
op everted upper lld. 



The keynote of the trachoma situation is cleanliness. It is difficult to cure 
the cases of trachoma, hut it is easy to prevent them. Prevention is more 
than a bargain. It is cheap. The necessity is for clean wash basins, clean 
water, clean soap, clean towels, clean hands, and clean faces. 

It is highly desirable to have separate wash basins and separate towels 
under all circumstances. When a case of trachoma develops in a family, a 
school, or in a factory, what before was desirable be- 
comes absolutely necessary. 

Turning again to the tables prepared by Pro- 
fessor Bell, we find that nearly twice as many go 
blind between the ages of 10 and 19 as lose their sight 
under 10. I have never seen a close analysis of the 
causes of blindness in this group. Some of them are 
the result of smallpox; some of cerebrospinal menin- 
gitis, and more are due to other infections. 

Looming large in this group are the accidents of play. The "sane 
Fourth" movement has demonstrated that the play customs of children need 
not endanger their sight. I am sure that the census of 1920 will show a 
smaller number of cases of blindness that are the result of the accidents of 
Play. 

A large portion of this group, though, is due to accidents of work rather 
than to accidents of play. The "safety first" movement has had a marvelous 
growth in the last five years. Born out of the flood of workirgmen's com- 
pensation laws which were passed after 1905, this movement has had the 
moral and financial support of large corporations and men of brains, energy, 
judgment, organizing ability, as well as means. 

On no part of their program is there more concentration of energy than 
that relating to protection of the eyes. It will be ten years before the result 
of these activities can be seen in statistics. 

I learn that the chief difficulty is with the men 
themselves. Goggles are a nuisance. They are in the 
way; they are hot. The glass gets covered with dust 
or clouded with moisture. 

I have often seen workingmen picking particles 
from each other's eyes. I have seen them picking out 
iron particles with a knife blade and other particles 
with a handkerchief. They are adept at it. But every 
now and then an eye becomes infected; the sight is 
lost, and sympathetic ophthalmia costs the sight of the 
second eye. 

The remedy is the use of shields and goggles. 
Because the men will not always do what is best for them the facilities 
around factories for caring for injured eyes should be improved. 

Professor Bell found that one in each twenty persons between 90 and 
100 years of age was blind. For those over 100 the rate was one in fourteen. 
Among the old are to be found the congenitally blind, the blind from trachoma 
and from accident, and to these have been added those blind from the changes 
of age, including cataract. 

Cataract is to be found among the old of every land, but some peoples 




Fig. 59. — Showing 
Method of Everting 
Upper Lid, Using a 
Tooth Pick and Fin- 
ger. Foreign body is 
seen near end of finger. 



THE SIGHT FAILS 117 

are more subject than others. It is much more common in hot countries than 
in cold ones. It is said that in Egypt one person in every fifty is blind, and 
cataract seems to be more prevalent in India than in any other portion of the 
world. 

Among workingmen, glass blowers are noted for having cataract. 

There has been a great deal of discussion of the cause of cataract among 
people in hot countries and among men working at hot occupations. 

It has been charged to the glaring sunlight, the dust and the dryness of 
the air. Some have thought it due to ultraviolet rays. 

So far as glass blowers are concerned, the tendency of the times is to 
charge it to the effects of the heat on the cornea and lens. 

Whatever the condition is due to, some part of it can be prevented and 
some remedied. 

THE SIGHT FAILS 

There are a number of conditions of the eye which tend inevitably, at 
least in a fair proportion of the cases, to blindness. The result can be foreseen 
a long time in advance. In some of these diseases death can be foretold. 
For instance, when the blindness results from Bright's disease, death within 
less than two years can be expected. 

In a case in which inevitable blindness is in prospect and the outlook for 
a long life is good, it is the duty of the physician to inform the unfortunate 
person frankly yet sympathetically of what is in store for him. Given an 
opportunity, he can then equip himself to increase his capacity for work and 
pleasure. 

Dr. Parke Lewis, in his pamphlet entitled "Preparations for the Oncom- 
ing of Blindness," says : "Of first importance is it that he continue actively 
in the world's work." 

Warned, he may devote the months of fading sight to training his other 
faculties to take the place of sight. In the first place he should learn to 
typewrite, making use of the touch system. He should train his fingers to 
read rapidly manuscript prepared for the blind. He should learn to carry 
on his present occupation without the use of his eyes, or else he should learn 
and become settled in a new occupation, one that can be carried on without 
the use of sight. 

During this period of failing sight he can learn orderly habits for his 
wardrobe that will enable him to pick linen or to choose cravats without see- 
ing. He can train his touch and muscle sense so that he can find his way 
around and avoid dangers and accidents. He can learn to sense his sur- 
roundings, to see with his fingers. 

Given some months of warning, fully understanding the meaning of his 
infirmity, and with a will to overcome difficulties, he may train himself for a 
life of usefulness and happiness. It is not necessary that he should become 
antisocial, embittered, soured, morose, morbid, careless, or even inefficient. 

Some of the happiest people have been blind. Some of the most useful 
people have been sightless. Not only have some of the greatest geniuses of 
the world seemingly had their talents increased by blindness, but some people 
with ordinary minds have not let blindness cut them off from useful lives. 



118 THE EYE 

Some men who, while they had sight, labored with their hands, who seemingly 
had no talent but pluck, after losing their sight have led efficient lives. 

The period of failing sight offers an invaluable opportunity for training 
for blindness — training of body, mind, and soul. 



TRACHOMA 

Trachoma is one of the diseases which the old-style health officer missed 
completely. He might pore over death returns as long as he pleased and still 
be in ignorance of trachoma. A health department which concerned itself 
with diseases usually fatal would miss it entirely. It is not until health de- 
partments become interested in increasing efficiency that they take notice of 
trachoma, for trachoma Minds but does not kill. 

It is not until health departments go gunning for defects, calling the 
adventure sanitary surveying, or health survey- 
ing, or some similar name, that trachoma is 
thought worth while. The man with trachoma 
must be sought out. Rarely does he come of 
his own accord. The condition is so mild, so 
symptomless, so free from pain, so slowly pro- 
gressive that the subject sees the shadows slowly 
close around him, the light slowly fade away, 
and makes little effort to save himself, or makes 
Fig. 60.— Eyedropper. some effort but is easily discouraged. 

The government has inspectors who try to 
turn back immigrants with trachoma because, at one time, it was a Euro- 
pean disease and we thought our uncrowded people were free from it. 

Some good authorities hold that trachoma is not a specific disease due 
to one germ, but that it may develop from any case of neglected sore eyes. 
These people hold that, where many people use the same wash basin and the 
same towel, the "sore eyes" of the one presently become the trachoma of the 
group. At any rate, trachoma is now as abundant in the United States as in 
Europe. 

Kentucky is making a trachoma survey. They have examined about 
4,000 people in Knott, Perry, Leslie, Breathitt, Lee, Owsley, and Clark coun- 
ties and have found that about one out of every eight has trachoma. Six of 
these countries are in the mountains and one is in the blue grass country. 

The physicians at the Hebrew Dispensary, Chicago, have no trouble in 
finding cases by the hundred among the people who come to them. The 
probability is that a nationwide survey would show trachoma in all parts of 
the United States and among all classes of people. 

We of the city are wont to think there is no sickness and disability 
among the people who live in the pure air and sunlight of the mountains. 
The people of the neglected mountain country see the great machinery for 
human care in the cities and conclude there can be no eyes developing tra- 
choma from neglect in such surroundings. 

There is an Arkansas story of a log camp lad who marveled at the clothes 
brushes, shoe brushes, hair brushes, tooth brushes, towels and soap of a city 




TRACHOMA 119 

visitor and exclaimed: "Is yo ? always that much trouble to yo'sef?" The 
heart of the trachoma situation is in being trouble to "yo'sef" — care of the 
eyes by oneself, by the parent, by physicians, by the school authorities, by 
boards of health. 

Trachoma is a chrome inflammation similar to, and may be just what we 
formerly called granular eyelids. In time the scar tissue contracts and pulls 
the lids away so that the eyeball is not properly protected and is harmed. It 
is contagious. It kills nobody, but reduces the efficiency of many people, 
especially in the crowded districts in the city. It puts many otherwise able- 
bodied people on charity or in county institutions. It burdens families and 
is a heavy drag on taxpayers and philanthropists supporting homes and hos- 
pitals. 

A while ago somebody became suspicious that there was trachoma among 
the school children of Tuscaloosa, Alabama. The attention of the public 
health service was called to the situation and it sent Dr. Herring there to 
investigate. He examined the entire school population of Tuscaloosa, 1,122 
pupils, of every station in life, and in addition 497 students in rural schools 
in the neighboring country. 

He found that one child out of about every twenty positively had tra- 
choma, and, in addition, the eyes were suspicious of trachoma in one out of 
about every sixteen. If these be counted as cases it means that in Tuscaloosa 
one school child out of every nine has trachoma. 

Neglected trachoma is a serious disease. In the first place it is catching. 
It is spread by towels, wash basins, handkerchiefs, fingers. Unlike pink eye, 
it does not tend to get well. On the contrary, it tends to get slowly worse 
and in time to impair the sight seriously. 

It passes through a stage wherein there are granular lids and a little mat- 
tering of the eyes. In this stage light hurts the eyes; the sight is slightly 
impaired, and headaches are frequent. 

It finally enters the cicatricial stage. In this stage the lids are drawn 
in, or out, or down. They are persistently red along the edge. The vision 
is very much impaired. The poor vision may result in persistent headaches 
and other forms of nervous disturbance. In this late stage the disease is not 
thought to be contagious. 

However, before either of these stages is reached there is a stage on 
which I want to center attention. Get it clear in your mind, even if you 
must forget the other stages. The eyelids are opened not more than half so 
far as if normal. The eye holes out through a narrow fissure. In most cases 
the lids are stuck together in the morning and there is a little matter in the 
inner corner. 

A little mucus-like secretion is sometimes found in the corner of the eyes 
during the day. Light is a little unpleasant. These signs may not mean 
anything more than pink eye ; or, if they keep it up, may not mean anything 
except eye strain, need for glasses. 

The majority of the children in Tuscaloosa found to have trachoma did 
not think their eyes were wrong in any way. In the case of some of them 
the parents thought there was some trouble with the eyes and if it did not 
get well shortly they would have glasses for their children. 

These symptoms do not necessarily mean trachoma. They indicate that 



120 THE EYE 

suspicion of trachoma is justified. When an eye man sees these cases he 
turns the lids out. 

If trachoma is present he will find small rounded red elevations mostly 
just inside the margin of the lower lid. There may be small solid red spots 
in the same location on the upper lid. The lids may be slightly thickened. 
The eyeball may be involved. A little redness of the inner portion of the 
eyeball is almost certain to be found. There may be a little matter under 
the lids. Trachoma in this stage is actively contagious. 

This is the combination that makes it necessary for fathers and mothers 
to know about trachoma (it is not enough that the physicians know about 
it), an actively contagious disease, causing very little annoyance and yet 
inevitably bound to injure the eyes seriously. 

Conditions like those found in Tuscaloosa have been found in so many 
places in all sections of the United States that no town is justified in thinking 
trachoma of no importance to its people. 



EYE FATIGUE 

Alger says, "When one stops to think that most people use their eyes 
almost constantly and that many tasks involve a continuous strain for hours 
at a time, one begins to understand why vision necessitates expenditures of 
nerve and muscle energy beyond almost any other function/' 

There are three types of eye fatigue which show themselves in different 
trades. Gilders and polishers and all others who watch bright surfaces or 
look at bright lights suffer from eyestrain, which is the result of retinal 
fatigue. 

Holden tells us that for a long time fatigue from strain on the eye 
muscles was a student's monopoly. Nobody suffered from eye headaches but 
the bookworms. Now the students, thanks to glasses, better lighting, and 
better printing, have almost got out of the class having eye headaches, but 
certain kinds of workers have moved into it. 

Today there are many trades in which the worker sits hour after hour 
intently watching some machine. The same picture is being constantly re- 
peated on the same part of the eye mirror hour after hour. So long as every- 
thing goes well the worker has nothing to do, but if anything goes wrong, he 
must see it and see it quickly. To do this he keeps his eye muscles in the 
same state of contraction all day long. His muscles get tired; his nerves 
get tired; his brain gets tired. 

The garment workers probably are the most unfortunate of the lot. 
Their eyes are under a great strain. The muscles which control their eyes 
are overworked. Usually they work in badly ventilated rooms. The light is 
even poorer than the air. As Alger says, "If they allow their eye muscles 
to relax a second it means indistinct vision and that means mistakes in their 
work, and that means fines and deductions.'' The margin between earnings 
and the cost of living is not great enough to allow for many fines. 

They need extra good muscles to stand this strain. Nothing in their 
lives makes for good muscles. Their muscle strain passes into neurasthenia 
and general tire. Therefore it is that a large part of the garment workers 



DANGER TO THE EYES 121 

are neurasthenic. Nothing is more hysteric and neurasthenic than a garment 
makers' strike. 

The employer whose factory conditions make against mental poise at 
times feels most keenly the effect of that lack of poise. Whenever an employer 
thinks his employees are most hysterical, it is well for him to inquire if the 
conditions of his employment do not make for hysteria. 

Miner's nystagmus, a jerking of the muscles which move the eyeballs, is 
the result of another kind of eyestrain. Cohen found that 45 per cent of the 
German lithographers and 51 per cent of the typesetters suffered from pro- 
gressive nearsightedness. In addition, he found that 10 per cent of the blind- 




Fig. 61. — In Every Normal Eye There is a Normal Blind Area. Close one eye and gaze 
steadily at the cross. Hold the paper ten or twelve inches from the eye Move it to and 
from the eye. At the proper distance the white spot will not be seen. 

ness in Germany developed out of this variety of shortsightedness. Ordi- 
nary shortsightedness tends to be automatically corrected as age advances. 



DANGER TO THE EYES 

Nature intended that man should see. For the purpose a most intricate 
piece of apparatus was made — the eye. No machine made by man is so 
elaborate or so perfectly put together. This machine is made in duplicate. 
It is covered well and provided with a well-nigh perfect dust removing ap- 
paratus. To serve it twelve muscles are provided. Of the twelve important 
nerves which come off directly from the brain, one-third, or four, are for the 
service of the eyes. 

As we start off, or soon after, we are endowed with good eyes. How do 
we preserve the asset given us ? If we work at certain occupations we ruin it. 

The eye suffers from some industrial poisonings. Probably the worst 
of these is that from wood alcohol. Wood alcohol is now used for many pur- 
poses. In some its presence is not suspected. For instance, Tyler reports a 
whole room of girls who had eye trouble from shellacking pencils. 

Alger gives other industrial poisons harming the eyes, such as chemicals 
used in making rubber, explosives and anilins. Tobacco and lead workers' 
also suffer from poisoning of the eye nerve. 

The eyes are mechanically hazarded in all dusty trades. Among those who 
suffer are the men who work over emery wheels, and also the metal and stone 



122 THE EYE 

polishers. Masons and plasterers usually suffer from lime in the eyes. Flour 
mill employees have eye trouble; so do hop pickers. 

An exceedingly bad eye condition is that which develops in workers 
around arc lamps and other highly intense lights. These lights produce 
many violet and ultraviolet rays. The lens and the outer coats of the eye 
take up most of these rays, but some get through, and such destroy the visual 
purple faster than it can recover. 

There results a condition of fatigue akin to snow blindness. The retina 
may fall away. The nerve may be destroyed. 

Closely akin are the eye troubles of stokers, bottle-makers and glass- 
blowers, as the result of the intense light of the open fires or the molten 
glass. One observer found 40 per cent of the bottle-makers in one establish- 
ment had beginning cataract, even though the great majority of them were 
less than forty years old. The left eye, the one nearest the fire, was the 
more affected. Heat seems to be more important than light in causing glass- 
blowers' cataract. 

The lens of the eye differs from the lens of a microscope in that it is 
soft and gelatinous. The eye, being a combined microscope, telescope, and 
several other kinds of scope^ must have a lens which for one work can be molded 
into the form best for a microscope and for another use into the form best 
for a telescope. To mold it, special muscles are provided. 

However, a lens which has not been fairly treated will age. It ages by 
passing from a gelatinous-like mass into a solid mass. It may finally pass 
into almost a stony mass. 

This aging is called cataract. The importance of cataract from the 
health and efficiency standpoint is well understood. 

There is need that attention be called to the fatigue of eye, of body and 
of mind which come while the cataract is in the making — the season when 
no eye specialist can tell that a cataract is to come next Christmas or next 
fall. While the man is developing this condition of extreme wear, it will be 
certain that he is suffering from other forms of fatigue. 



SMITH CATARACT TREATMENT 

Out of India has come the most used and the most discussed operative 
procedure for the eye of this century. According to the old methods cataracts 
were not operated on until the sight had been lost. An English army surgeon, 
Colonel Smith, working in India, devised a method which makes it possible 
to operate on green cataracts as well as on old opaque ones. 

The following is the usual history : A man past middle life notices that 
his vision is failing. He goes to see his family physician, who examines 
his urine and finds it normal; then makes a physical examination and finds 
nothing wrong, and then sends him to an eye specialist. The eye specialist 
tells him that he has a cataract, and nothing can be done until the cataract has 
ripened. A year or so later, after the man has been unable to work for 
months or years, he is ready for operation. 

That was the old way. The Smith way is to operate upon a cataract as 
soon as it begins seriously to disturb the vision. Whenever the sight gets 



SMITH CATARACT TREATMENT 



123 



20-70 or worse the eye is ready for operation. A man with a vision of 20-70 
sees well enough to work ; his general health is good ; he is in no sense disabled. 

The old operation removed the cataract and left the capsule. The Smith 
operation removes the cataract in its capsule. 

Smith was stuck away at a remote point in India. Cataract was a com- 
mon complaint. The people were poor. They could not carry the burden 
of blindness from cataract while awaiting the ripening. They must be oper- 
ated on as soon as the vision became impaired. 

Furthermore, they could not lay up for after-treatment. The operation 
must be one that required little or no after-treatment. The Smith operation 
was devised to meet these requirements. 

Smith has operated on more than 30,000 cataracts. In the Punjab there are 
20,000,000 people, and 25,000 cataract operations are done each year. Ninety 



INTERNAL RECTUS 
MUSCLE 




EYE LID 



OPTIC NERVE 



EYE LID 



INFERIOR 
OBLIQUE MUSCLE 



Fig. 62. — Outside of Eyeball. Muscles which move the eyeball upward, downward, out- 
ward, inward and obliquely. 



per cent of them, or about 22,500, are done by the Smith method. Most of the 
eye men in India are using this method. 

For some reason cataract is unusually prevalent in India, as has been 
known for years, and the eye men in India have had the richest experience 
in the world. Furthermore, the experience with this operation has extended 
over several years. 

Those who read this volume are not interested in the finer technical 
points of operations or the ordinary points of advantage of one operation over 
another. They are interested, however, in a procedure that does away with 
the old time months or years of near-blindness while waiting for the 
cataract to ripen. 

If this procedure can make good, the man with the cataract need not 
lose more than a month all told from his work, waiting for operation and 
after-care combined. The word of men who have performed the operation 
25,000 times is that it has made good. 

For a number of years eye specialists from all over the world have been 
going to India to learn the method. Many of them are in the United States 



124 THE EYE 

doing the operation as occasion offers. Some have done more than 500 of 
these operations — not a Smith record, but a rich experience as cataract experi- 
ences in this country go. 

SQUINT 

Strabismus (squint) exists whenever the two eyes are not directed toward 
the same object. Normally the action of the ocular muscles is such as to 
keep both visual lines always directed to the object under regard and, although 
each eye receives its own image, only one object is perceived by the brain, 
because the images are formed on the same corresponding parts of the retina. 

If, owing to faulty action of one or more of the ocular muscles, one eye 
deviates and the visual lines cease to be directed toward the same object, two 




Fig. 63. — Far-sighted (hyperopic) Eye. Focusing Parallel Rays of Light Behind Retina 
at a Convex Glass (1) is required to Converge the Rays (dotted line) so They Will 
Focus Exactly in the Retina at r. 

images of the same object are seen, but on nonidentical parts of the retina^ 
and the result is double vision. 

To avoid this inconvenience patients for the most part soon learn to ignore 
or suppress the image formed in the squinting eye, the result usually being 
that this eye becomes defective. This power of suppressing the false image 
is learned most easily in early life, and hence the necessity for early treat- 
ment of squint to avoid this. 

Squint may be either paralytic or nonparalytic. Nonparalytic squint in 
children may be either congenital or acquired. The general causes of ac- 
quired squint are imperfect vision in one eye from opacities of the cornea or 
diseases of the choroid, retina, or optic nerve, rendering it unable to par- 
ticipate in binocular single vision. 

Causes of paralytic squint may affect either the muscles themselves, the 
nerve trunks, or the nerve centers. Lesions of the nerve trunks are most 
frequent and are caused by syphilis, rheumatism, hemorrhage, tumors, alco- 
holism, influenza, and other acute diseases. Paralytic squint may be congeni- 
tal. In the early stages of paralytic squint the treatment will depend upon 
the cause. 

ISTon-paralytic squint is more common and occurs in early childhood. It 
is convergent; that is, one eye turns in toward the nose. The defect is 
manifested early in life — in fact, when the child begins to use his eyes for 
near vision, looking at picture books, etc. The majority of such children 
develop a squint before the age of three. 

As a rule the squint develops slowly, and the parents are not the first 




SQUINT 125 

to notice it. They generally assign as the cause an illness such as measles or 
the imitation of a squinting companion. 

In some cases we observe the squint only when the child gazes on a 
near subject. In others the squint is constant, but more marked when the 
focusing power is brought into play or when the child is tired. Most chil- 
dren who see equally well with each eye often squint with either indifferently. 

Contrary to the common belief, children seldom "grow out" of it. If 
neglected, the squinting eye usually becomes blind from disuse. Neglected 
"cross eyes" are responsible for many blind eyes in adults. 

If prescribed sufficiently early, correct glasses accomplish cures in many 
of the cases. Even very young children can wear glasses without danger. 

The treatment by glasses, 
which is so efficacious in the 
young, is naturally much less 
so in older patients who have 
had squint for some years, and 
then operative interference is 
necessary. 

The condition where the 
eye turns out is rarely seen in 
young children and mostly de- "* 6i - Foc ^ e Ze^Z !£" " A ""^ 
velops at puberty or later — in 

fact, when myopia or nearsightedness is progressing. In the majority of 
cases, when once developed, nothing short of operation is any good. 

Cross eye and cock eye are varieties of squint. A person has squint if, 
when he looks at an object, one eye is directed toward that object while the 
other is aimed in another direction. Normally, the muscles of the two eye- 
balls work together so that both eyes aim at the same object. Under these 
circumstances, the light rays carry the image to the same spot on the retina of 
each eye. The imprint of these images is carried by the optic nerve to the 
visual area in the brain in such a way as to merge them as one image. The 
brain sees a single picture. 

Sometimes the balance of power between the opposing muscles for the 
eyeball is lost. If the muscles on the nose side are too strong the eye "crosses." 
Sometimes one, sometimes both eyes "cross." If the outside muscle is too 
strong the eye turns out. 

The picture on the retina is the image of the picture at which that par- 
ticular eye is aimed. When a cross-eyed person looks at a thing he aims 
one eye at it. The image on the retina of that eye is a picture of the object 
viewed. But the other eye is aimed at something else. On its retina there 
is a picture of the object it is viewing. The optic nerves send in two pictures 
to the sight center in the brain. The sight center can only record one of 
them. 

When rays of light enter the eye they pass through the lens and from 
there to the dark chamber to the retina. The dark chamber has a shutter. 
The shutter is the iris. The hole in the shutter is the pupil. 

Syphilis of the eye affects especially the shutter, the iris. Inflammation 
of the iris is called "iritis." While the spirochetes of syphilis may locate in 
any part of the eyeball they show a liking for the iris. 



126 THE EYE 

Syphilis of the eye causes blindness, though it is less important than 
gonorrhea from this standpoint. Physicians are able to diagnose syphilitic 
iritis from the appearance of the eye as seen with proper instruments. If 
there is a doubt a Wassermann test will establish the diagnosis. The con- 
stitutional treatment for syphilitic iritis is that of syphilis elsewhere in the 
body. 

PINK EYE 

Pink eye is frequently the result of a scratch from dust or some other 
foreign body. At the season of the year when the wind and dust are spread- 
ing infection of all kinds there are many cases of sore eyes. In most cases 
only the mucous membrane lining the lids and covering the eyeballs is in- 
volved. The eyes are red and there is a discharge that sticks the lids to- 
gether in the morning. They feel heavy and burn, but there is no actual 

pain. There is a sensa- 
tion as though there 
were sand in the eye. 
In many cases only one 




V ■***^- * _. _ ^ I \ ^^^^^^l e y e * s mv °l ye d at first, 

but soon the infection 
goes over to the other 

Fig. 65. — Near-sighted or Myopic Eye Focusing Paral- e y e * 

lel Rays from a Distant Object at f in Front of If the eyes are kept 

Retina. A Concave Lens (1) Will Cause Parallel d &nd fpee from dig . 

Rays to Diverge, as from a Near Object (r), and so . 

Focus Exactly on the Retina at b. charge the inflammation 

will be over in from four 
to ten days. The discharge from such an eye is infectious. People who 
have pink eye should not use towels or handkerchiefs that may later be used 
by another person. Failure to observe this precaution is the reason why this 
condition "makes the rounds." It frequently does this in schools, boarding 
houses, and business institutions. 

There is a serious side to attacks of pink eye. Occasionally the cornea or 
clear part in front of the eyes becomes involved, and ulcers form. The ulcers 
of the cornea are very grave because the scars they leave interfere with vision. 

Inflammation of the inside of the eye is sometimes associated with pink 
eye. The danger signals warning us of one or more serious conditions are 
pain, dimness of vision, and swelling. Any one of these three should make 
us go at once to a physician competent to treat diseases of the eye. 

When pink eye is caused by a spark from a cigar or a piece of hot ash, a 
drop of olive oil or castor oil will usually relieve the .pain until medical advice 
can be had. 

Cannot Dissolve Cataract. — P. J. H. writes: "For several years, as the 
result of hemorrhages of the retina, there has been a bluish or grayish 
matter just inside the pupil of my right eye, causing total blindness in 
that eye. Recently I met a physician who said that he had a liquid which 
was to be dropped in the eye twice daily and by this method cataracts and 
similar growths were absorbed. He does not claim that it does the work 
in all cases, but that it is effective in a large percentage of cases, and that 



PINK EYE 127 

it is harmless. By this method he claims the lens is saved, whereas by an 
operation for cataract it is removed. Do you know anything about this 
method? If so, is it harmless and is it advisable to take the treatment? 
This physician seems to be honest. 

"2. How can one determine whether a physician is honest or a quack? 

"3. I am going South to stay for some time in or near pine woods. 
Have been told that in those regions the wood tick, if it gets on a person, 
causes a fever that is always fatal. Is this so and what should one do to 
avoid itf 

Reply. — 1. No liquid has any such power. Drops to dissolve cataract 
and absorb retinal hemorrhage are a fake. Furthermore, they have been 
exposed and denounced as frauds any number of times. 

2. One way is to read the exposures of frauds in the newspapers and 



N*-'1* 



h 




Fig. 66. — Far-sighted (hyperopic) Eye Showing the Focusing of Rays from Near 
(n) and Far Objects (h.h.) Behind the Retina. 



to clip and preserve the items. This paper has a fairly extensive card 
index of frauds and quacks, and we will answer inquiries about any that 
we have on our list. The American Medical Association has a better list 
of frauds than ours, and they are willing to answer inquiries as far as 
they can. 

3. The bite of the ordinary wood tick is never fatal. You have in 
mind the spotted tick found in a small area in Montana. To grease the 
"bite" with butter kills the tick and helps the bite. This is enough to do. 
Many of our correspondents have sent us their remedies. These have 
appeared in the Tribune. 

Trachoma. — E. B. writes: "Will you kindly publish a cure for tra- 
choma; also the symptoms and results, if not cured?" 

Reply. — Trachoma is a chronic inflammation of the covering of the 
eye and lining of the lids. It is the result of an infection. It is con- 
tagious. 

Most of the cases of granular sore eyes or granular lids are cases of 
trachoma. 

After the lids have been mildly inflamed for a long time the scar tissue 
begins to contract and deform them. They may turn in; whereupon the 
eyelashes scratch the eyeball or turn out. 

No home treatment is of service in bringing about a cure. Some 
physicians treat trachoma by scraping away the granulation; some by local 
applications of antiseptics and caustics. 

To prevent it, when you must associate with people who have it, be 
certain to use individual face bowls and face towels and hand towels. 
Keep your hands very clean. 




128 THE EYE 

Granular Lids. — Mrs. A. F. writes: "1. What is the cause of granulated 
eyelids? 2. Is yellow oxid of mercury in ointment applied to the lids 
heneficial? 3. Is there any danger of mercuric poisoning from using it in 
the eyelids of a healthy child of 3 years? k- What causes dandruff? 5. 
What removes dandruff and causes it to disappear permanently?" 

Eeply. — 1. Granulated lids is a term loosely used. Frequently it means 
trachoma — an infectious disease. Find out if your child has trachoma. 

2. Ointment of yellow oxid of mercury is good for many affections of 
the lids. 

3. No. 

4. Some cases mean that the scalp has not been kept clean enough. 
Other cases are due to some skin germ not 
identified. The very bad cases in babies, 
sometimes called dandruff, are due to faulty 
nutrition. 

5. Frequent washing, followed by the use 
of a little grease and good brushing, will rem- 
Fig. 67. — Simple Hyperopic edy many cases. Eesorcin ointment is service- 
Astigmatism Shown in Sue- able in others ; sulphur in others. 
ceeding Figure Corrected 

by a Convex Cylindrical Floating Spots.— E. C. M. writes: "For 

Glass. In astigmatism the , 7 777 -, 7 

curve of the lens or cornea is t' ie ^^ ^ en years 1 have been troubled With 
irregular and uneven. black floating spots and rings hefore the 

eye. I have been wearing glasses for four 
years, but they do not do away with the spots. My work is that of book- 
keeping and of course my eyes are at constant strain. Will my eyes in 
time get worse with more spots or is there no danger in them? I am also 
troubled with catarrh in the nose and throat. Has this an effect on the 
eyes? Has the stomach anything to do with the eyes?" 

Eeply. — Floating spots before the eyes are of no consequence. They 
occasion unnecessary worry. Exercise proper care to have the light fall 
on your books right, adjust your glasses as they need to be adjusted from 
time to time, and you will be doing all you can to preserve your eyes. 
It is not probable that your eyes are affected either by your nose or your 
stomach. 

Rings Before the Eyes. — J. S. R. writes: "I have been annoyed by 
small rings and double lines in front of my eyes. They flow in front of 
my sight. There is one set of rings within a double line, and whenever 
I look on white objects I always see this as a large spot dancing in front 
of me. What must I do to get rid of these?" 

Eeply. — There is nothing that you can do. No harm will come from 
them. Pay no attention. They will never injure your sight. 

Cause of Infant Blindness. — M . H. writes : "The baby of my friend, a 
neighbor, had sore eyes at birth and became blind. A doctor has told me 
that it was no doubt the result of a venereal infection. He said that a 
great many innocent young wives are infected by their husbands, and 
abdominal operations are sometimes necessary to save their lives. He 
quoted Dr. Joseph Price of Philadelphia as saying that 95 per cent, of his 
abdominal operations on women — usually innocent women — are for such 
infections. If this or a tenth part be true, what shall we do to protect our 



PINK EYE 129 

daughters? The great majority of your readers, like myself, are entirely 
ignorant of such dangers" 

Reply. — Your informant is probably correct. The baby is blind because 
of an infection of its eyes with gonococcus. To prevent this, the eyes of 
newly born babies should be washed in a weak silver solution soon after 
birth. Twenty-five per cent of blindness is from this cause. A large per- 
centage of young girls [1 month to 10 years old] are infected [innocently, 
so far as they are concerned] by this coccus. The remedy is: (1) birth 
registration; (2) routine washing of the eyes of the newly born with 
silver solution; (3) reporting of venereal disease like other forms of 
contagion; (4) education of the public as to the harm of venereal dis- 
eases; (5) the control of prostitution along the lines recommended by the 
Chicago Vice Commission. 

Eye Drops for Baby. — S. C. writes: "In one of your articles last 
summer I noticed that you prescribed a boric acid solution and nitrate of 
silver for treatment of a baby's eyes at time of birth. Will you please give 
directions as to just how to use this treatment, how strong the solution of 
boric acid should be, etc.V' 

Reply. — Drop one drop of silver nitrate solution into each eye. Follow 
immediately with a drop of salt solution. Do not use the same dropper 
for the two solutions. This procedure is to be carried out within two 
hours after birth. After that, if the eyes need cleaning, use a boric acid 
solution. Drop this from a piece of cotton held close to the eye. Use fresh 
cotton or cloths for each eye. Strength of solution — Nitrate of silver in 
distilled water, 2 per cent (solution must be fresh) ; salt solution — table 
salt in boiled tap water, 1 to 2 per cent; a level teaspoonful of boric acid 
to a quart of boiled tap water. Many boards of health now furnish eye 
drops ready to use. 

To Prevent Blindness. — J. T. wants to know what solution should be 
dropped into the eyes of a newly born babe to prevent it from going blind. 

Reply. — As soon as the baby is born it should be cleaned. Use separate 
cloths, or cotton, for the head. Clean the eyes with fresh sterile gauze. 
Do not clean one eye with a piece that has touched the other eye. Separate 
the lids and drop one drop of a 2 per cent solution of silver nitrate in 
each eye. See that the eyes are cleaned each day with a saturated solution 
of boracic acid and clean sterilized gauze. 

May Need Glasses. — A. B. writes: "Will you kindly describe the con- 
dition known as retinal hemorrhage? Do the eyes discharge blood? My 
eyes are often bloodshot, with the 
lids slightly inflamed, especially in 
the morning. At such times they 

are quite sensitive, but there is no j^ / ;/ \^^ t • / 

discharge of water or pus. There ""*"^3r~- «*»A 

is sometimes pain over or in the 
eyes; otherwise I am free from 
headache. The sight is not im- 
paired. What causes this condi- FlG ' 68.-Simple Hyperopic Astigmatism. 
tion?" 

Reply. — 1. The retina is in the back of the eyeball. It is the part of 
the eye in which are located the delicate nerves of sight. The front of 
the eye is a mechanical apparatus for the purpose of properly throwing 
the light on the retina. The blood vessels in the retina are delicate. If 




130 THE EYE 

one of these small vessels breaks, a little blood pours into the retina, mak- 
ing a hemorrhagic speck. The speck can only be seen with a special 
instrument. It usually consists of a drop of blood, or less. The eyes do 
not bleed. 

2. A thorough examination would probably show that you need glasses. 

Bloodshot Eyes. — L. H. S. writes: "What causes bloodshot eyes and a 
burning sensation in those organs? What would you suggest as a remedy? 
Would glasses give relief?" 

Reply. — Bloodshot eyes and a burning sensation in the eyes are symp- 
toms. They mean need of glasses more frequently than anything else. 
When your eyes are properly examined for glasses the oculist will find any 
other cause if any is there. 

Tears Symptom of Closed Ducts. — Sheldon writes: "About a month 
ago I took cold sleeping in a draft. I felt at once that it had settled in 
my left eye, as it became watery and gave me a great deal of trouble. 
My doctor thinks the tear duct is closed and insists that it should be 
operated upon. It troubles me most in the open air. What are the symp- 
toms of closed ducts?" 

Reply. — The tears overflow. In most cases the operation is simple, 
consisting of repeated passing of a probe. 

Glasses for Astigmatism. — L. M. B. writes: "Will you kindly inform 
the writer if there is any cure for astigmatism of the eyes?" 

Reply. — Glasses that fit will cure the defect in vision. An astigmatic 
eye is one shaped somewhat differently from a normal eye. 

Operation for Cataracts. — S. A. writes: "My mother is 65 years old, 
She has somewhat recovered from general illness, caused by hardening 
of the arteries, and, though she is better, she complains of rheumatic pains 
and a numbness of the limbs and stomach. Is there any help for this 
condition? She also has cataracts on her eyes, and in one is about totally 
blind. Should she have it operated upon now or wait till she is stronger? 
Would the operation be done successfully at the state eye and ear infirmary 
on Adams Street, Chicago?" 

Reply. — 1. Have her keep her teeth clean. If she has any sore throat, 
have her physician see that that is cleared up. Keep her in the open air; 
have her take exercise. Massage will help. Have her eat enough meat to 
build her up. 

2. Have her wait until she is in good physical condition. Cataracts 
commonly are allowed to harden, or ripen, before they are removed. It is 
not an operation that one need be in a hurry about. 

3. Yes. 

Failing Sight. — Paxton writes : "I know a man whose sight is failing, 
though he is not 50 years old. He has chewed tobacco and been a drinker 
to some extent, had led a bad life and had a vile disease several times. 
Is this disease responsible for the condition of his eyes and do you think 
he can be cured? Glasses do him no good." 

Reply. — I guess the "vile disease which he has had several times" is 
the one which does not cause blindness in the way described by your letter. 
That one causes the eyeballs to suppurate and ulcerate, and blindness to 



PINK EYE 131 

come in a few days. The vile disease that sometimes causes blindness to 
develop slowly is not a disease that one "has several times." Tobacco not 
infrequently causes the sight to fail. It produces a paralysis and, finally, 
an atrophy of the main nerve of the eye — the seeing nerve. My advice 
to him is to see a good eye specialist. If his eyeball is getting senile — 
and he is just at the right age for that — proper glasses will fix him up. 
If it is tobacco amblyopia, he should get better if he quits chewing. 
Whisky makes no difference except that it makes his eyes old before their 
time. 

Tears Best Eyewash. — E. R. writes: "What is tetter than boric acid 
water to strengthen the eyes? Which is the better to take the first thing 
in the morning, hot or cold water?" 

Eeply. — 1. No sort of eyewash will strengthen your eyes. Eyewashes 
only wash the outer coat, or conjunctiva. At that the tears, a weak solu- 
tion of salt, are better than any man-made eyewash. The structures that 
are of consequence are deep in the eye beyond the reach of washes. 

2. Either is good. Perhaps cold is better. 

Cataract "Ad." Untrue. — H. F. A. writes: "A doctor advertises that 
he can cure cataracts by what he calls a dissolvent treatment. Is this 
possible without injury to the eye itself?" 

Reply. — No. 

Treatment of Styes. — R. J. G. writes: "Please tell me the cause of 
and cure for styes. My daughter, about 6, and myself, 37, are bothered 
frequently in this way. Do they denote weakness of any kind?" 

Reply. — Styes are caused by infection of the edge of the lid with pus 
cocci. Some disturbance in the general health or some error of refraction 
may be the predisposing cause. In the early stages the eyelash which runs 
through it should be pulled out and an application of strong carbolic acid 
or tincture of iodin made to the diseased area. If this fails to effect a 
cure it may be necessary to have it lanced to let out any pus which may 
have accumulated. Warm applications or hot stupes are then made to 
relieve the pain and hasten suppuration. An application of mercurial 
ointment rubbed over the diseased part promotes recovery and has a ten- 
dency to prevent recurrence of the disease. Usually it is wise to have 
your family doctor or an oculist treat the disease, especially where there is 
a tendency to recur. Where the stye occurs as a result of a lowered state 
of health efforts at correction are to be made by giving suitable tonics. 
Where it results from errors of refraction suitable glasses are to be used. 

Infection Causes Stye. — Mrs. F. wants to know the cause of stye on 
the eye. Also, whether it is, as a great many people declare, helpful. Last 
week she had a small stye on the lower lid. Now one is coming on the 
upper lid. 

Reply. — A stye is due to an infection o| the root of an eyelash or of 
an eyelid gland by a pus coccus. It is not different from a small boil. It 
is not helpful in any sense. Eye-strain contributes to it indirectly; un- 
clean lashes and lashes which should be removed are another factor. 

Oculists are like other people — some honest, some not. They average 
better than the run of men. 

You must exercise care in selecting your oculist as you do in selecting 



132 THE EYE 

your milkman, grocer, or husband. If you need glasses you should wear 
them. 

Strained Eyes. — Mrs. M. M. writes : "I am SJf years old and am having 
trouble with my eyes for the first time. I am cooking on an oil stove. The 
room is small and is heated by an oil stove. I cook two meals each day by 
oil lamp,, making six burners lighted at one time. I am poor and do wash- 
ing every day. Two children depend on me. Do you think the kerosene is 
the cause of my trouble f 

Reply. — Six burners would use up a lot of air and pour a lot of car- 
bonic acid into the room. Unless you ventilate well this would be trying 
on your general health. It would not hurt your eyes especially, however. 
If the light is poor and you strain your eyes you may be harming them. 
Your age is about right for the development of senile changes in the eye, 
principally long-sightedness. See if glasses will not relieve you. 



CHAPTER XI 

The Ears 




THROAT 



Dl\uri HEAT> 



AN EARLY SIGN OF DEAFNESS 

The ordinary method of hearing is that in which sound waves strike the 
ear drum and the impulse is transmitted by the bones of the ear to the place 
where bony movement irritates certain delicate nerves. The irritation of 
these nerves is carried to the brain, where the impulse is recorded as a sound. 

Impulses can be carried to these nerves by bones other than these small 
bones of the ear drum. In fact, the bones are in touch with each other so 
that some little 
sound impulses can 
travel to the ear 
from far - away 
places. We can 
hear a little with 
our hands and our 
feet; we can hear 
still more with the 
bones nearer the 
ear bones. 

Bournier offers 
the following test 

for the extremely early stages of failing hearing: The foot of a vibrating, 
deep-toned timing fork is held against the elbow or wrist. If the hearing is 
normal, the vibrations are felt, but no sound is heard. If the hearing is 
beginning to fail, the sound of the vibration will be heard through the bone. 

The theory is that when the ear drum begins to thicken up and ear drum 
hearing loses some of its acuteness, the indirect or bone hearing becomes 
somewhat more acute to compensate; that when this test shows bone hearing 
to be more delicate than normal, it is a sign that ordinary hearing is going 
away a little. 

This sign probably would not hold good for the deafness of old age. 
Its field is those who, by reasons of neglected earaches in childhood, or by 
reason of thickening of the drum, or other changes in the middle ear, are 
getting deaf before their time. 

The methods of testing the hearing are simple. There are elaborate 
devices and expert examiners, but no one need wait for either of these. In 
a perfectly still room, ascertain if the watch tick can be heard at two feet, or 
a whisper at eighteen feet. Try each ear with the other closed. Learn if a 
tuning fork held an inch from the ear can be heard for eighty seconds. 

133 



Fig. 69. — Sketch Indicating Connections Between Exter- 
nal and Middle Ear, Mastoid Cells and Throat and 
Nose Cavity. 



134 THE EAES 

These are simple tests and can be made without much apparatus. They 
are not exact but they give one a fair idea as to whether his ears are losing 
accuracy. If he remembers, or if he learns, that, as a child, he had many 
earaches or many attacks of sore throat, or was a mouth breather, it is ad- 
visable for him to take stock of his ears at his annual inventory. 

If the man is of a deaf family, it is also well to take stock. Deafmutism 
is hereditary. The laws of its inheritance are pretty well worked out. 

Deafness developing in middle life also runs in families. The reason 
for that has also been worked out. It is because certain families have more 
earaches in childhood and certain of these families are disposed to neglect 
the earaches of their children. 

EARACHE 

Deafness belongs in that group of conditions in which interest is so 
rapidly awakening — the conditions which produce inefficiency. Dr. Alexander 
Graham Bell is behind the Volta bureau for the increase and diffusion of 
knowledge relating to the deaf and its monthly publication, the Volta Review. 

In this bureau there is a card catalogue relating to 4,471 marriages of 
deaf mutes. Analytical study of these shows that as to 2,Q42 sufficient data 
are in hand to make the information on the card of value for study. Of these 
2,342 marriages resulted in hearing offspring. In 300 some of the children 
could hear and some were deaf mutes. 

Studies of people who become hard of hearing in middle life show that 
this condition has a little disposition to run in families. 

We grow deaf because of infections of the middle ear. The infection 
travels to the middle ear from the nose. When bacteria and the poisons of 
bacteria are absorbed by the lining of the nose they are carried to the adenoid, 
or pharyngeal tonsil, and to the eustachian tonsil. 

The first of these is near the duct to the ear and the second is near it. 
For this and other reasons many colds end in earache. 

Certain families are more subject to colds than others. This is partly be- 
cause of inherited susceptibility and partly because of the habits of the 
family. Certain families are more subject to earaches as a result of colds 
than others. 

The customary way of treating an earache is to pour some oil into the 
external canal. As this does no good we may say that the customary way 
of treating earache is to do nothing for it but to wait for nature to cure it. 
This nature does satisfactorily, so far as the immediate result is concerned. 
But the ear is a delicate organ. It cannot be slammed around promiscuously 
and repeatedly without being harmed. 

These earaches leave a little thickening behind. When to this thickening 
the changes of age are added the party grows deaf. Absolutely to lose the 
hearing from this cause is unusual. We speak of it as "getting hard of hear- 
ing." As was said a while ago, this condition runs in families. 

Nobody can afford to neglect earaches. In spite of this people will con- 
tinue to pour in some oil or laudanum, and let it go at that. 

Some people can afford it better than others. If a man belongs to one 
of those families wherein they get hard of hearing at about 50 years of age 



WHAT THE MOTHER OF A DEAF CHILD OUGHT TO KNOW 135 



he can be certain that he cannot afford the earache, however safe it may be for 
others. 

REEDUCATION OF HEARING 

A large number of people are partly incapacitated by poor hearing. "As 
soon as one does not hear the human voice well, he does not hear any longer, 
because it tires him to listen ; he isolates himself as far as his hearing is con- 
cerned until he relapses into a deafness more and more complete." 

This condition parallels that of the rheumatic cripple who quits trying. 

Some day parents will watch their children's earaches so well that this 
procession of people hard of hearing at 50 because of earache at 10 will stop. 
But, for the present, we have to 
deal with their forty-year-after deaf- 
nesses. 

When I go into the workroom 
of Dr. McMillan of the Board of 
Education I find instruments for 
testing the acuteness of hearing, 
just as I see other means of testing 
the acuteness of vision. 

Dr. Maurice of France has de- 
vised an instrument for reeducating 
the hearing. This he describes in 
the Annals for Nose, Throat, and 
Ear Diseases. He does not get much 
help from massaging the drum of 
the ear with a little air pump, be- 
cause he says it vibrates the drum 
at low speed, while in hearing the 
sounds vibrate the drum at high 
speed. 

The instrument invented by Dr. 
Maurice is called the kniesiphone. There are several other devices in use 
for the same purpose. Instruments of this type are to be used under medical 
direction. 

The patient himself can do a good deal in the way of reeducating his 
hearing. Listening to sounds is of service. Talking machines can be made 
use of. 

I think I can see where a thinking person could devise a method of 
self-help making use of a dictaphone. The telephone can be made use of. 
There is an advantage in using those instruments, such as a telephone ear 
piece, dictaphone tips, or a stethoscope, instruments in which the impulse 
is transmitted to the ear drum by a column of air. 




Fig. 70. — Section of Left Ear and a Por- 
tion of the Skull Showing External 
Canal Ear Drum, Middle Canal Ear 
Drum, Middle and Internal Ear and 
Tube to Nose and Throat. 



WHAT THE MOTHER OF A DEAF CHILD OUGHT TO KNOW 

In the first place, she ought to know that to meet the situation honestly 
is the only policy that means efficiency and happiness for her child. The 



136 THE EARS 

ostrich head-in-the-sand policy is selfish. It is a manana policy, and, like all 
manana policies, it costs more than it comes to. 

In the next place, she should know that she should begin to teach her 
child to read lip movements soon after it has passed its first birthday. 

Some time ago a mother wrote me that she had been delaying the 
instruction of her child because she had heard that speech deficiencies work 
themselves out, that the power of speech came around in time. 

Not only does delay make teaching more difficult, but there is the added 
danger that the child may have acquired social habits that it will be difficult 
to break. 

In his book on the subject Wright advises, first, that a careful examina- 
tion of the ears and speech organs, sight, and mental state be made by a 
competent physician; then, that instruction be begun when the child is about 
15 months of age. 

The next step in instruction is to talk to the baby in clear, distinct tones, 
without exaggeration of lip movement or facial expression. The mother 
should watch the baby's eyes ; she should speak to him only when she has his 
attention. The meaning of words, sentences, commands, and entreaties should 
be taught by association, as in the case of children who hear. 

Until the child is about three years old no effort should be made to teach 
him to talk. I am writing now about wholly deaf children. Miss Torrey 
says in the Volta Review that even the slightly deaf should be taught lip 
reading. The education in speech of a slightly deaf child should begin at the 
usual time for teaching babies to talk. 

During the first three years of the life of a deaf child it is enough to teach 
him to read the lips, to train his mind, to inculcate companionship and social 
instincts, and to develop the body. 

Speech should be taught even to the wholly deaf and the children of low 
intelligence. The best authorities are agreed that these children should be 
taught to talk with the vocal organs and not, even in part, with the fingers. 

Wright holds that if the mother is intelligent and the home is good 
the child should not go to school until he is at least 5 years old. After that 
age the child will learn faster in school than at home. 

Some don'ts given by Wright are: 

Do not consider the deaf child as different from other children. 

Do not cease talking to him. 

Do not speak to him with exaggerated facial movements. 

Do not exempt him from the duties, tasks, and obedience properly de- 
manded of all children. 

Do not let him grow selfish. 

Do not let him grow indifferent. 

Do not be in haste. 

Do not show impatience. 

LIP READING 

A very large number of people have a tendency to become hard of hearing 
as they pass middle life. A fair proportion of these a few years later are 
more than hard of hearing; they are deaf. 



LIP BEADING 137 

The largest element in causing this infirmity is infection of the nose, 
throat, or ear in early life. Deafness developing in middle life runs in fam- 
ilies, partly as a matter of inheritance and partly because it is the custom 
in certain families to neglect earaches and colds. 

Some of the hard of hearing settle down into a dull insularity — keeping 
away from people, avoiding lectures, missing church, reading, sewing, or knit- 
ting all day long — oversensitive. Some undertake to keep in the current by 
using trumpets and hearing accessories of one sort or another. Some try to 
get along by having those around them talk in a loud tone or with mouth 
to ear. 

Miss Torrey thinks that the way to avoid all this is to learn lip reading. 
She says lip reading ought to be considered the first resort of even the slightly 
deaf, if the case is beyond medical relief. A reputation for being deaf causes 
people to avoid deaf people or to dread trying to talk with them, or to talk 
to them in a loud voice, or in a manner otherwise unnatural. 

To avoid this she advises that those in whom deafness is coming on learn 
lip reading as soon as incurable deafness is diagnosed. A good method of 
beginning is by the study of some book, such as Miss Yale's "Formation and 
Development of English Elementary Sounds." 

The Volta Review contains a wonderful story by Mrs. Jelks. Her little 
girl at two years of age had an attack of scarlet fever which left her entirely 
without hearing and with no capacity for spoken speech. 

The mother has trained her to speak perfectly. She can interpret the 
spoken words of children around her. In school, in play, in the walks of her 
young life, she is a part of the life around her. She began lip reading and 
speaking with a study of Miss Yale's book. 

In beginning it is advisable to spend some time before a mirror studying 
the position of the mouth when uttering different words. 

There are two principal systems of lip reading, the Mullerwalle and the 
Nitchie. As Mr. Xitchie says, these are teaching methods; the student must 
pay special attention to the practical ; that is, actually to make the sound and 
note the positions of the vocal organs. 

"It is always difficult for a deaf man or woman to find a position. Why 
not read the lips before deafness becomes so noticeable that the work is 
affected? The results of the training, in alertness, absolute concentration, 
and quickness of perception, become an asset which is valuable in any line 
of work." 

Perforated Ear Drum. — C. W. L. writes : "I am 21 years old and since 
I can remember have been unable to hear with my right ear. When a 
child I was troubled with earache. Upon consulting a physician I was 
advised that there was a hole in the ear drum and that nothing could be 
done for it. Would a patent ear drum restore my hearing in this earV 

Keply. — Evidently when you were a child an infection spread from 
your nose to your ear and pus discharged through the drum. The cause is 
plain. The ear drum cannot be restored, but you will be able to find an 
apparatus which will improve your hearing. Try those offered for sale 
until you find the one which gives you the best results. Be careful not to 
buy without a guarantee and do not buy one that does not give results 
after several days' trial. 



138 THE EAES 

Cotton in Ears Harmless. — J. K. writes: "Some time ago I ashed you 
if cotton put in the ears at night to shut out the noise was injurious to 
the ears if the habit was kept up continually, and you have not replied. 
Will you please do so?" 

Eeply. — It will not harm you to put cotton in your ears before retiring. 

Your Physician Will Determine. — H. E. K. writes: "Our little girl of 
seven years has been troubled with earache, and upon examination we find 
that adenoids are just coming. Are they the cause of the earache, and 
should they be removed at once? One ear has been lanced. Is it the 
safest to operate on the ear?" 

Reply. — Suppuration of the middle ear as shown by earache and sup- 
puration means infection extending from the tonsils or adenoids. The 
focus of infection must be cleaned up. Your physician will determine if 
operation on the ear is also needed. 

Remedy for Earache. — L. W. H. writes: "Kindly advise a remedy for 
earache of a child five years old, who is bothered at times with tonsillitis." 

Reply. — A hot salt bag to the ear is better than medicine dropped in the 
ear. But why not go after the real trouble — the tonsillitis ? 

Approach of Deafness. — M. W. writes: "What measures can be taken 
at home to ward off the inroads of deafness in approaching age?" 

Reply. — Something can be accomplished by removal of any contribut- 
ing causes in the nose, throat, or ear. However, results are generally 
unsatisfactory. The trouble is that deafness after middle age is usually 
due to neglected throats in youth and that puts help out of reach. 

See Ear Specialist. — Miss B. writes: "By what means can a girl of 
26 be relieved of head noises? They have lasted for four years, and at 
times become perfectly maddening. I had hardened ear wax and adenoids 
removed three years ago, so there are no obstructions. Inflating the ears 
gave no relief." 

Reply. — There are many causes of head noises and the cure of a given 
case depends on the cause. Although you have had more than one search 
for the cause in your case, it has not been found, and you should continue 
your search. See the best ear specialist available. 

Partial Deafness Hereditary. — I. C. 0. writes: "Is partial deafness 
ever hereditary? In a family of ten children three were slightly hard of 
hearing from no apparent cause. The mother of this family was the same 
way. One of the girls is about to be married. Do you think her children 
will have the same trouble?" 

Reply. — 1. Yes. 

2. Some of them will. This subject is well covered in Bell's "Study of 
the Inheritance of Deafness." 

Running of the Ear. — D. E. A. writes: "Is there a cure for running 
of the ear without an operation? Is there anything that could be done at 
home to cure? Does it affect the eyes?" 

Reply. — Running of the ears sometimes stops of itself. To keep the 
ears clean will help. However, one is not justified in neglecting running 



LIP HEADING 139 

ears, even when the running stops spontaneously. The condition is gen- 
erally the result of infection which has spread from the throat to the ears. 
It is the usual cause of deafness. The way to prevent deafness is properly 
to cure these infections. When, ten years later, deafness is discovered 
nothing can be done. 

To Prevent Deafness. — Monmouth wants to know whether coffee causes 
deafness. Does catarrh cause it? What will relieve severe headaches? 

Eeply. — 1. No. 

2. Infections which spread from the nose to the ear thicken the ear 
drum and cause deafness. To prevent deafness one must take care of the 
nose and throat. 

3. There are many kinds of headaches. Follow your physician's in- 
structions to get rid of them. 

Meniere's Disease. — M. E. V. writes: "What is Meniere's disease? 
Is it incurable? Is it dangerous to follow one's vocation if suffering from 
this disease? Is it possible to help oneself by fasting, etc? Does this 
disease cause throbbing in the ears?" 

Reply. — 1. Meniere's disease is a disease of the semicircular canals — a 
part of the internal ear. These canals have to do with maintaining the 
body in a steady equilibrium. When the canals are diseased there is dizzi- 
ness and a disposition to fall. 

2. (a) Some cases are incurable, others are curable; others show a 
tendency to remain at a standstill, (b) Depends on the person and his 
work. 

3. Yes. Even in those cases in which cure is not possible, one can gain 
much by readjustment. Sometimes diet helps. A milk diet benefits some 
cases. 

4. There are different causes of throbbing. Meniere's disease is one 
of them. 

Lip Reading. — R. writes: "Please let the deaf know of the advantages 
of lip reading. If persons who are losing their hearing would start to 
learn lip reading promptly they would be gainers. I have been taking 
lessons for about four months and am able to understand members of my 
family and many outsiders without hearing their voices. I am gradually 
learning to forget my defect, and human intercourse is becoming more a 
pleasure than a torture. The Yolta Bureau, Washington, D. C, will furnish 
names of teachers of lip reading. Some of the public schools have evening 
classes in lip reading." 

Ringing in the Ears. — P. E. G. writes: "What causes and what is the 
best remedy for the singing, roaring sounds in the ears of so many Chicago 
people? I am asked so often to talk a little louder. I know people who 
have paid large sums of money to specialists, with no good results. Would 
mullein oil, Haarlem oil, or any of the oils be of benefit, or warm water 
forced in with a few drops of glycerin?" 

Reply. — The ringing in the ears and the deafness which develop in 
middle age are the results of the neglect of throats and noses in youth. 
Generally nothing can be done and those inconvenienced go from specialist 
to specialist, trying to get some help. Haarlem oil, mullein oil, and reme- 
dies of that type will do no good at all. Occasionally a sufferer will find 



140 THE EAES 

some relief from surgical or mechanical procedure, but the best the average 
person can do is to content himself as best he can, resolving that he will 
not allow his children to suffer from the same neglect. 

The next generation will have much less deafness than ours, even 
though the dinning of continued noises is making hearing generally less 
acute. 



CHAPTEK XII 

Rheumatism 

Rheumatism is a term frequently used to cover almost every kind of 
ache or pain. The disposition among medical men now is to limit its use 
rather sharply to inflammatory rheumatism. 

Inflammatory rheumatism is an inflammation of a joint accompanied by 
fever and general aching. These inflammations are due to infection of the 
joint by bacteria which have got into the body at some distant point, have 
found their way into the blood, and have been thrown out of that fluid into a 
joint. 

Some of these rheumatisms, so-called, are due to venereal disease bacteria, 
others to the germs of the pneumonia group. Most cases of acute inflamma- 
tory rheumatism are due to germs — sometimes one kind, sometimes another — ■ 
which get into the blood through the throat. 

In its relation to old age the principal interest in rheumatism lies in its 
effect upon the heart. When the germs are traveling from the throat to the 
joint they pass through the heart. Some stop. Acute heart disease, in the 
course of rheumatism, is always dreaded, but it is more important to know 
that a heart can be crippled by rheumatism and not show it until months and 
sometimes years have passed. 

There is a group of joint affections akin to rheumatism, yet very different, 
called rheumatoid arthritis, or arthritis deformans. To illustrate : A woman 
about 50 years of age notices her fingers are becoming crooked and the bones 
larger at the joints. Perhaps she notices that the skin over the joint is tense 
and shiny. Without causing much pain, her disease progresses until her 
hands are badly deformed. This is a type of rheumatoid arthritis which is 
easily told from rheumatism. 

From this type the disease merges into another — one which causes pain 
and at times fever. Much oftener than the other type it begins in younger 
people. Having begun, it progresses until the joints are twisted, gnarled, de- 
formed, and locked. 

Whether the sufferer be in tne one group or in the other, somewhere in the 
body, and usually ic the nose or mouth, there will be found a focus of mild — 
very mild — infection. Nearly always it is in or around the teeth. It may be 
in decayed teeth, but more frequently it is in the gums — the usual cause is 
pyorrhea. 

Lambert states that in 172 cases where special search was made for an 
infection focus 141 had badly decayed teeth or the teeth had dropped out. 

The man with rheumatism, should have his mouth, throat, and nose ex- 
amined to locate the focus of his trouble. 

The man with beginning rheumatoid arthritis should seek the focus of 
trouble in his teeth and gums. 

141 



142 RHEUMATISM 

Most of the people who have aches and pains are not rheumatic ; they are 
gouty. Among the gouty aches Paget puts muscle pains, lumbago, sciatica, 
neuritis, some headaches and neuralgia. 

To these Dyce Duckworth adds such maladies as deep-seated pains in the 
bones and spine, obstinate patches on the skin, and inability to digest richly 
cooked foods. There is an inflammatory joint type of gout — rich man's gout, 
if you please — but the cases are few. 

Our especial interest is in the forms of atypical gout so much in evidence 
in the spring, the gouty aches and pains which make people call for spring 
medicines — blood purifiers. 

Just as the true rheumatic is the field from which most of the heart dis- 
ease is recruited, the gouty is that from which arteriosclerosis (hardening of 
the arteries), high blood pressure, apoplexy and chronic Bright's disease draw 
their subjects. 

While we sympathize with the inconvenience of lumbago and other gouty 
aches, gout as a cause of apoplexy, paralysis, and Bright's disease is of much 
more importance. 

Living to avoid gouty aches and pains is so simple! Its simplicity makes 
it difficult, because the doing of simple things does not accomplish results un- 
less there is persistence — and persistence is a rare virtue. 

What is simpler than to eat no more than you can burn up by exercise 
and work, and to exercise and work enough to burn up all that you eat ? 

What is simpler than to follow the example of the fireman who puts on 
more coal than the fire can burn? He knows that he will partially smother 
the fire, get too much ashes, and make black smoke. What does he do about 
it? He shakes down the fire, gets rid of the ashes, and opens the drafts so 
as to feed more air. 

The man who has a gouty headache takes a purgative and walks two 
miles. Up to this point he follows the example of the fireman. But a good 
fireman does not habitually overstoke or neglect the draft. And there is 
where his example is not followed. The gouty subject, feeling better again, 
eats out of balance, exercises but little, and breathes foul, warm, dry air. 



FORMS OF RHEUMATISM 

The acute inflammations of the joints with swelling and fever are called 
acute rheumatism. These are due to infection of the joint or joints with any 
one of several germs. Some of these germs are violent in their local effects, 
some are violent in their general poisoning, but not destructive locally ; others 
are mild both generally and locally. 

Therefore, no two cases of rheumatism can be judged by the same stand- 
ard. Those who suffer from this kind of so-called rheumatism should : 

1. Secure proper treatment for the general and local symptoms. 

2. Discover the type of infecting germ causing this particular attack. 

3. Discover the point where the infection is getting into the tissues, 
whence it is carried to the joints. 

4. Remember that rheumatism of this type is largely responsible for the 
heart disease of later years. 



"FULL OF RHEUMATISM" 143 

5. Eat lightly during the attacks, eat well between them. Red meats are 
of much service between attacks. 

What is called chronic rheumatism is another group into which a dozen 
different diseases are commonly thrown. Some of them are nerve diseases, 
some are infections, some are the effects of senility. They are caused by a 
dozen different causes, and what is good for one harms another. A good il- 
lustration is that chronic deforming change in joints called deforming arthri- 
tis, which leaves them twisted, gnarled, and stiff. 

Some of these cases are due to infections through the tonsils or elsewhere ; 
some are due to nerve disease. 

To cut these people off from meat, to send them around to oaths and 
cures, is just as foolish as anything can be. In this group called chronic 
rheumatism there is need for analysis. Some are helped by baths, others not; 
some need more food, some less. 

In between these comes a great medley of pains in joints, muscles, and 
nerves that people loosely call rheumatism. They are milder than the fever 
kind of rheumatism. Some of these are mild infections. A good illustration 
is the growing pains in children, usually due to mild infections. 

The proper treatment of this group is to find and clean up the point 
where the infection is getting in. 

The largest part of the cases usually called rheumatism and belonging to 
this class are really gout. These cases are suffering from bad habits. The 
quantity of food which they eat is too large, or it contains too much proteid, 
especially meat ; or they are constipated, or they are not good heat makers, or 
some part of their body is susceptible to chilling, or several or all of these 
combined. These are the people who are benefited by baths, by cures, by diets, 
by massage, by flannel binders, and the like. 

Such measures relieve symptoms in a satisfactory fashion. Sufferers do 
not get permanent relief until they eat less food, eat less meat, exercise more, 
retrain the susceptible parts of their bodies by local cold baths. The man who 
does not go deeper into his condition than to call it rheumatism will waste a 
lot of time and may do himself a good deal of harm. 

No form of so-called "rheumatism" should be allowed to run. It may lead 
to bad consequences. The bad habits of the gouty forms should be corrected 
and kept corrected. There must be no "falling from grace." The infection 
forms must have their causes removed. We are greatly at sea when it comes 
to the nerve forms. 

Why not quit talking about rheumatism as though it were one disease? 
Why not speak of a case as an acute, subacute, or chronic infection of a joint, 
or the joint change in a certain nerve disease, or a painful gout of a certain 
muscle, nerve, or joint? 



"FULL OF RHEUMATISM" 

Old people are generally "full of rheumatism." What "full of rheuma- 
tism" means, scientists are not agreed on. In fact, probably half a dozen 
pathologic conditions are thrown together in the condition called "full of 
rheumatism." There is acute inflammatory rheumatism, gout, rheumatoid 



144 RHEUMATISM 

arthritis, Heberden's nodes, Dupuytren's contraction, Marie's ringers, senile 
arthropathy, muscular rheumatism and neuritis. 

The sufferer may have any one of several things in mind. He may refer 
to the knobs around the joints and the crooks in his fingers. He may refer 
to periodical attacks of inflammatory rheumatism. He may have in mind a 
persisting soreness in his joints with creaking. He may refer to a general 
muscular stiffness with a marked tendency to develop soreness and pain upon 
slight exposure to changes of temperature or out of the ordinary exertion. 

The acute inflammations need one treatment. The remainder of the group 
needs another. Attacks of acute inflammatory rheumatism become less fre- 
quent as men become old. 

The reason is plain. Old men are less liable to infections than young 
ones, and we now know that acute inflammatory rheumatisms are due to infec- 
tion. The infection is usually through the throat or nose. 

Old people who are "full of rheumatism" should throw away their pocket 
pieces — their buckeyes and potatoes — and have their tonsils, gums and upper 
breathing apparatus put in good order and thus maintained. Saundby says : 

"If elderly patients follow the rules of hygiene, temperance in diet and 
regular exercise, they will suffer little, if at all, from goutiness and its various 
manifestations/' 

If you were to ask a dozen doctors which of the symptoms that make 
up a "full of rheumatism" group are due to gout and which to other causes, 
you would get close to a dozen answers. Then let us broaden Saundby's state- 
ment so as to make it: If elderly patients follow the rules of hygiene, tem- 
perance in diet and regular exercise, they will suffer little. 

As it is, elderly people suffer much. What are, then, some of the policies 
to follow? 

To go to the baths once or twice a year, when feasible. 

To take massage, exercises and osteopathy from time to time. 

To spend some time every day "suppling" the muscles and joints. 

To wear plenty of warm clothes. 

To get some fresh air every day. 

To eat good plain food, but with discretion and moderation. 

While some meat may be best for them, the quantity should be much less 
than taken by younger people. Meats should not be highly tasty. Meat broths 
and meat teas should be avoided. 

Just that part of the meat which is cooked out of beef and into the broth 
in boiling is harmful. 

GROWING PAINS 

Some time ago, while I was in a drug store in Eochelle, Illinois, "killing 
time" between trains, a woman came in. She had two children tagging along. 
She called for a fifty-cent bottle of rheumatism cure. She said she had found 
it fine for growing pains. Her children were accustomed to much drugging 
and looked the part. They were typical, spindling, pale medicine takers. It 
was not necessary to listen to the woman or to see the purchase to know that. 

The mother paid her half-dollar and went on her way with her bottle of 
sure cure for growing pains. Had she gone into her yard and thrown a half- 



ARTHRITIS GERM INFECTION 145 

dollar at a post she would have missed the post and lost her half-dollar. That 
is just what she did in the drug store. IV hat she had got had not cost the pro^ 
ducer a tenth of a dollar and it was worse than useless to the child who took 
it — so she lost her half-dollar. She also missed the post, and that is what 
counts most. 

She had been relying upon medicine to cure rheumatism in her children. 
They did not hare rheumatism. "Growing" pains are not growing pains. The 
woman had learned that much. She had taken one step. Neither are growing 
pains rheumatism. They are infections. The infection finds entrance through 
the mouth. The mother had not taken that step. She had heard enough to 
get by the growing-pain stage, but she had stopped there. 

Nature had partly cured her children. The mother was satisfied with the 
cure and told the druggist so. She did not tell the druggist that such curing 
as was done had been accomplished by nature. She had not found that out. 
She had not even learned that cure of rheumatic pains in children is a poor 
makeshift; that children properly cared for would be prevented from having 
pains. She had wasted her 50 cents, but, far worse than that, she had missed 
the post. 

Those children should have had their tonsils and adenoids put in order. 
They should have been living the laws of hygiene. She was not thinking much 
about right living for her youngsters, because her limited experience told her 
that fifty cents' worth of medicine would ease the growing pains. Filling 
their stomachs with medicine, she was bringing up a pair of pasty, flabby 
youngsters trained to run to the medicine cabinet. 

We have well developed, active, and efficient departments of public hy- 
giene. Thinking people know these to be the best agencies used by government 
for the promotion of social efficiency. There is no organized agency for the 
promotion of personal hygiene. Such effort as there is is individual and 
sporadic. In consequence, the yellow wrapper and the lurid picture still hold 
the field. In consequence, mothers are still throwing half-dollars at posts and 
children are growing up pasty, spindle-shanked, and perpetually dope-hungry. 



ARTHRITIS GERM INFECTION 

It is now generally agreed that many of the so-called "rheumatisms" are 
caused by germs. The proof as to ordinary inflammatory rheumatism has been 
accumulating for a long time. In the last few years the proof as to rheuma- 
toid arthritis has been piling up. 

In the Journal of the American Medical Association Dr. Billings says 
that his opinion is that the deforming joint changes usually found in middle- 
aged people and known as rheumatoid arthritis are due to infection with a 
germ. The germ usually gets into the blood through the mouth or tonsils or 
nose. It sometimes gets in through suppuration elsewhere in the body. 

A chronic appendicitis, or an old pus tube, or an infected gall-bladder can 
cause it, as well as can catarrh and pyorrhea, bad teeth, and foul tonsils. It 
can be caused by an old gonococcal infection of the prostate gland and certain 
tubes running through it. 

This being true, the person developing rheumatoid arthritis, instead of 



146 



KHEUMATISM 



searching for some springs to go to, should search for the old spring within 
him, the spring of pus hidden away in some pocket in his insides and pouring 
germs into his blood. 

This spring, being found, should be cleaned up whenever possible. Most 
of the cleaning up will have to be surgical. The teeth, tonsils, nose pus sac, 
or offending tissue, wherever it is, should be made clean or else removed. 

Using vaccines made from the germs found present, Dr. Billings has dis- 
covered, helps some. Then follows an important point. Good food, sunshine, 
fresh air, massage, and rest can do a great deal to increase the capacity and to 
decrease the suffering of the person with deformed joints. 

The custom has been for the person with a developing arthritis to ruin 




Chicago Health Department. 
Fig. 71. — Cross Section (A) of The Head of a Normal Child and (B) of One Whose 
Tonsils and Adenoids have Enlarged so as to Block the Nasal Air Passage, 
Thereby Making a Mouth Breather of Him (B). 

his digestion with salicylates and iodicls; to ruin his vitality by strict dieting, 
abstaining from meat and other nutritious food; to ruin his pocketbook run- 
ning around to springs, and finally to lose confidence in everybody and every- 
thing, to come to the conclusion that he has an incurable disease, and then 
to lapse into helpless, hopeless invalidism. 

To drain the pus sacs and to clean up the dirty areas is the proper treat- 
ment for those who are in the earlier stages. It is well for the other group to 
know that it does not follow that its members should become helpless merely 
because they cannot be cured. 

It is well for the doctor to get the idea in his head that people with in- 
curable diseases are doubly in need of help; and arthritis patients, living hy- 
gienic lives and properly directed, will gain greatly in efficiency, as well as in 
comfort. 

PEOPLE WITH STIFF LEGS 

Any injury to, or infection of, a joint is liable to leave the joint stiff. 
The everyday man is still wrestling with the question : Which came first, the 



PEOPLE WITH STIFF LEGS 147 

hen or the egg. When the cynic would floor the bacteriologist for the count 
he asks : "Whence came the first bacillus ?" 

These busy little debaters have nothing on the anatomists who try to an- 
swer the question: Which came first, the muscles to move the joints or the 
joints to be moved by the muscles ? 

On this question, among anatomists, there are two hostile camps. But 
whichever came first, they both agree that, with all the ordinary joints, unless 
movement is kept up the joints will grow stiff. The ends of the adjacent 
bones will be bound immovably together. 

The tissues that make up the joints are low grade tissues. They have 
little power to resist germs. When germs are floating around in the blood 
the liver will pick up its share and more, and so will the kidneys. But these 
organs pitch them out instantly. 

However, when germs come the way of the joints the poor tissues there 
have no power to resist. Some form of infection results. Among these infec- 
tions are some that are commonly termed rheumatism. 

The low grade tissue of a joint, when inflamed, can do but one thing, and 
that is to pour out a sticky fluid. This fluid is about the same as the fluid 
which binds together the two sides of a cut. 

If the inflamed joint is neglected, this fluid glues the ends of the bones 
together. As time goes on, the union becomes stronger. 

At first, to limber up the joint causes some pain, but it can be accom- 
plished. After a while the adhesions are so strong that operation is required 
to break them up. 

Even if movement in a joint is not entirely lost from an attack, it will 
be noticed that after each attack the range of movement is more limited than 
before. All of which results from improper personal hygiene. 

It is proposed that when the joints are acutely inflamed the ends of the 
bones shall be kept apart by weights, as in fractures ; that, after an attack of 
rheumatism or other infection of the joints, massage, baths, and exercises be 
continued until full movement is established — to employ a term used by the 
Germans, that the cure be completed. 

Surgical procedures, though, are always halfway houses. In time, men 
will know enough to cure cancers without cutting them out and to do things 
in better ways than by surgical procedures. 

The direction of the present-day effort is toward the germs. Some are 
injecting antiseptic solutions into the joint, some are using vaccines ; some are 
working on antitoxins. 

Now that people are losing faith in charms such as buckeyes, are no longer 
depending on red flannel underwear, are no longer afraid of red meat, are no 
longer chasing a climate cure, things will look up. 

Effort expended on the hygiene of the gates through which rheumatism 
gets in, while the doctors perfect the method of curing that which has got in, 
will banish rheumatism. 

Another of the rheumatism fetiches that we have chased when we should 
have known better was the climate cure. Eheumatics are walking interrogation 
points in their search for a climate that cures rheumatism. 

There is none such. The English army is stationed in every portion of 
the world. Troops drawn from the same stratum of society are scattered from 



148 EHEUMATISM 

the tropics to the arctic. Some are at sea level and some at high altitudes. 
Some are in humid countries and others in the desert. 

The daily routine of these groups is pretty much the same, at least, it is 
much more uniform than is that of the different peoples of the different lands. 
The rheumatism rate is about the same. 

Hirsch, in his geographical pathology, tells us that rheumatism is every- 
where that man is. Perhaps there is a little less liability in hot climates ; per- 
haps there is a little less liability in the warm months, but the difference is 
slight. 

There are hot countries where the records show a great deal of rheuma- 
tism, and in India and Algeria there is more rheumatism in warm weather 
than in cold. 

The rheumatism rate given by Hirsch among British troops in Canada is 
35.9 and in the West Indies, 38.4. 

These facts have been known since the Civil War, and yet, because the 
people generally have not known them, a lot of people have wasted a lot of 
energy chasing a good rheumatism climate. 

However, it seems to me that in what are known as chronic rheumatic 
conditions, there has been most of loose firing and general waste of gunpowder. 
The custom is to call almost every persisting pain rheumatism, particularly if 
it be a leg or arm or a back pain. Likewise almost every ailment of a joint has 
been and still is called rheumatism. 

Hippocrates and the Arabian physicians thought all rheumatisms, aches, 
pains, joint affections, and catarrhs were the same thing. About 1600 the 
physicians separated these affections into two groups — rheumatism and ca- 
tarrhs. About 1800 they divided rheumatism into two groups — one, the acute 
rheumatic fever; the other, the disorder which twists and gnarls the joint — • 
rheumatoid arthritis. 

It was more than one hundred years ago that rheumatoid arthritis was 
found to be in nowise related to rheumatism. Yet nine people out of ten who 
have twisting fingers and locking joints think they are rheumatics. 

They have been the round of the springs and baths ; they have gone with- 
out red meat for months ; they have tried all the medicines and methods rec- 
ommended for rheumatism, and it has all been wasted. 

A hundred years ago there were those who had found out that rheumatic 
measures did not help these people. But there have been no popularizers to 
tell the people about these things and so they have not learned them. 

Rheumatoid arthritis probably in time will be divided into two or more 
diseases. The proper way to handle the rapidly crippling disorder that de- 
velops in people usually before middle life will be found quite different from 
the proper way to handle the slowly progressive disease that starts in old men 
and women and that enlarges and twists their fingers and toes throughout the 
remainder of their lives. 

The first variety is probably an infection taking place through the gums 
in many instances, and through some part of the mouth or nose in most in- 
stances. The infecting gum is not one of those causing rheumatism. The in- 
fection is not even in the joint. 

In rheumatoid arthritis the trouble is in the bone. The heads of the bones 
enlarge, and secondary changes occur in the joints. 



HYGIENE VERSUS RHEUMATISM 149 

In a normal joint everything is arranged in an extremely orderly fashion. 
Everything has a place and keeps to that place exactly. There is no surplus 
tissue. Every part is cut to fit. 

If there is an excess of fat elsewhere over the joint it dimples down to 
bone and sinew. The tendons run in nicely adjusted sheaths. - 

The joints are lined with a smooth membrane. The membrane is arranged 
as a closed, self-oiling sac. 

The ends of the bones grow larger than their shafts and they take just the 
shapes that best fit them for their functions. 

In rheumatoid arthritis there is an exceedingly mild, long continued in- 
flammation in these bone ends. For months nothing is noticed except a little 
tenderness. Then it is noticed that the joints are getting larger, which means 
that the bone ends are getting larger. 



HYGIENE VERSUS RHEUMATISM 

There are many generally held opinions about rheumatism and allied dis- 
orders of the joints that do not jibe with the known facts. Some of these 
popular ideas are not in accord with the facts that have been known for a long 
time but that the people have not heard about, probably because the doctors 
would not talk to the people about them and nobody else thought they had 
any right to do so. 

For instance, there is acute inflammatory rheumatism — the kind that 
makes the joints swell and throws the patient into a fever. Before the present 
rheumatics were born as good an authority as Hirsch, an author whose books 
are still standard, wrote : 

"Then, years ago, I conjectured that rheumatic fever is a specific, in- 
fective disease. . . . Today rheumatic fever has an assured place among the 
acute infective fevers." 

This was written somewhere about 1870. Yet there are rheumatics who 
have been shunning red meat for these forty years. 

Acute rheumatism is an infection. The bacteria causing it may get into 
the blood stream through almost any part of the body. Some of the organisms 
that cause it are extremely prone to get in through the tonsils. 

However, acute inflammation of the joints may result from different bac- 
teria, just as the lungs may be inflamed from tubercle bacilli or from pneu- 
monia cocci. Some of these are never known to get into the tonsils. For in- 
stance, the germs of venereal disease are especially liable to cause rheumatism. 

When one is subject to rheumatism, it is advisable to have the tonsils put 
in order and kept in order, but, with some people, that is not enough. The 
overhauling must not stop until every gateway for infection has been put in 
order. 

The proper treatment of acute inflammatory rheumatism is on the basis 
of infection. Salicylates to relieve the pain are all right. They make life 
more endurable ; possibly also they limit the injury done by the infection, but 
they do not run to the root of the trouble. 

Plenty of water to drink and the use of cathartics also serve their pur- 
pose. They rid the body of poison and increase resistance. 



150 BHEUMATISM 

Some of the best physicians now advocate treating rheumatism surgically. 
They say that the joint is infected; that the bones of an infected joint will 
grow together and stiffen the joint unless precautions are taken. Therefore, 
they put the limb up in a splint. The splint they prefer is one that pulls the 
ends of the bones apart. 

This method not only separates the bones, but it also overcomes the spas- 
modic pulling of the muscles — the source of much of the pain. After the 
trouble begins to subside they massage and exercise the joint. 

Then it will be noted that the ends of the bone, instead of meeting 
squarely end to end, come together at an angle. The joint can no longer be 
made perfectly straight. If it be the index finger, it will be noticed to be 
crooked at its last joint. 

The seat of the trouble lies not in the joint; it is in the end of the bone. 
As that enlarged, the joint had to shift itself somewhat; the ligaments and 
tendons were gradually pushed around into new places. 

Perhaps after a while the joint became completely locked, but this process 
was different from the rheumatism process which affects the joint but leaves 
the bone alone. 

So rheumatism has nothing to do with these gnarling chronic processes 
and when we go after these on a rheumatism basis we gain nothing. On 
the other hand, we have started on the right track when we quit the wrong 
track. At last we have made a beginning, and that is something. 

Is there anything that can be done for rheumatism ? Yes ; much can be 
done in the way of both prevention and cure. Skilled care will bring most 
men through an attack without any damage to his heart, kidneys or joints, 
even employing remedies for the relief of symptoms and allowing nature to 
cure the infection. 

In addition, the vaccines for rheumatism have approached perfection 
closely enough to have found their way into quite general use. 

There are many who think the surgical treatment already referred to 
gives results that are all that can be desired. 

Much the more important side of the matter, though, since it concerns 
more people, is the answer to the question: Can rheumatism be prevented? 
Again the answer is yes. The person who has proper regard for personal 
hygiene will lessen the number of attacks of rheumatism and may wholly 
escape. 

The first effort at personal hygiene should be to locate and clean up his 
focus of infection. It may be his tonsils or his gums. It may be a sinus, 
opening from his nose. 

Hippocrates thought rheumatism and catarrh were identical. In some 
cases of catarrh there is infection of one or more cavities. The pus drips into 
the nose and comes to be known as a catarrhal secretion. 

The so-called "catarrh" is a chronic infection of this cavity. At times bac- 
teria will absorb from this cavity, circulate for a brief period in the blood, and 
then locate in some joint and set up a case of rheumatism. 

Using the terms rheumatism and catarrh loosely, there was reason for be- 
lieving the two diseases to be closely akin. The more accurate information of 
our day brings some conditions called catarrh and some conditions called rheu- 
matism back again to kinship. 



HYGIENE VERSUS RHEUMATISM 151 

In those cases where the gateway of infection cannot be located or, "hav- 
ing been located/' cannot be cleaned up, personal hygiene can still help out. 
If chilling is prevented the organisms may not absorb or, having absorbed, 
they may not locate in a joint. 

The wearing of woolen underwear, of warm footwear, the use of rainproof 
clothes and shoes — such procedures cause the proper organs to eliminate the 
bacteria from the blood and prevent them from locating in the joints. 

Personal hygiene finds no more 'promising field than among the rheu- 
matic families. Such need not be perpetually up against it. They can throw 
away their buckeyes. 

Causes of Rheumatism. — J. J. C. asks what causes rheumatism. 

Reply. — Acute inflammatory rheumatism, which is, I judge, what you 
have in mind, is due to an infection. The infection travels to the joint 
through the blood. It may enter through one of several places, but the 
usual place where it gets in is the tonsils. A man having acute inflam- 
matory rheumatism should have his throat examined, and then have what- 
ever treatment may be found necessary directed to his throat. Nothing 
is gained by dieting in this form of rheumatism. Red meats are not harm- 
ful. What is called chronic rheumatism is a group of joint diseases. 
Sometimes what is called chronic rheumatism will be one of these. Some- 
times it will be another. Some of these are benefited by change in diet. 
Some are not. 

Rheumatoid Arthritis. — M. E. W. writes: "What is rheumatoid ar- 
thritis? If the blood in the small veins settles in little circles and spots 
on the legs, between the hips and knees, and back of both knees in spots 
larger than a silver dollar, causing a stiffness in the legs, what is the 
probable cause?" 

Reply. — 1. Rheumatoid arthritis is a chronic inflammation of the joints 
and the tissues around them, resulting from a mild, long continued infec- 
tion. In its most frequent form it is the condition seen in middle-aged 
people, especially women, causing the fingers slowly to stiffen and crook. 
A much more severe form is that which twists the joints and locks them. 
The infection gets in through the gums and tonsils. 

2. The dilation of the small veins under the skin, especially of the legs, 
is frequently found in women. It is of no consequence; does no harm; 
does not stiffen the legs, and does not lead to ordinary varicose veins. 

Rheumatism and Climate. — P. P. writes: "Will you kindly answer 
the following questions: 1. What climate in the United States is best for 
one afflicted with rheumatism? What climate is worst? Is the rate of 
rheumatic cases high at and near Chicago? 2. If a person had inflamma- 
tory rheumatism during the winter of 1910-11 and had now about recov- 
ered from the effects, would he be apt to have another attack this winter? 
3. What is the value of 'medicated' woolen underclothing which is recom- 
mended by some doctors for rheumatism? What is the best underwear for 
a person subject to rheumatism to wear? l+. Should a person bothered with 
rheumatism wear rubbers during the winter months? 5. Should a person 
who has had two bad attacks of inflammatory rheumatism during the last 
five years have his tonsils removed? Both cases of inflammatory rheu- 



152 RHEUMATISM 

matism were preceded by tonsillitis. 6. Is not the percentage of the cases 
of rheumatism in this section of the country on the increase? 7. Is rheu- 
matism hereditary? 8. What is the benefit of mineral baths for rheuma- 
tism? 9. What is the best diet for a person troubled with rheumatism?" 

Reply. — 1. There is but little rheumatism in the tropics. A warm, 
moist climate such as that of Georgia, Alabama, and Mississippi has some 
advantages, particularly during the late winter and for northern people. 
But climate is of secondary importance. As rheumatism is not a report- 
able disease it is impossible to do more than guess whether Chicago's rate 
is high or not. 

2. Yes. 

3. The "medicated" part is rank foolishness. Woolen underwear is 
proper. 

4. Yes. 

5. Yes. 

6. There is no way to tell. The statistics from army posts give infor- 
mation as to the amount of rheumatism amongst soldiers in different parts 
of the country and in different years. Conclusions from this as to con- 
ditions among the general population would be valuable. 

7. No. 

8. Mineral baths such as Benton Harbor, Mount Clemens, and Martins- 
ville will benefit certain kinds of so-called "rheumatism" and be of no serv- 
ice in others. I should say that what you call rheumatism is an infection of 
your joints by a germ which gets in through your tonsils. Baths will not 
help you any during an attack. They will help the soreness that stays 
after. 

9. A good nutritious diet containing meat is proper between attacks 
in the kind of trouble indicated by your letter. Muscular rheumatism, 
non-inflammatory rheumatism, rheumatic pains — the gouty type — do better 
on a low protein diet. 

Troubled with Rheumatism. — E. M. writes: "Will you please inform 
me whether raw fruit is beneficial in case of rheumatic trouble, and how 
about beer, whisky, or wines?" 

Reply. — 1. Strongly acid fruits should be avoided in the first stages. 
2. Alcoholic beverages of any kind should be avoided. 

Rheumatoid Arthritis Treatment. — R. writes: "What is arthritis? Is 
it curable? What are its symptoms? Does a person afflicted with it have 
to abstain from drink (alcohol)? What is the best remedy?" 

Reply. — 1. Arthritis means inflammation of a joint. Rheumatism is 
one form of arthritis, gout another. No doubt what you have in mind is 
rheumatoid arthritis. 

2. If this is what you have in mind, some cases can be cured; some 
cannot. The efficiency of the incurable cases can be lowered by neglect. 

3. Pain in the joints, slow enlargement, gradual locking. 

4. A little more need of abstaining than a well man has. 

5. Have tonsils, teeth, and nose put in good order, and kept so. Exer- 
cise, massage, nutritious food, vaccines. 

Meat and Rheumatism. — 8. J. writes: "I am a woman of 61 years. 
I have had rheumatism for several years, especially in my knee, and have 
gouty fingers. I have always been inclined to be anemic. Will beef in 



HYGIENE VERSUS RHEUMATISM 153 

moderate quantities cause rheumatism? Will meat cause either rheuma- 
tism or cancer f" 

Reply. — 1. No. 

2. It will not cause cancer. A high meat ration is not good for people 
with certain types of rheumatism. A small meat ration will not harm 
anybody. A diet made up largely of sour milk in its different forms, 
cheese, vegetables, and fruits is of some service in some cases of thickening 
joints in elderly people. 

Flannel No Rheumatism Cure. — Subscriber writes that medicated red 
flannel underwear is a cure for rheumatism. 

Reply. — In the good old days our fathers wore red flannel underwear 
and pretty nearly all had rheumatism. The red flannel cure for rheuma- 
tism has had its tryout and has gone the way of the buckeye. Of course, 
the medicated feature is a straight fraud. Old rheumatics are better off 
when warmly clad. Flannel underwear is warm. That is the only virtue. 



CHAPTER XIII 

Gout 

THE GOUTY DIATHESIS 

Men earn their diseases. 

This, however, does not mean that nothing contributes to a man's diseases 
but his own acts. A sick man may try to make his sickness individual, to pul 1 
away from his fellows like a sick dog that crawls under the house, but he can- 
not escape this fact — that disease is social, and, whether contagious or not, its 
effects can never be closely limited to the man who is sick. Nor is it a con- 
tradiction of the opening statement to say that one generation can no more 
escape the imprint of its predecessors than one individual can stand alone. 

Just as no sick man can stand apart, no generation, from the sickness 
standpoint, can fail to influence its successors. Dispositions toward obesity, 
cancer, apoplexy, feeble-mindedness, deafness, heart disease, consumption — 
called diatheses — are passed on in family strains. They are inherited. One of 
these, called by Duckworth the arthritic diathesis — the disposition to have 
rheumatism and gout — is an inherited tendency. 

A man with a gouty diathesis is subject to sore throat, rheumatism, and 
a variety of gouty pains. Such are families where there is a disposition toward 
apoplexy, heart disease, high blood pressure, arteriosclerosis and chronic 
Brighfs. 

But no man has the right to "lie down" because of his individual or fam- 
ily disposition. Such information should guide him in his method of living. 

A man whose family "runs to consumption" can eat as much as he wants, 
and frequently should eat more than he does. Life insurance figures show 
that fat men are not very liable to consumption. 

It is known that a man of the gouty type who has contracted consumption 
stands a fair show of curing it. Certainly there seems to be an antagonism 
between the gouty habit and consumption. 

Knowledge of these things increases rather than decreases personal re- 
sponsibility. If a man, knowing that consumption is in his family strain, 
neglects colds or ventilation, he earns that disease. If a man, knowing that 
apoplexy, heart disease, or rheumatism is in his family strain, does not regu- 
late his life accordingly, he earns the attacks which come. 

Being of a gouty type, there is the greater reason why he should have 
clean tonsils and teeth, why he should eat and drink temperately and keep 
himself fit. 

As spring comes tradition, to which we are all slaves in some measure, 
says that we should take spring medicine and blood purifiers. In olden times 
we went to the woods and dug up sassafras root or gathered some other kind of 
aromatic herb from which we brewed teas tasty and strong, therefore good. 

154 



THE GOUTY DIATHESIS 155 

It was noticed that the members of the family who got most out of the 
blood purifier were those who went into the woods to dig for the herbs. When 
herb doctors brought their goods to our doors both herb doctors and herbs fell 
into disrepute. 

Now herb sellers never prosper, druggists begrudge shelf room to spring 
medicines, and blood purifiers never go except where fortunes are spent in ad- 
vertising them. 

There were reasons for the rise and fall of spring medicines. The rise 
was because there is and always has been a need that the human animal, 
housed all winter, should be unhoused in the spring; the fall, because their 
advocates got their wires crossed. They held on to the herbs and abandoned 
the exercise and outing of a day in the woods. 

In the early spring people have a lot of skin eruptions which may be 
loosely termed as "gouty/' Usually these do not show until the "shank" of the 
winter, and they get better as the weather opens up in the spring. 

A few hours or, at most, a few days in the moist, outside air, a few rounds 
of good muscle exercise, a few "lathering sweats" and the bad effects of im- 
proper living during the winter are washed out, not of the blood but of the 
tissues. To drink plenty of water along with the exercise is a proper pro- 
cedure, and it does neither good nor harm to flavor the draught with sassafras 
and call it sassafras tea. 

While a few days of right living in the spring cures the eruptions, heals 
the skin and makes it soft, takes out some of the joint creaks and pains, and 
is generally to be recommended as a better procedure than drinking herb teas, 
blood purifiers, and spring tonics, it should not be forgotten that it is, after 
all, only a cure and, therefore, does not go to the heart of things. 

A better way to prevent gouty aches and pains and shin eruptions in the 
spring is to live lightly through the winter. 

Even though spring penance remove the visible expression of winter sin 
Old Man Gout sets the senility peg forward a hole. 

Lessened contagion and improved environment are moving the life period 
called old age to the farther side of 70; are setting the old age death mark 
beyond 90. On the other hand, venereal diseases, lead poisoning, gout, and 
rheumatism are doing their best to move them toward the period of middle life. 

The fight to postpone senility will make great headway as rheumatism is 
prevented through shielding against infection and gout through simpler, more 
wholesome living. 

In 1911 Mr. Eittenhouse of the Equitable Life Insurance Company pub- 
lished an interesting statistical study showing the growing importance of gout, 
Bright' s disease, and heart disease from the life insurance standpoint. 

He estimated the number dying in the United States in 1909 from these 
diseases as 235,660, as against 126,744 from consumption. He says: 

"It seems to me that the life threatened by apoplexy is just as much worth 
saving as the life threatened by tuberculosis. The loss of adult American life 
through the more important noncommunicable diseases has increased with 
extraordinary rapidity. Allowing for the increase in population, about two 
persons die now where one died thirty years ago from preventable or post- 
ponable diseases of the heart, arteries, kidneys, and brain, which usually affect 
a person in the most valuable and effective years in life." 



156 GOUT 

The principal reason for this increase is that so many of the population 
who formerly died in infancy, yonth, and early maturity are now living to the 
age of risk from heart and kidney disease. 

Let us imagine the citadel of long life surrounded by a series of hedges. 
As some of the outside of these — infant mortality, typhoid, contagion, con- 
sumption — have been cut away, the thorn trees called rheumatism and gout 
loom constantly larger. 

Gout. — M. M. C. writes: "What is the hest kind of diet for one who 
suffers with gout, and what should be avoided? Is it incurable in a man 
past middle age? What diet is best for a woman who has enlargement of 
the liver and weak stomach?" 

Reply. You should decrease the amount of food you eat by, say, 10 
to 20 per cent. Quit eating big, heavy dinners. Swear off. Make up the 
deficiency in ordinary food taken by eating fruit freely. I should advise 
the same course for the woman with an enlargement of the liver and a 
weak stomach, though much more important than the above is my advice 
to both of you to go to your physician and find out what is the matter 
with you. Gout, enlargement of the liver, weak stomach are all loosely 
used terms and cover a good many different conditions, some important, 
some not. 

Lumpy Fingers Show Gout. — H. E. R. writes: "Will you tell me what 
causes small lumps, which become sore, to form on the joints of the fingers, 
and if there is a simple remedy for them?" 

Reply. — My guess is that these are manifestations of gout. If so, so far 
as the present lumps are concerned, nothing will cause them to disappear. 
By changing your diet and your general method of living you will be able 
to stave off the development of additional lumps. 

Diet in Gout. — C. P. L. writes: "I am a sufferer from gouty fingers. 
Kindly indicate a diet that might prevent an increase of the trouble. If 
sweets are forbidden, is honey included?" 

Reply. — Decrease the quantity of food eaten. Double the quantity of 
water consumed. Reduce the quantity of meat to one-third your present 
ration. Increase the quantity of fruit and vegetables. Eat sweets and 
honey, but with the same temperance that applies to other foods. Do not 
tolerate constipation. Exercise in the open air. 

Rheumatism and Gout. — D. V. writes: "What is the difference between 
inflammatory rheumatism and gout? Does diet affect one who is subject to 
either of these complaints? Is the climate of Chicago much worse than a 
warmer and drier one for people who are inclined towards rheumatism?" 

Reply. — 1. Inflammatory rheumatism is probably a bacterial disease. 
The waste products found in the tissues during the disease are secondary 
in character. It usually occurs in those between 15 ,and 30. Heredity is 
not a factor in its causation. Several joints are involved. Gout is dis- 
tinctly a perversion of nutrition. Heredity is a strong factor. It is a 
disease of advanced age. The pain is usually localized in the big toes. 

2. Diet does not play much of a part in the production of rheumatism. 
Gout is caused by dietetic disturbances, chiefly the defective oxidation of 
proteids. Alcohol and rich and highly seasoned foods are important causes. 



THE GOUTY DIATHESIS 157 

Malnutrition and bad hygienic surroundings cause what is classed as "poor 
man's gout." 

3. A climate warmer and drier than that of Chicago would be beneficial 
to those who are strongly rheumatic. 



CHAPTEK XIV 

Diabetes 

It will come as a surprise to some who read this article that diabetes is 
not a kidney disease. In diabetes, sugar produced elsewhere in the body is 
excreted by the kidneys. It greatly irritates them, and, through this irrita- 
tion, it causes the secretion of large quantities of urine — quarts or gallons 
instead of pints. This, of course, means an enormous increase in the work 
of the kidneys, and, under this strain, kept up for years, the kidneys may 
give way and Bright's disease result. 

But diabetes, while it may eventually cause kidney disease, is not a kidney 
disease — diabetes means sugar in the urine, a symptom of a disease elsewhere 
in the tody. 

It may be caused by gluttonizing, gourmandizing, eating more food than 
the liver can handle. It may be caused by brain tumor. It may be caused 
by disease of the pancreas. Here are three abnormalities, each characterized 
by diabetes. 

The pancreas, called the sweetbread, is a gland which secretes a part of 
the digestive juices. In addition to the duct portion, it contains small islands 
of ductless glands that secrete a substance poured directly into the blood. 
This secretion turns sugars into harmless substances. When there is not 
enough of this secretion, the sugar is not changed, but stays in the blood as 
sugar, and, so long as they have the vitality to do the extra work, the kidneys 
separate it out. 

If a man's diabetes is of the first kind, say the liver kind, all that he 
has to do is to eat and live sensibly. In fact, the liver kind of diabetes, par- 
ticularly in a sensible person past middle life, is of no particular consequence. 
All that he need do is recognize that thereafter he must "sing a slender song," 
and, doing so, he may live to a round old age — say eighty or a hundred years. 

But the last type — those due to deficient secretion of the pancreas — are 
much more serious. They require the most skillful medical control — and 
control is a fine word to use in speaking of diabetes. 

Diabetics are subject to infections. A boil becomes a carbuncle — one boil 
develops a crop. A cold develops into pneumonia; consumption follows an 
exposure which an ordinary man would have no trouble with. 

This serves to introduce a phase of another most interesting question — 
what causes infection ? Of course, the infecting germ is necessary — that needs 
no emphasis — but that is not all. Why is it that germs in the skin of a healthy 
man do not infect at all or cause a boil at most, while in a diabetic they cause 
carbuncles, gangrene, and blood poisoning? Diabetes heightens susceptibility 
to blood poisoning, to pus cocci, and to consumption germs. An ordinary 
infection in a diabetic will cause the production of highly poisonous acetone 
bodies. This hypersusceptibility is not peculiar to those having islands of 
disease in their pancreas, 

158 



DIABETES 



159 



Acromegalics, cretins, those having Addison's disease and, in small meas- 
ure, those having- goiters, are more subject to infections and infections are 
more frequently fatal than in those with normal secretions. 

The sign by which the diagnosis is generally made is the presence of sugar 
in the urine. The test for sugar is so easily applied that the diabetic com- 
monly judges of his condition by the amount of sugar in his urine. 

WHOLE M/LK S/f/M M/LK 




FUEL VALUE- 



E 



PPOTE/n: 3.3 

'ARBOPY£>PATES:5. 



UNSWEETENED 
CONDENSED M/LK 




TE/At:3.A 

*AP0o#y/>PAr£s:5.t 



FUEL VALUE. 



310 CALORICS PEP POUND 



(65 CALOP/ES PEP POUA/&. 



BUTTERMILK 



fat:9. 



WATEP: 
9IO 



ASP: 17 



FAT.'O 
ASH: 0.7- 




780 CALOPIES PEPPOUPO 



PP0T£/N:30 

WB0PYDPAT£$;4A 



UT£/A/:2.S 
PBOPyDPAT£S:4i& 



FUEL VALUE: 



FUEL VALUE: 

□ 

160 CALOP/ES PEP POUN& 865 CALOP/ES PEP POUND 

Farmer's Bulletin, 363, U. S. Dept. of Agriculture, Chart 11. 

Fig. 72. — Food Values of Milk. 

The test for sugar is to add a few drops of urine to one-half an inch of 
hot Fehling's solution in a test tube. If the solution turns to a yellow, muddy, 
opaque liquid, sugar is present. The diabetic comes to know that the amount 
of sugar present can be gauged by the number of drops of urine required to 
produce the change in color. He judges of his condition by the amount of 
sugar in his urine. This is a good enough sign by which one's condition can 
be judged in an ordinary, slowly progressive case of diabetes. However, it is 
good judgment for the diabetic to keep in touch with his physician and to 
report to him at stated intervals for a careful, complete examination. 

Because the diabetic watches the sugar in his urine he frequently gets 
some wrong ideas as to the origin of sugar in the urine and the importance of 
sugar as an article of diet. 

The kidneys do not manufacture sugar. They merely remove sugar 
from the blood. The blood of all people contains sugar. In a normal person 



160 DIABETES 

the sugar of the blood is burned into carbonic acid. Sugar is manufactured 
everywhere in the body. Some of it is made from starch ; some from fat, and 
some from protein. Some of it is absorbed as sugar from the food; some is 
taken in the food as starch and converted into sugar by the digestive appa- 
ratus. The surplus sugar is stored as glycogen. Some of the blood is made 
from glycogen, the stored sugar surplus. 

When the sugar in the blood is in excess and the sugar appears in the 
urine, the common way to begin treatment is by cutting off that part of the 
sugar excess which comes from the diet. The articles cut out are honey, 
sugar, ordinary flour or bread, biscuits, rusks, toast, arrowroot, oatmeal, 
cracked wheat, potatoes, tapioca, sago, beans, turnips, carrots, parsnips, as- 
paragus, artichokes, squashes, beets, corn, rice, hominy, cabbage, lettuce, figs, 
grapes, prunes, apples, pears, bananas, jams, syrups, sweet pickles, chocolate, 
cocoa, liquors, wines, beer, liver, and oysters. 

The foods which are eaten are meat, poultry, game, bacon, ham, fish, eggs, 
cream cheese curd, buttermilk, cream, butter, olive oil and fats of all kinds, 
sauerkraut, lettuce, sorrel, mushrooms, cress, spinach, chicory, celery, cucum- 
bers, mustard, sour pickles, lemons, oranges and nuts, gluten breads — those 
kinds that contain only a small percentage of starch — bread crusts, milk and 
alkaline mineral waters. 

On the one hand food is not the only source of sugar, and on the other 
the diabetic diet may be so low in heat and energy units that the tissues of 
the body are burned to supply the deficiency. Therefore some diabetics do 
better when given a diet that is more liberal in starches and sugars. 

Old diabetics, especially those with a tendency to acid coma, need some 
starch and sugar in their diet. Some of them can be shielded by giving them 
a very large amount of fat, butter, olive oil, cod liver oil, cotton seed oil, fat 
meat. Some get relief by adding two apples to the daily ration. Some need 
oatmeal, and some potatoes cooked with the jackets on. 

Diabetes — Cause and Diet. — M. L. F. writes: "Will you kindly advise 
the real cause of diabetes and the best course to pursue to cure same? Am 
a middle-aged woman formerly of stout and healthy constitution." 

Reply. — 1. Diabetes may be caused by overeating — eating more than 
the liver can handle. It may also be caused by a diseased pancreas or 
tumor of the brain. 

2. The diet is the most important thing to be considered in treating a 
case of diabetes. The food should be nourishing and at the same time as 
free from carbohydrates — sugars and starches — as possible. Try the fol- 
lowing : 

Breakfast 

Four prunes cooked without sugar. 
Fresh bran muffins, with plenty of butter. 
Oatmeal with lots of cream. 
Coffee. 

Lunch 

Poached egg on toasted bran muffin, buttered. 

Crackers (diabetic) and a bit of cheese or some fresh rhubarb. 

Tea or milk with plenty of cream. 



DIABETES 161 

Occasionally chocolate, sweetened with saccharin, or buttermilk. 
Rhubarb sweetened with saccharin and glycerin, after it is cooked (use 
saccharin sparingly). 

Dinner. 

Any meat except liver. 

Fish of all kinds. 

Vegetables — Cabbage, cauliflower, asparagus, green beans, lettuce, rad- 
ishes, olives, celery, tomatoes. 

Desserts — Custards, made with very rich milk; strawberries, fresh. 
Sour orange and grapefruit. Eresh peach cobbler, batter made with gluten 
flour. 

Cheese, any kind. 

Nuts, any kind except chestnuts; often peanuts are excluded. 

A diabetic should never allow himself to get ravenously hungry. This 
is one of the great dangers that he faces, as it may cause him to overeat 
or eat the wrong food. One is about as bad as the other. If a diabetic 
feels the need of food between meals he can with safety take an eggnog 
with all the cream in it he can stand, or cup custard. It is a good plan to 
make up custards, baked in little brown bowls (individual) and keep on 
ice to eat between meals when hungry. A glass of buttermilk or nuts will 
often relieve a sense of hunger. A diabetic should, by all means, hava 
medical advice. 

Possibly Diabetes. — C. D. H. writes: "What is the cause of passing so 
much urine? I have to get up five and six times every night. I am 
troubled a great deal with my back and it gets so sore at times I can 
scarcely bear the weight of my clothing on it. I have always been a very 
light eater, but of late I am hungry all the time. I never seem to get 
anything that satisfies my hunger." 

Reply. — Have your urine examined for evidence of diabetes. 

Diabetes Sometimes Curable. — J. H. writes: "Is diabetes a curable 
disease? Give a list of things a diabetic may eat. How many years may a 
person 52 years old expect to live? Is medicine any good as a curative for 
diabetes? The patient lost twenty pounds before the disease was sus- 
pected." 

Reply. — 1. Some cases are curable, some are fatal, and some run on 
indefinitely. 

2. A diabetic can eat anything. He should eat sparingly of foods that 
contain much sugar and starch — for instance, bread, pastries, desserts, 
and potatoes. However, your question cannot be answered in this space. 
Get a cookbook for diabetics or von ISToorden's small book on diabetes. 

3. Ordinarily a diabetic 52 years old can count on many years of life. 
Rapid loss of flesh is a bad sign. 

4. As a cure, little; to relieve symptoms, medicine is of service. 

Diabetes and Bacillus Bulgaricus. — F. M. asks: "What curative value 
has 'Bacillus bulgaricus' in diabetes?" 

Reply. — I do not think it has any. I have seen an abstract of Metchni- 
koff's paper read in Paris in June and think those who have written me 
misunderstood his article. At most, this bacillus would help only that 
kind of glycosuria due to eating more sugar and starch than the system 



M% DIABETES 

could convert. It would not help in cases of diabetes due to nerve, brain, 
pancreas, or to some liver changes. 

Symptoms of Diabetes. — C. K. writes: "1. What are the symptoms of 
diabetes? 2. Does continued sitting affect the kidneys and are fruits and 
sugar injurious to the kidneys? 3. What is the best diet for persons with 
kidney trouble? If. What causes a steady ache in the small of the back 
and spells of weakness and faintness?" 

Reply. — 1. Sugar in the urine, frequent urination, large quantity of 
pale, heavier-than-water urine. There are many other symptoms. These 
are the more frequent and the easiest recognized. 

2. No, as to both questions. 

3. There are many different kidney troubles. The two most frequent 
are Bright's disease and diabetes. For Bright's disease the caution is 
against overeating, especially overeating of meats. For diabetes, against 
overeating, especially overeating of starch and sugar. 

4. The most frequent cause of backache is nervousness and nerve tire. 
Sometimes Bright's disease causes backache. The causes of weakness and 
faintness are many and varied. To try to say what causes them with you 
would be as risky as traveling in a flying machine. 

Examination of Urine for Diabetes. — P. 0. L. writes: "Please tell me 
the symptoms of diabetes/' 

Reply. — Any physician or laboratory and some druggists can examine 
for diabetes. The tests are simple. The most reliable symptom is the 
presence of sugar in the urine. A large quantity of urine is a symptom of 
some value. Repeated boils or carbuncles suggest the possibility of dia- 
betes. 

Stages of Diabetes. — M. W. writes: "1. Is diabetes a liver trouble or 
disease? 2. When the sugar deposit is thirty-four grains to the ounce, is 
the condition serious? S. What is acetone? When this stage is reached, 
is it the last in this disease? k> What are usually the last or serious devel- 
opments? 5. When developed between the ages of 50 and 60, is it rapid or 
slow in progress? 6. Is it hereditary? What seems to be the most general 
cause of this trouble?" 

Reply. — 1. Diabetes is the term usually used to cover all conditions that 
result in sugar in the urine. Sugar in the urine may result from disease 
of the brain or pancreas or from some of the disturbances of liver function. 
Therefore some cases of diabetes are due to liver trouble. 

2. Yes ; or it may easily become so. 

3. Acetone is the result of acid fermentations due to incomplete oxida- 
tion of albumin. It represents an advanced, though not necessarily the 
last, stage of the disease. 

4. Marked susceptibility to infections — acidoses — profound intoxication 
with the products of incomplete oxidation. 

5. Usually slow. 

6. (a) Some families suffer from it more than others. Strictly speak- 
ing, it is not hereditary, (b) Overeating. 

Not Diabetes Symptom. — A. M. W. writes: "Does a smarting and ach- 
ing after urinating indicate diabetes? Is diabetes curable? Ought one to 
follow some diet, and what should it be? For many years my ears have 



DIABETES 163 

rung. My hearing is acute. What occasions those sounds? Is there any 
connection between them and frequent expectoration of a clear mucus f 
Some days the expectoration is almost constant. Isn't it weakening to 
expectorate so frequently? I appear to have the average health and com- 
pare favorably with others except for the ills I mention, which may be 
reducing my vitality." 

Eeply. — 1. No. 

2. Some cases are. Most cases are not bad, but one can learn to live 
with diabetes and thus live out his full expectancy. 

3. If one has diabetes he should have his physician outline his diet and 
then supervise both as to diet and general habits. 

4. Probably some infection which traveled to your ears years ago. 

5. Probably, I think. 

6. No. Your physician will probably find nothing of importance wrong. 

Testing for Sugar.- — F. E. F. writes: "How is urine tested for the 
presence of sugar?" 

Reply. — By heating about a dram of Haines' solution and adding a few 
drops of urine. Sugar turns it yellow or reddish yellow. Iodin is not 
used. Albumin is tested for by placing about an inch of pure nitric acid 
in a test tube and floating some urine on it. If albumin is present a white 
solid ring forms at this line of contact. The specific gravity is taken with 
a special apparatus called the urinometer. Casts, pus, and blood are found 
by microscopic examination. These are the more usual and simpler tests. 

Buttermilk in Diabetes. — B. M. C. writes : "Is a quart of buttermilk a 
day too much to be taken by an invalid who has diabetes and hardening 
of the arteries and is unable to take exercise of any kind, being seated 
almost the entire day?" 

Eeply. — If he takes neither meat nor vegetables in addition — no. If the 
quart of buttermilk is a part of a fairly liberal diet — yes. 

Diabetes not Hereditary. — K. K. writes: "Will you kindly tell me 
something about diabetes? Is it hereditary? Is it contagious? Is it liable 
to be contracted by both sexes? What are the first symptoms or stages? 
Is one 68 years old liable to have it?" 

Reply. — 1. Diabetes is not a hereditary disease. Certain races are more 
susceptible to it than others. In essence it is caused by long continued 
nervous strain, which results in a disturbance of the pancreas and liver. 
The kidney symptoms are secondary. 

2. It is not a contagious disease. 

3. Both sexes suffer from diabetes. It not infrequently happens that 
man and wife are both affected by it. The relationship is not clearly under- 
stood. 

4. The first symptoms are increased thirst and sometimes increased 
appetite, a larger amount of water passed through the kidneys than usual, 
emaciation, and itching of the skin following. 

5. It is possible to have diabetes at the age of 68. Diabetes in a person 
63 is not grave. The younger the diabetic the graver the outlook. 

Diet and Diabetes. — L. M. writes: "1. Can diabetes be cured in its 
early stages? 2. What bread should one eat? 3. Is saccharin injurious?" 



164 DIABETES 

Keply. — 1. Diabetes is a symptom present in several different condi- 
tions. Some are curable; some tend to persist indefinitely without doing 
great harm; some are incurable and rapidly progressive. The outlook in 
any given case must depend upon the conditions of that case. 

2. Do not accept any diabetic bread merely because it is advertised as 
such. Insist upon a statement as to the amount of starch present. Do not 
try to do without starches entirely. Know how much you are eating and 
keep your starch diet below your danger line, or, better still, your harm line. 

3. It is. However, if you are a diabetic and must have sweets, saccharin 
is less injurious than sugar. The best plan is to learn to do without sweet 
tasting foods and drinks. 

Teeth in Diabetes. — J. G. 0. writes: "I am a diabetic and for the last 

five years have used saccharin as a sweetener for such food as requires it. 
I have an excessive deposit of tartar on my teeth, and consequently must 
fight pyorrhea constantly. Is it not dangerous to use saccharin continually 
as I do? Does it contribute to the tartar deposits? What can I do to pre- 
vent the tartar deposits and pyorrhea?" 

Keply. — 1. The referee board of the Department of Agriculture has 
decided that saccharin is harmful. Use none, or the minimum quantity. 

2. No. 

3. There is nothing to do except to visit your dentist for treatment of 
your teeth and gums at regular intervals. By intelligent care, a diabetic 
can live to a ripe old age. By intelligent care, also, pyorrhea can be held in 
check for many years. 



CHAPTEE XV 

Pellagra 

No other statement made at the recent meeting of the American Public 
Health Association was so important as that of the Public Health Service 
that the pellagra situation had been solved, that is, from the public health 
standpoint. As I understand the Service's position it is this: 

Pellagra is caused by a diet out of balance in certain directions. It can 
be prevented by the habitual use of a properly balanced diet. Where in a 
given closed community, for instance a hospital, pellagra is found to be pres- 
ent to a considerable degree, the disease can be banished by a rearrangement 
of the diet. In an open community, ordinary town and country life, the dis- 
ease can be eradicated according to the degree of change in diet which the 
people can be induced to make. 

So much for the position of the Public Health Service on the positive 
side. On the negative side it holds that the disease is not contagious nor com- 
municable; that it is not spread by flies or insects of any sort; that it is not 
caused by eating cornmeal; that it is not the result of living in insanitary 
houses. 

As to the ability of a change in diet to cure the individual case of pella- 
gra, that depends on the stage of the disease and other factors. On that point 
the Service had but little to say. Its work is with public health, not personal 
health, and still less with curative medicine. 

The changes in the diet recommended by Dr. Goldberger to prevent 
pellagra consist essentially in increasing the amounts in the daily diet of 
good fresh meat, peas, and beans. 

"The eventual eradication of pellagra from our South will depend largely 
on the successful introduction of common dried legumes into the winter 
dietary. A valuable step in this direction would be an increase in the cultiva- 
tion of some of the varieties of peas and beans and their preservation in the 
dried state for winter consumption. The farmers of the far south are plan- 
ning to decrease greatly the cotton acreage in 1915. They are investigating 
other crops. Under the stimulus given by the Public Health Service in ad- 
vocating this preventive for pellagra, there should be a large demand for peas, 
beans, fresh meat, milk, and eggs/' 

Cornfield peas grow well in most portions of the South. They are a 
good winter dish. Perhaps Mexican frijoles will also suit the southern soil 
and climate. 

Incidentally it occurs to me that the Public Health Service should in- 
quire as to the amount of pellagra among the frijole-eating Mexicans. 

Although the Public Health Service concerns itself with the problems of 
public health, in the main it can never keep closely within its field, nor keep 

165 



166 



PELLAGRA 



wholly out of other fields. The fields of public health, personal hygiene, and 
curative medicine constantly overflow one into the other. 

Along with Goldberger's recommendations of a certain diet list for those 
who would avoid pellagra there goes a detailed diet list for those who have 
the disease and would be cured. 
He says: 

"The patient should be given and urged to take (if necessary, tube fed) 
an abundance of fresh milk, eggs, fresh lean meat, beans, and peas (fresh and 
dried, not canned). 

"Milk. — Fresh milk alone, 
or in alternation with butter- 
milk, should be given freely. An 
adult should be urged to take 
not less than a pint and a half 
to two pints in twenty-four 
hours. 

"Eggs. — Fresh eggs should 
be allowed freely. In addition 
to the milk and meat an adult 
should take not less than four 
eggs a day. In certain of the 
severer forms it may be neces- 
sary to give the eggs in the form 
of albumin water. 

"Meat.— The meat should 
be fresh, lean meat. Whether 
all fresh meats are equally valu- 
able in treatment we do not 
know; future studies will have 
to determine this. Our experi- 
ence has been with beef alone. 
This may be served as scraped 
beef, as a roast, or as steak. 
Where mastication is painful, meat juice may be given instead. An adult 
should be urged to take at least half a pound of lean meat a day in addition 
to the milk, eggs, and legumes. It may be necessary in some instances to 
work up gradually to the point where these quantities can be taken. 

"Legumes. — We have been much impressed with the favorable results 
following the use of beans and peas alone. The beans and peas should be fresh 
or dried, not canned. A palatable pea or bean soup should be prepared and 
may be given freely. In addition to or in alternation with the soup the beans 
or peas should be served and eaten in any one of the other well-known 
forms. 

"In cases presenting only moderate or no gastro-intestinal symptoms there 
may be added in restricted amounts oatmeal, rice, and barley as cereals, pota- 
toes and onions as fresh vegetables, fresh or dried (not canned) fruits, and 
wheat or rye bread or biscuits." 




Fig. 73. — Buffalo Gnat, accused by some author 
ities of spreading Pellagra. (After H. Garman.) 



DIAGNOSIS AND TREATMENT OF PELLAGEA 



167 



DIAGNOSIS AND TREATMENT OF PELLAGRA 

In a paper read before the last meeting of the Associated Fraternities of 
America, Dr. Cloyd of the Woodmen of the World said that in 1911 pellagra 
was responsible for about three-quarters of one per cent of the deaths amongst 



tGMGRAMCE OF 
IATURAL 
lLTH LAWS 




DEFECTIVES ARE REPRODUCINGTHEIR 
KIND MORE RAPIDLY THAN THE NORMALS 



TO PREVENT THE CONTINUANCE OF SUCH 
CONDITIONS WE MUST HAVE THESE - 



SANITARY LIVING- 

CONDITIONS FOR 

RLL CLA55ES 




SOCIAL CENTER 
AUDIENCE ROOM 
FOR THE 
COMMUNITY 

WHERE THE PEOPLE 
CAM MEET SOCIALLY 



i 



nicwenn STATE 




Fig. 74, 



168 PELLAGRA 

the members of that order ; that in America there were nearly 10,000 known 
cases of the disease ; that while it was not contagious, no nurse nor physician 
nor other person having ever been known to contract the disease either in this 
country or in Europe from contact, nevertheless pellagra is spreading rapidly 
in all parts of the United States. 

He thought that there is — and beyond question he is right — a great need 
that physicians learn how to recognize pellagra when they see it. 

A few years ago one of the great diagnosticians of a northern city, while 
visiting in a southern state, carefully studied a typical pellagra and made a 
diagnosis of glossitis. That there was inflammation of the tongue — glossitis — 
was true, but that was present as one of the symptoms of pellagra. 

This able man was so struck by the red tongue present in the case that 
he saw that he made a diagnosis of inflammation of the tongue. Other men 
have seen nothing beyond red, cracked skin in some case or other and have 
made diagnoses of sunburn, eczema and like diseases. Others have called 
pellagra diarrhea, and still others have not been able to see beyond the mental 
state and have diagnosed cases of pellagra as melancholia. 

The moral is that both physicians and people must be on the alert for 
pellagra as an underlying cause of certain symptoms any one of which in a 
given case may stand out like Gibraltar. 

A very red, fiery, and painfully burning tongue is quite characteristic. 
The sensation of burning is felt all down the throat and gullet to the stomach. 
Diarrhea is generally present. It may alternate with constipation. The stools 
are very offensive. The breath is highly offensive. In my experience, these 
digestive symptoms from mouth to intestines are the most uniformly present 
and most characteristic. 

The skin symptoms consist of a bright red sunburn with thickening, 
roughening, scaling of the skin. As the skin scales off it leaves behind a pig- 
mentation similar in appearance to that of sunburn, and also similar in its 
distribution — the hands and forearms, the face, neck, and upper chest. The 
line between the affected and unaffected skin is sharp as is sunburn. When 
one passes his fingers over the affected skin it feels "as if sand were in the 
skin." 

The nervous symptoms from nervousness through melancholy to insanity 
are usually later and of less diagnostic value than the digestive disturbances 
and skin changes. 

As to treatment we quote Dr. Cloyd from the Western Review of No- 
vember, 1912: 

"The diet should be easily assimilable and highly nutritious. Meats, as a 
rule, agree with pellagrins and form an important part of the diet; eggs can 
generally be used to advantage ; milk is useful when it agrees, but as it often 
does not, peptonized milk, buttermilk, etc., should be used. Vegetables and 
cereals also can be given freely. Corn in all forms should be avoided until 
the corn theory of the etiology of the disease is disproved. The diet should be 
adjusted to the individual case, always remembering that the problem of the 
bodily upkeep in pellagra is of basic importance and should never be lost 
sight of from the beginning of the management. 

"General hygienic treatment is of great importance. Plenty of fresh air, 
quiet and pleasing surroundings, rest, and regularity in daily habits are es- 



DIAGNOSIS AND TREATMENT OF PELLAGRA 



169 



sential. Frequent baths are important in the treatment of pellagra ; hot and 
cold baths, simple and medicated douching, moist or dry rubs accompanied by 
special massage, have proved their worth. The special methods chosen must 
be adapted to the individual case. 

"Drugs are used in pellagra to treat the special symptoms as occasion 
arises. No specific treatment has yet been found. For general constitutional 
treatment arsenic in some form is generally used. 

"At the present time the measure that promises the greatest amount of 
success is removal of the patient to a high, cool altitude. The proof of this 
is found in the fact that most incipient cases clear up in winter. Patients sent 



£ £7 IT! ' ^ D\SerA5t\i 




State Board of Health, Jacksonville, Fla. 

Fig. 75. — Alert as to Contagion in His Cattle — Indifferent as to Contagion in His 

Own Family. 

to Asheville, North Carolina, and Tate Springs, Tennessee, have nearly all 
been benefited. I do not know of any patients who have been sent to the 
mountains of Colorado or the west, but it appears to me that a residence in 
that region ought to be tried." 

What shall the pellagrin do? First, change his diet. Eat more protein 
and less starch.. Second, live more hygienically. These he can and must do. 
If he can he should do the third — seek out the base of some perpetually snow- 
clad mountain. As the season progresses he should climb, keeping always 
above the snowline. 

Concerning Pellagra. — P. J. wants to know some of the symptoms of 
the beginning of pellagra and other information concerning the disease. 

Reply. — Pellagra is widely spread. There is much of it in Chicago and 
in the surrounding states, as well as in the South. Physicians in the South 
have learned how to recognize it in the last few years. Physicians in this 
part of the country (the Middle West) have not learned how to diagnose it 
until it is so far advanced that the subjects have had to be placed in insane 



170 PELLAGRA 

asylums. The reports of cases in Illinois have come from the Dunning 
institution and from the state asylums, particularly Bartonville. 

Something should be done to let people know what symptoms point 
toward pellagra. Most cases begin with a persisting heartburn. This is 
followed by diarrhea. If a man has a persisting heartburn and a diarrhea 
which keeps up, he had better see a doctor and get an examination. One 
of the things which he should ask is: Does this mean pellagra? About 
the same time the mouth gets red and raw areas are sometimes seen. The 
gums get sore. The tongue is red and patchy. The patient begins to lose 
weight. The patient is "blue" and melancholy. He thinks that his friends 
are not treating him right and that his family is going back on him. 

The eruption starts on the hands and face. At first it looks like an 
ordinary browning from the sun. Later it looks like a deeper sunburn. 
Sunburning in a person who has not been exposed to the sun enough to 
burn should always excite suspicion. One of the first diagnoses made in 
South Carolina was a man who sunburned brown in the summer, and he 
had not been out enough to account for it. But the doctor was not suspi- 
cious. In midwinter he turned up with a bad sunburn. His physician got 
suspicious, studied him more carefully, and made a diagnosis of pellagra. 

A diagnosis in an early case can only be made after a careful study 
of the case. That is the work of the doctor. 

The part of the patient is to get suspicious and go to a doctor if there 
is a heartburn which keeps up, a continued diarrhea, persisting sore, red 
gums, persisting red, splotchy tongue, blues, sunburn out of season or not 
explainable by exposure. 

Symptoms of Pellagra. — H. T. W. writes: "What are the most pro- 
nounced symptoms of pellagra?" 

Reply. — 1. Digestive system — Fiery red tongue, burning pain extend- 
ing from the mouth to the stomach, diarrhea, offensive stools, offensive 
breath. 

2. Skin — Sunburn on the hands and forearms, on the face and on the 
chest. The sunburn is usually limited to the exposed parts of the body. 
It usually looks like an ordinary sunburn. It may come without any 
exposure to the sun. 

3. Mental symptoms — Those of melancholia, mental distress, mental 
weakness, some delusions. 

The digestive symptoms generally come first and predominate. The 
skin symptoms next. The brain symptoms last. Every case has some of 
the above symptoms; few have all of them. 

Cause of Pellagra. — 8. writes: "What is the cause of pellagra? What 
is the length of time one generally lives after the first symptoms? Would 
you advise doctoring with home doctors or not? Is there such a thing as 
eating certain hinds of food and being protected from it? Do people have 
pellagra in a cold climate?" 

Reply. — 1. The cause is not certainly known. 

2. Some say two years. Some cases live longer than that. Many die 
rather quickly after they know of the disease. 

3. Your home doctors know about pellagra better than anybody else. 
Beware of pellagra cures. 

4. The Public Health Service says so. Ask Congressman Humphreys to 
get the public health report of October 23 for you. 

5. Yes. 



DIAGNOSIS AND TREATMENT OF PELLAGEA 171 

Warnings of Pellagra. — D. A. writes: "Will you please give the symp- 
toms of pellagra? Can a person have the disease without feeling some ill 
effects? Is there any other disease similar to it?" 

Reply. — What you want to know is what symptoms should cause you 
to suspect pellagra and investigate further. 

1. A persisting red sore tongue. 

2. Burning in the esophagus or gullet. 

3. Sunburn without adequate cause. Generally speaking the sunburn 
is in the ordinary locations of sunburn — the neck, chest, shoulders, and 
forearm. 

4. Sense of weakness for which there is no other cause. 

5. Persisting indigestion. 

Any one of these symptoms should cause you to investigate the possi- 
bility that you have pellagra. The disease is often confused with other 
diseases. 

Thousands of Cases. — 8. W. R. writes: "Will you kindly advise 
whether there has ever been an authentically diagnosed case of pellagra in 
North America? I should also like to have you state what the disease is 
and its cause" 

Reply. — Yes, many thousands. Several die of it each year in Chicago. 
They are so registered in the Bureau of Vital Statistics. Some were diag- 
nosed by a man who had seen a great deal of pellagra in the United States 
and abroad. Its cause is not determined. The symptoms fall into three 
groups: Those which affect the digestive apparatus, those which affect 
the brain, and those which affect the skin. 



©HAPTEK XVI 

Beriberi 

This disease is of no direct interest to the people living within the United 
States. To us it is a medical curiosity. Few of our people have it. Never 
in our history have many people had it. There is no likelihood that they will 
ever have it. Then why take the trouble to learn about it ? 

There are several reasons. We see in the fight against beriberi one of the 
conquests of preventive medicine. From a study of the proved facts about 
beriberi we get some facts that are of value on the general food situation. 

Finally, beriberi is somewhat like pellagra and infantile scurvy, and the 
fight against beriberi may teach us something about these other diseases. 

Since we took possession of the Philippines the United States army has 
maintained a small native army known as the Philippine Scouts. These 5,200 
natives are scattered in small companies throughout the islands. Although 
widely scattered, they are fed a uniform ration provided by the government. 

The government spent six years in trying to develop a plan to combat 
beriberi. 

In 1908, 618 cases and in 1909, 558 cases of this disease developed in this 
small army. Some of these cases died, and some were invalided on account 
of disability. 

By 1910 the army authorities had matured their plan, and in that year 
they got it going in earnest. In 1910 the number of cases dropped to fifty. 
In 1911 there were three cases; in 1912, two; in 1913, none, and in 1914 (the 
first six months), one. 

Out of each 1,000 scouts in 1908, 121 were disabled from beriberi — about 
one-eighth of the entire command. Out of each 1,000 in the last four years 
twenty-eight were disabled per year — about one for every 4,000. The last death 
of a scout from beriberi occurred in 1911. In that year there was one death 
from this disease. 

The largest number of admissions to the hospital for this disease in any 
month was in January, 1909 — 138. The last month in which more than one 
case was admitted to the hospital for beriberi was August, 1910 — two cases. 
No case was admitted to the hospital from June, 1912, to April, 1914. 

There has been no case of beriberi among white troops serving in the 
Philippines since January, 1910. 

The United States army has succeeded in the last ten years in entirely 
controlling a group of very important diseases, not only in its own ranks but 
in the communities over which it has had control. These diseases are yellow 
fever, smallpox, typhoid fever, and beriberi. These four diseases have been 
absolutely wiped out in the various divisions of the army. If the army has 
been able to wipe out these diseases, it will be able to wipe out others. 

What we are more interested in is the next proposition. If the army can 

172 



BERIBERI 



1*3 



wipe out these diseases, then civil populations can wipe them out. They have 
already wiped out yellow fever. When will they wipe out smallpox and 
typhoid ? 

Furthermore, the army has demonstrated its ability greatly to lessen 
pneumonia, malaria, and venereal disease. The reports from Panama show 
that it has been able to lessen pneumonia to one-half and malaria to one-tenth 
of its former rates. The statistics of the army itself show that it has lowered 
the venereal disease rate to one-third of its former rate. 

If the army has accomplished 
this much with pneumonia, why 
should we not begin? If malaria 
is lessening the price of land in 
Mississippi and malaria can be con- 
trolled, why does not Mississippi 
control it? 

The army ration in use by the 
Philippine scouts when beriberi was 
so prevalent consisted of fresh beef, 
twelve ounces; flour, eight ounces; 
baking powder, one-third of an 
ounce ; rice, twenty ounces ; potatoes, 
eight ounces; coffee, roasted and 
ground, one ounce; sugar, two 
ounces; vinegar, salt and pepper. 

In place of fresh beef one of 
the following was substituted at 
times: bacon, eight ounces; canned 
meat, eight ounces; canned or fresh 
fish, twelve ounces. In place of the 

flour and baking powder, hard bread, eight ounces, was substituted at times; 
in place of the potatoes, eight ounces of onions. 

Instead of twenty ounces of polished rice were substituted sixteen ounces 
of Filipino rice No. 2 or Sargon rice. These are undermilled or unpolished 
rices. In place of potatoes they used camotes, eight ounces, and mongos, four 
ounces. Camote is a vegetable akin to the sweet potato; mongo is a species 
of pea. The coffee ration was cut in half and half an ounce of ginger root 
was issued. The use of Filipino No. 2 rice continued until June, 1911. 

Since June, 1911, the ration in use has been the following: fresh beef, 
twelve ounces ; flour, eight ounces ; baking powder, one-third ounce ; unpolished 
rice, twenty ounces; potatoes, eight ounces; coffee, roasted and ground, one 
ounce; sugar, two ounces; vinegar, eight one-hundredths gill; salt, two-thirds 
ounce; black pepper, one-fiftieth ounce. 

At times in place of fresh beef eight ounces of bacon or eight ounces of 
canned meat, or twelve ounces of fish, fresh or canned, was used; in place of 
the flour, eight ounces of bread; in place of potatoes, eight ounces of onions 
were used. 

While twenty ounces of unpolished rice was the allowance, the authorities 
insisted that not over sixteen ounces be drawn, but that some other vegetable 
food be substituted. For instance, in place of four ounces of the rice they ad- 




Virginia Health Bulletin. 

Fig. 76. — A Good Type of Dry Earth Privy. 
Door raised to show bucket. 



174 BERIBERI 

vised sixteen ounces of beans. They required that as much use as possible be 
made of such native products as camotes, mongos, and squash. 

The essential difference between the diet under which the men got beri- 
beri and that under which they escaped it was in the rice. The difference was 
not so much in the amount of rice eaten nor in the proportion of rice to the 
other foods in the different diets. The difference was in the quality of the 
rice. 

The men developed beriberi when they ate high grade polished rice. They 
did not get it when they ate undermilled or unpolished rice. The Filipino No. 
2 rice evidently contained a good deal of rice mills. 

Major Chamberlain of the United States Army, who was in charge of 
the beriberi work among the scouts when this change was being effected, says : 

"Filipino No. 2 rice was unsightly and consequently aroused opposition 
among the men. Ginger root could not be made popular. Therefore the 
ration was changed on May 8, 1911, to that shown in table 4 (the last given), 
which has continued in force to the present time. 

"This ration obviates the practical disadvantages of the preceding one, 
yet embodies all the features important for beriberi prevention, viz., use of 
unpolished rice in an amount not exceeding sixteen ounces and compulsory 
consumption of sixteen ounces of beans. The beans used are ordinary dried 
navy beans, for which mongos may be substituted. 

"The undermilled rice is of the highest grade, has a white pericarp, is 
palatable and not unsightly in appearance, and contains 0.4 per cent of phos- 
phorus pentoxid." 

In the opinion of Dr. Chamberlain the phosphoric acid of rice is not the 
element which prevents beriberi, but it is present in that portion of the outside 
of the rice berry which is necessary if beriberi is to be prevented. Therefore 
to determine the amount of phosphoric acid present is the easy way to tell 
whether the rice will cause beriberi or not. 

The vitamin necessary to prevent this disease is contained in considerable 
quantity in the hard white outer layers of the berry. 

Let no one understand that rice causes beriberi. It is treated rice which 
does it. No food is better for beriberi than unrobbed rice. 

Other foods which have been shown to produce beriberi are fine wheat 
flour, white wheat bread with or without yeast, macaroni, ship biscuit, sago, 
hominy, cornstarch, various breakfast foods, and potatoes. 

Do not get the idea that eating a mixed ration in which there is fine 
wheat bread will cause beriberi. It will not. If the diet consists of white 
bread entirely, or largely of it, or if there is nothing in the ration to supply 
the something which was taken from the wheat berry in the milling process, 
beriberi develops. 

Another fact which has been well established is that prolonged cooking 
and cooking at high temperatures destroys the vitamins which prevent beriberi. 
If a food substance which in the 'raw state contains barely enough vitamins 
is cooked at a high temperature above 250 or is boiled at a lower temperature 
for a long time, enough cf its vitamins will be destroyed to put it into the 
class of foods capable of producing beriberi. A temperature of 200 does not 
affect it. The substance which prevents scurvy in babies is destroyed by a 
temperature of 200. 



BEEIBERI 



175 



In a general way what ice learn from the work with beriberi is that we 
have been in the habit of ov err e fining and overpreparing our foods, We have 
got too far away from nature. We shall be better off if we backtrack a little 
on the route by which we have come up from the cave man. 

While it is not necessary that we should grub roots with our fingers, 
crack nuts with our teeth, and eat raw meat, we shall be somewhat more 




Fig. 77. — Framework for Model Privy House. Such a house is not necessary, but can be 
conveniently and cheaply built about the privy box. The latter is the all-important part 
of the privy. 



176 BERIBERI 

resistant to disease and somewhat freer from what the doctors call "diathesis" 
if we eat more bran with our cereals, our rice, and our flour; more peeling with 
our fruit, more fiber with our meat, and more fresh vegetables and fruit, and 
if some time during the day we eat some suitable article of diet in the. raw 
state. 

Beriberi begins with a loss of appetite, headache, a mild fever, pain in the 
stomach and a sense of weight in the chest. The disease progresses unevenly. 
It gets worse for a while and then lets up, gets better and then gets worse. 

There are four varieties of the disease. In the mildest form there are pain 
in the legs, swelling of the ankles, weakness in the muscles of the legs, and 
finally a loss of sensation below the hips. In the atrophic form the weakness 
of the leg muscles is followed by paralysis and muscular atrophy. The 
muscles shrink up somewhat as in infantile paralysis. Patches of skin on the 
legs lose all sensation. In other areas there are neuralgic pains. There is 
generally dropsy in the feet. 

In another variety dropsy of the legs overshadows the wasting. The 
dropsy may be elsewhere in the body, as well as in the legs. In this variety 
palpitation of the heart and difficult breathing are prominent symptoms. 

In the fourth variety the prominent symptom is weakness, accompanied 
by great disturbance of the heart. The heart disturbance takes the form of 
palpitation. Breathing is difficult. 

As a result of the deficiency in the diet there is inflammation of certain 
nerves. Just which nerves are most inflamed determines which symptoms are 
most prominent. In most cases the involved nerves are those which run to 
the legs; therefore, in most cases the prominent symptoms are paralysis of 
the legs, wasting of the leg muscles, dropsy of the legs, and a division of the 
skin of the legs into painful areas and areas in which there is no feeling. 

The symptoms of pellagra are very different from those of beriberi. The 
nerves and organs involved differ from those of beriberi. And yet when we 
analyze more closely, when we study the phenomena which lie below the sur- 
face, there is a good deal of similarity between the diseases. 

The present trend of opinion is that the cause of pellagra lies in freak 
diets. The Public Health Service is advising that the disease be prevented by 
changing the diet. One of the changes which it recommends is that more 
beans and peas be eaten. With this exception the changes in diet recom- 
mended for pellagra are not those recommended for beriberi. 

Infantile scurvy is a condition of great importance. There are cases in 
which the baby is very definitely sick. The more important group of scurvy 
cases are the babies who are not definitely sick. They teethe slowly, are slow 
about sitting alone and crawling. They seem weak in the back. More fre- 
quently than otherwise they are fat. 

These are very mild cases of infantile scurvy. As in the case of beriberi, 
they need some change in their diet. Generally they need less fat and more 
starch. What is more important, they need orange juice, prune juice, per- 
haps lemon or lime iuice, perhaps some apple, and possibly some potato. 



PEEVENTION" OF BEEIBEEI 



177 



PREVENTION OF BERIBERI 

The Japanese, in preparing for the war with Eussia, decided that they 
would prevent preventable disease. They were a small nation; Eussia was a 
large one. Preventable disease was four times as destructive as bullets. If 
they were to prevent preventable disease and the Eussians were to follow prece- 
dents, their army would be as effective as an army four times as great. They 
would whip the Eussians by preventing preventable disease — simple enough! 




j f ^m m 

plank sides 



farfl, F,i/ 






Fig. 78. — A Good Cheap Privy. 



They overlooked one disease; they classed beriberi as a nonpreventable. 
Ninety-seven thousand of their troops had this disease. As a sick soldier re- 
quires another soldier to wait on him, that meant nearly 200,000 troops made 
ineffective. 

Beriberi is a baffling disease. It is an inflammation of the nerves. As a 
result of the nerve changes, the sick person has dropsy, becomes weak and 
eventually dies. 

There is a little beriberi scattered around the United States, but not 
much. We never thought much about it until we became imperialistic. 
When we took over coolies and laborers of similar standards of life we took 
over beriberi. 

We put our students to work on it at once. Those diseases of the other 
fellow, his wife and his children, interest us greatly. x\fter beriberi we went 
with hammer and tongs. 

It baffled the best specialists we had. Some said a bacillus caused it. 
Others said it was due to a monotonous diet of rice. 

Each side could show that the other side was wrong, but it could not 



178 BEEIBERI 

show it was right. The bacteria advocates showed in turn that each chemical 
in rice was incapable by its presence or absence of causing the disease. 

Wow the rice group has won. That it has proved its position is generally 
accepted. Beriberi is due to taking rice deprived of a delicate ferment pres- 
ent in the bran. It is caused, not by eating rice, but by eating polished rice. 
If the rice is not polished it can be fed indefinitely without harm, or, if a little 
bran is added, the harm is escaped. 

If beriberi subjects, in the early stages, are given a little of this bran, 
they recover from the disease. It has been proved many times on fowls, and 
is now being applied to men. 

It is proposed to change the eating customs of the rice-eating people, at 
least to the extent of having them eat undermilled rice. 

Why did the chemical escape the earlier analyses ? They were for phos- 
phorus, carbon, proteins, carbohydrates, and similar gross substances. No- 
body thought of looking for this delicate ferment in the bran, and, besides, 
it was present in a minute homeopathic dose, a grain to a barrel or a similar 
laughable dilution. 

Major Hess of the army tells us that the Japanese discipline was equal 
to their preparedness. It has been recently decided that they shall eat under- 
milled rice, and they will thus prevent the disablement of 97,000 of their 
troops. 



CHAPTEE XVII 

Scurvy — Scrofula — Rickets 

SCURVY 

"In scurvy there is a swelling around the eyes over which the skin has the 
color of a bruise, and a pale face which looks bloated." There are rheumatic 
pains. The gums swell and the teeth become loose. The breath is about 
as offensive as after salivation. There is nosebleed and there is bleeding from 
the gums. The hemorrhage may be profuse. There are small hemorrhagic 
patches in the skin. Meanwhile the rheumatic symptoms become much worse. 

Such is old-fashioned scurvy. Some of the soldiers of '61 remember it. 
Some sailors have seen it, but few of the ordinary run of people know this 
picture. Yet a large part of the population will have a "touch of scurvy" 
every year before May. 

With some it will go no further than repeated spells of bad breath ; with 
others a multitude of vague aches and pains variously called rheumatism, 
sciatica, lumbago, gout; with others there will be attacks of sore gums; with 
others the face will be pale and a little bloated, with dark circles and slight 
bloats around the eye ; with others there will be patches of skin eruption. 

To call these conditions scurvy is to exaggerate. To say they are touched 
with scurvy is perhaps as good as any way to put it. 

Babies are prone to scurvy. The gums swell, become spongy and sore. 
Sometimes there is a soreness and swelling of the thighs. Barlow says : 
"Sometimes there develops a rather sudden swelling of one eyebrow, with 
puffiness and very slight staining of the upper lid." 

With babies, as with grown children, a touch of scurvy is much more fre- 
quent than the fully developed disease. 

An investigation of 134 epidemics of scurvy, going back 400 years, shows 
that the disease is one of winter and spring. In the ordinary forms of scurvy 
and near-scurvy it is also true that "spring is the proper season for scurvy 
and next to it would come winter." This is because of the weather as much 
as it is because of the difference between winter and summer foods. 

One of the first men to write about scurvy, Lind, thought the wet and 
cold of the spring months were responsible for this disease. He put great 
stress upon the amount of the disease among common sailors, "whose clothes 
were frequently drenched and whose sleeping bunks were usually damp." 

In 1795 Blane drew up the English regulations for provisioning ships 
which won for the English navy the sobriquet of "lime suckers/' but which also 
ended epidemic scurvy in that navy and indirectly brought the disease under 
control in the civilized world. Since that time there has been a universal 
opinion that the food of winter and spring has been the cause of scurvy in 
those seasons. 

179 



180 SCUKVY— SCKOFULA— BICKETS 

Everybody is agreed with the opinio?! of Hirsch that in the causation of 
scurvy "diet is the alpha and omega/' So far as scurvy in babies is con- 
cerned the opinion of the American Pediatric Society, rendered some twenty 
years ago, was that "the farther a food is removed in character from the 
natural food of a child the more likely its use is to be followed by the develop- 
ment of scurvy." 

The above statements are true of touches of scurvy as well as of developed 
scurvy. After a person has been living on a meat and bread diet for several 
months and has developed a touch of scurvy it is necessary in order to cure 
him to go a little further in the dieting line than would have been necessary 
had the intent been to prevent alone. In other words, the diet must act as 
a cure as well as a preventive. 

The consensus of opinion is that the vegetable acids and carbonates are 
the chemicals in vegetables and fruit which prevent scurvy. 

Most of the diets put out as proper for certain diseases are without scien- 
tific basis. Here is one of the few exceptions. Scurvy, including touches of 
scurvy, is to be cured by diet and practically by diet alone. 

A long while ago Hirsch printed the following as the grains per ounce 
of carbonate of potash in certain foods: 

Large potatoes 1.875 Beef (salted) 0.394 

Small potatoes 1.310 Onions 0.333 

Lime juice 0.852 Wheat bread 0.258 

Lemon juice 0.846 Cheese (Dutch) 0.230 

Unripe oranges 0.675 Flour (best) 0.1 

Mutton (cooked) 0.673 Oatmeal 0.054 

Beef (raw) 0.599 Eice 0.1 

Peas 0.529 

The best foods for scurvy, according to this list, are potatoes, lime juice, 
and lemon juice. 

While we are not all agreed as to just what chemical does the work, 
there is a general agreement that it is some chemical found in fruits and 
fresh vegetables. Among fruits the best are lemons, oranges, and grapefruit, 
though all fruits are good. Among vegetables those heading the list are 
potatoes, watercress, cabbage, lettuce, and sauerkraut. 

Of course, babies cannot go so far as sauerkraut. Usually they must 
stop with orange juice, prune juice, and perhaps some of the older ones can 
take lemon or lime juice. 

Well-cooked potatoes may come along after the infant has been trained 
to digest starches, with oatmeal gruels and crackers. 

Some of the old-time reports on vegetables and scurvy are interesting. 
Herr says that in the Army of the Potomac in the winter of 1862-63 there 
was much scurvy. Fresh vegetables could not be had at all. After a great 
deal of difficulty the soldiers got a small stock of potatoes and cabbages. 
The beneficial effect of even this small supply was marvelous. 

In the siege of Paris in 1871 "it was when the supply of fresh vegetables, 
particularly of potatoes, failed that the disease broke out." 

The amount of scurvy has greatly lessened in the last few centuries. 
Drawitz wrote in 1647: 



SCURVY 181 

"All mankind will soon be scurvied, for most children are conceived in 
scurvy and born with it." 

In the sixteenth century vegetables were so few, Hirsch tells us, that 
when Catherine of Aragon, wife of Henry VIII, wanted a salad for her table 
she had to send her gardener to Holland to get it. 

In that meat-eating age scurvy was rife, not directly because of the 
abundance of meat but indirectly because of the scarcity of vegetables and 
fruits. 

It would be proper to say that the railroads cured the worst of the 
scurvy situation. Cold storage deserves about as much of the credit. Truck 
gardeners and fruit growers are entitled to their, share. 

However, those who read this volume are especially interested in the 
personal side. "How can I get through this winter and early spring without 
skin eruptions, rheumatic pains, puffy face, and the other signs of a touch of 
scurvy ?" 

The first requisite is to eat fruit for breakfast. Especially should the 
Southern people substitute fruit for some of the meat in their heavy biscuit- 
steak-waffles breakfast. Two fruits should be eaten each morning — one raw 
and one cooked. 

The best raw fruits are oranges, limes, lemons, grapefruits, pineapples, 
and apples. In addition cooked apricots, apples, peaches, pears, baked 
apples, or other fruit should be eaten. As soon as the berries come in the 
spring scurvy goes out. 

An excellent plan is to keep apples handy. A plate of well washed 
apples should be in the sitting room. Indoor workers will do well to eat at 
least one apple during the day and one before retiring at night. 

If apples are not to be had there is a good substitute — the turnip. Every 
farmer can go into winter quarters with plenty of turnips. A nice raw turnip 
is about as palatable for most people as a raw apple. Eaw turnip is no more 
apt to give stomachache than is a raw apple. 

Winter is the season of the year when raw carrots are good for the 
complexion. A muddy complexion characterizes scurvy unless profuse hemor- 
rhage has changed it to a ghastly color. 

Eaw carrots, by preventing and curing spring touches of scurvy, may 
prevent some muddiness, some pumness, and may cure up some spring 
blotches. 

An excellent preventive of scurvy, not in good standing with some 
people, is collards. This vegetable, sometimes called winter collards because 
it stands the cold well, is found in the gardens of most negroes in the South. 
It is worth a great deal to health that the winter-bound negro laborers, 
living on a narrow diet, can have a mess of collards, the great scurvy killer, 
once or twice a week. 

Eaw vegetables are better than cooked from the scurvy standpoint. There 
is some reason for thinking that there are ferments — delicate chemical sub- 
stances — present in raw vegetables and essential for health, and that these are 
destroyed at the cooking temperature. Probably also the salts of vegetables 
are washed out in the cooking process, and- these necessary substances are 
thrown away with the cooking water. 

A good vegetable soup containing carrots, parsnips, potatoes, turnips, 



182 



SCURVY— SCKOFULA— RICKETS 



okra, and onion is healthy. Above we gave the usual list of vegetables pre- 
scribed by physicians — potatoes, cress, cabbage, lettuce, and sauerkraut. 
To it we have added carrots, turnips, okra, parsnips, and collards. 

We can also say a good word for greens of all sorts. Spinach is the 
most popular. It is easy to carry spinach in cold storage, and in consequence 
this top finds its way into market all through the winter. 

Just as good are mustard, turnip, and beet greens. Asparagus, cauli- 
flower, kohlrabi, and Brussels sprouts are in the same class with cabbage. 
Many people gain by making a soup of the water in which these vegetables 
have been cooked. Tomatoes and all other forms of tart vegetables and fruits 
are good means of warding off scurvy. 



SCURVY, HOW TO KNOW IT AND WHAT TO DO ABOUT IT 



Scurvy in babies develops when they are 10 to 14 months old. Some 
younger and some older ones have it, but those are the months of greatest 
danger. It will be noticed that this is just the time of life when the baby has 
been taken off fresh breast milk and has not yet got on a diet containing 
vegetables and fruits. 




Poupart's Ligament Group 
Perineum 
Genitalia 

Buttocks (internal aspect) 
Lumbar region 



Saphenous Group 
Foot 
Knee 
Leg 
Buttocks (external aspect) 



Fig. 79. — Diagram of the Gland Groups in the Groin and the Regions Which Should 
BE Examined for Sources of Infection When These Glands are Enlarged. 



SCURVY, HOW TO KXOW IT AND WHAT TO DO ABOUT IT 183 



The disease begins usually as follows : A fat but trail and flabby baby 
is feverish and fretful for a few days. Then it will be noticed that the 
child's limbs are so painful that it cries out when they are moved. The 
bones are swollen, sore, and tender. The skin over the areas of tender bone 
may be swollen and glossy. 

The gums are boggy and painful. Some children thought to be "teeth- 
ing" have scurvy. There may be pin-point or pin-head hemorrhages in the 
skin or the lining of the mouth, or there may be bleeding from the gums, 
the nose, or the bowels. 

In grown people the symptoms are about the same. I once saw a stone 
quarry worker brought into Dunning so 
pallid and orange tinted that he looked 
perniciously anemic. He suddenly bled 
like a consumptive with a hemorrhage — 
an extreme condition one seldom sees in 
our day. 

The baby having scurvy must have 
fresh food. Orange juice, almost a neces- 
sity with city babies, becomes not almost 
but altogether a necessity when scurvy de- 
velops. Lemon juice, peach juice, apricot 
juice, prune juice are also good. Eaw meat 
juice and a baked potato with plenty of 
good -gravy are better than medicine out 
of a bottle. 

A good doctor, anxious to do every- 
thing that should be done, will probably 
give the baby some iron and arsenic. If 
scurvy develops in a baby fed on sterilized 
or pasteurized milk, it is wise to change to 
a high grade, clean, fresh, cold raw milk, 
and such milk in a, large city means prop- 
erly certified milk. In the country or in 
smaller cities milk from a good cow kept 
on the lot fills the bill. 

For the cure of scurvy in grown persons the principles of treatment are 
the same, more latitude, however, being allowable. For instance sauerkraut 
and beef tea are fine for grown people with scurvy, but not for babies. 
Three pints of good fresh milk contain as much citric acid as one ounce of 
lime juice, and therefore milk is good, and so are pickles and all sorts of 
fruit and vegetables. 

Nansen prevented scurvy among his men by feeding them meats, dried 
fish, potatoes, and all sorts of dried and preserved vegetables and fruits, 
marmalade, condensed milk, preserved butter, and desiccated soups; as bever- 
ages they got tea, coffee, cocoa, beer, and lemonade. 

Some explorers have escaped scurvy by eating all the rats available, and 
by feeding on fresh dog from time to time. When we are disposed to grow 
discontented with the results of the battle against disease it is reassuring to 
think of scurvy. 



Y" 


I 


c* 




1 p 




/ f^ 




/w 




; 


] 




i 


yl 






a 






A 


% 




ul 


"^ 





Fig. 80. — Location of Lymph Glands 
Which Frequently Enlarge. 



184 SCURVY— SCROFULA— RICKETS 

We read of the Crusades, and of how scurvy beat back expedition after 
expedition, or we come down to 1780, and read of how Admiral Geary's chan- 
nel fleet was obliged to put back to England because 2,400 of the crew were 
down with scurvy. Let us compare this with the experiences of the present 
day. A family physician practicing among the average families in a town of 
fifteen or twenty thousand may go through his professional life without see- 
ing a case of scurvy. 

May Be Scurvy. — J. B. J. writes: "What is the cause of the gums 
becoming sore, also bleeding, and the spaces between the teeth increasing? 
A dentist says this is not pyorrhea. 1 am 28 and have never had any 
trouble with my teeth before. The gums seem to be falling away from the 
teeth. What would you advise?" 

Reply. — Assuming that your dentist is right and you have not pyor- 
rhea, you may have scurvy or some form of poisoning, such as mercury, 
lead, or phosphorus. Your trade may help you to an opinion as to the trade 
poisoning. You may get lead poisoning from drinking charged waters. 

Scurvy is the most likely of the group. Many people get moderately 
scurvied in winter. 

SCROFULA 

Strauss tells us that scrofula was so named because when the neck swells 
up in that disease it looks like the neck of a pig, and "scrofa" means pig. 
The Bureau of Animal Industry finds that practically every pig that has 
tuberculosis has enlarged glands in the neck. In most carcasses the tubercular 
glands in the neck are about the only evidence of tuberculosis in the body. 

However, this relationship between scrofula and tuberculosis, and par- 
ticularly between scrofula and the usual location of tuberculosis in pigs, is 
not the reason why the disease was called scrofula. 

Another name for scrofula was "king's evil/' The royal families were so 
frequently scrofulous in those early days that the disease came to be regarded 
as a morganatic hallmark of royalty. 

We see that they were trying to hitch scrofula up with all sorts of rela- 
tions because they did not know of the real relation of scrofula to tubercu- 
losis. About 100 years ago it first began to occur to scientists that scrofula 
and tuberculosis were the same disease, but the information in hand was so 
slight and the methods of examination so crude that the men who tried to 
find out if the two diseases were one came to the conclusion that they were 
not. 

About half a century ago Villemin proved that scrofula was tuberculosis, 
but the proof was but slowly accepted. Even Virchow, the master medical 
mind of his day, rejected Villemin's proof for a long time. 

Practically everybody now agrees with the view expressed by Osier that 
scrofula is not a disease of itself but only a special form of tuberculosis 
peculiar to children. 

In Strauss' history of the controversy over scrofula and tuberculosis we 
find many points touched upon that are now in the limelight as parts of the 
Friedmann plan of cure. 

Scrofula, meaning piglike, has some new claims to accuracy. Like pigs, 




RICKETS 185 

children get it by "following" cows; the tubercle bacilli are swallowed with 
the food, and the food usually eaten raw is milk. They are absorbed and 
go into the blood. The lymph glands filter them out. The blood is saved, 
but the lymph glands are badly punished, in fact may die. The bacilli may 
never get into the system. Sometimes they get by and set up an ordinary 
consumption. 

Behring and Harbitz think a great deal of the consumption is due to 
bacilli that have escaped from the glands. Other authorities cto not give this 
route of infection so much prominence. 

In scrofula, in addition to the enlargement of the glands of the neck, there 
is trouble in the mouth, nose, and throat. A dis- 
tinguished Frenchman, Velpean, once wrote : 

"The patients, even the physicians, get engrossed 
with the swelling in the neck and forget the condi- 
tions in the mouth, tonsils, teeth, nose, and throat 
which lie back of the neck condition." 

This is as true today as it was when Velpean \ » / 

wrote it. x, J S 

Scrofula is not what it used to be. The old, ' * 

, n -I-, o i Fig. 81. — Shape of the 

eternally running sinuses are seldom seen. Such scull in Ricketts. 

neglect would not be tolerated now. Their day 

ended when Fenger taught surgeons to dissect away carefully every bit of 

tubercular gland in the neck. 

At the present day cases are seldom neglected badly enough to make the 
Fenger operation necessary. Many of them are stopped now before any op- 
eration is necessary. Those that need operation seldom need the more radical 
operation. 

Having come so far, we should go a step farther and cease using tuber- 
cular milk. 

RICKETS 

Once upon a time one physician — a children's specialist — went through 
the wards of a municipal hospital closely examining the children. He found 
that 70 per cent of the children showed signs of rickets. A few days later 
another children's specialist went over the same lot of children and found 
only 5 per cent of them showed signs of rickets. 

A well-developed case of rickets no physician would fail to discover, 
but there are signs of rickets which might be overlooked by anyone, and 
others about which one person would hold one opinion and another person an- 
other. For medicine differs not from law or business or weather prognostica- 
tions in that in all of them, as in everything else, men differ. 

A physician who cannot diagnose diphtheria until the patient chokes, 
or typhoid until flies crawl over the eyes, or smallpox until the smallpox odor 
develops, is not much of a doctor, certainly is not worth his pay. And it is 
with rickets much as it is with other diseases — the serviceable time to find it 
is when it is beginning. 

This is less true of rickets than of most diseases. Neglect does harm, 
but the harm can often be remedied. For instance, rickets is the cause of 



186 



SCUEVY— SCEOFULA— RICKETS 




bowlegs. There is not one bowlegged grown person for every five bowlegged 
children. Why? The legs have got straight. Eidlou says this statement is 
not true. 

Unless the bone changes in a case of rickets are bad, they will clean up 
if the conditions which caused them are removed. Therefore a mother who 
notices that the baby is bowlegged or pigeon breasted need not be down- 
hearted. With a little intelligent direction and proper attention on her 
part the conditions will disappear. 

I think that we have all noticed that bony deformities are less often 
seen than formerly. Amongst the young we seldom see badly twisted spines 

and legs badly bent. 
Stiff joints and hunch- 
back should disappear 
in another generation, 
and as they go into the 
discard bowlegs, pigeon 
breast, rosary chest, the 
ricket-caused group, 
should lead the way. 

The bones of a 
child contain much car- 
tilage and little lime. 
As lime stiffens the 
bones the child learns 
to use its limbs for 
walking. The two proc- 
esses go hand in hand. 
Wise nature keeps 
either from getting ahead of the other. Not so in rickets, where the cartilage 
part of the bone continues to grow, in fact overgrows, but the deposit of lime 
salts does not keep pace. Thereupon the bones become like what we know 
commercially as whalebone, in that they bend in whatever direction any 
force drives them. The legs bow, and the arms would bow, too, if the child 
tried to stand on them. In fact, they do bow in four-legged animals suffering 
from rickets. 

The ribs take on unnatural curves, curves that make the lungs more sub- 
ject to consumption, and in the thumb-sucking child the palate arches up and 
the teeth are thrown out of line. 





Fiq. 82. — Cranial Contours (comparative) — Anteropos- 
terior — Circumference — Transverse. The upper fig- 
ure represents the hydrocephalic head and the lower figure 
represents the rachitic head. 



HOW TO KNOW RICKETS AND WHAT TO DO FOR IT 



A good sign is that the baby does not teethe right. Sometimes the teeth 
come too early; usually they come too late. When they come they crumble 
easily. If the year-old baby has no teeth or if teething starts and then no 
teeth come for several months the baby is rickety. 

Sweating of the head is a suggestive sign. If a mother notices that the 
baby's pillow is soaked with sweat she should look closely for other evidences 
of rickets. 



HOW TO KNW RICKETS AND WHAT TO DO FOE IT 187 



Another sign is marked slowness in walking, particularly if the baby 
has been nursed by a badly run-down mother or has been eating condensed 
milk or cereals. 

That he is fat is no sign that he is free from rickets. On the other hand, 
fat, fine-looking babies are frequently 
rickety, particularly when they are soft 
and flabby looking. 

The very foods which fatten babies 
• — sugared condensed milk, cereals, sweets 
— also cause rickets. These out-of -bal- 
ance foods sometimes cause overfatness, 
sometimes rickets, and sometimes both 
conditions, side by side, in the same baby. 

Following much the same mental 
process as the mother does when she 
thinks her fat baby is a healthy one, she 
thinks a sweaty forehead means only 
that her baby is fat — when it really 
means rickets. 

A rickety baby is liable to have a Daniel Webster head. A broad, over- 
shadowing forehead with a flat top may mean hydrocephalus, or water on 
the brain, or one or two other congenital conditions. Xine times out of ten 
a large, square forehead in a baby means rickets. The head sign of rickets 
most frequently found is a slow-closing fontanel. Instead of being %xl 




Fig. 83. — "Pigeon Chest." 





Fig. 



84. — Round Type of Chest. Incip- 
ient disease in right side. 



Fig. So. — Flat Type of Chest. Ex- 
pansion in one year, coincident with 
marked improvement. 



inch at one year of age, it measures 1x2 inches. Instead of closing at eighteen 
months, it does not close for two or three years. 

"Pot belly" is a rickets sign. So is peevishness, a mental irritability not 
otherwise explainable. Generally speaking, these are early signs and the 
mother who is shrewd enough to find them and change the baby's feeding 
in time never sees the development of bony deformity. Otherwise, presently 
the baby is found to be bowlegged or, what is of much greater importance, 
the baby, instead of being barrel-chested, is pigeon-breasted; or else, by the 



188 



SCUEVY— SCEOFULA— RICKETS 



side of the breastbone, and about one inch away on each side, there is a 
row of beady knobs. Or the skull becomes irregular and distorted, the fore- 
head large and square, and thin places appear here and thick ones there. 

While the legs usually bow out, they are liable to twist in any direction. 

A baby found to be rickety should go under medical direction. Not that 
medicine does much good, for, while phosphorous preparations help and symp- 





Fig. 86. — Bulging Backward on Ac- 
count of Scoliosis. Correction of 
scoliosis. 



Fig. 87. — Marked Shrinkage of Left 
Lung, Due to Postpneumonic Em- 
physema. Restoration of normal pe- 
rimeter in three months by exercises. 



tomatic treatment is called for, the main things to do are hygienic. The indi- 
cations are, change of milk — to get it purer and richer; drop some starch 
and sugar out of the diet; to bring about better home conditions. These are 
the things that need to be done — and that means medical direction. Going 
first to one doctor for a bottle of medicine, and then to another for some 
powders is not medical direction. 

Cause of Rickets. — M. E. T. writes: "What is the cause of rickets? 
How can rickets be prevented? What are the symptoms? What is the 
cause and what are the symptoms of infantile scurvy? 

Eeply. — 1. Eickets may be caused by one of several things. It may be 
caused by several things operating together, and usually is. The cause that 



o 




Fig. 88. — A. Nearly Normal Stomach. B. Dilated Stomach. 

found in rickets. 



A condition frequently 



overshadows all others, however, is poor food. The usual fault with the 
food is that it contains too much sugar and starch and not enough fat. 
In other words, the child gets too little cream and too much cereal and 




HOW TO KNOW EICKETS AND WHAT TO DO FOE IT 189 

bread. Other causes are overheated and overcrowded living and sleeping 
rooms, dark rooms, rooms opening out on dark and dirty alleys, poorly 
constructed and ill-ventilated apartments, basements, and the like. Some- 
times the mother must work and the baby must be left with children who 
feed it mildly spoiled milk, watery milk, too much cereal. 

2. By correcting such conditions as named above. 

3. Scurvy is caused by eating too much stale food and not enough fresh 
food, especially good fresh milk and fruit juice. Older children suffer 
from scurvy when they do not get vegetables and fruit. The symptoms are 
about as follows : The baby is feverish and fretful for a few days. Then 
it will be noticed that the child cries out when its limbs are moved. Exam- 
ination shows the bones to be 
swollen, sore, and tender. The 
skin over these areas is swollen 
and glassy. The gums are boggy 
and painful. There may be hem- 
orrhages in the skin or lining of 
the mouth. There may be bleed- 
ing from the gums, the nose, or 
the bowels. 

Child Has Rickets.— C. A. M. 

writes: "Our hoy, 19 months old, 
was horn with a slight curve in 

the lower part of his limbs. This FlG - 89.— Shape of Head in Rickets. 

was harely noticeable, however, 

until he started to creep, or hitch, and this doubled one leg under the other, 
so that, after four months, one leg is badly curved. He has been walking 
for two weeks "and both limbs curve outward at the knee. He has some 
stomach trouble and is rather nervous. We have given him for the last 
year almost entirely malted milk, which agrees with him. Cows' milk is 
tabooed, as he cannot digest it; also it causes constipation. Aside from 
the legs he is perfect physically and is plump. What would you advise in 
regard to the limbs?" 

Reply. — You should take the boy to a children's specialist. He is 
rickety, and probably has been for months. That he has not walked until 
nearly 19 months old suggests rickets; that his bones are so soft that they 
bend under pressure proves it; that he is "perfect physically and plump" 
(except for the curves in his bones) does not disprove it. Babies that get 
a good deal of starch and sugar are apt to be plump and rickety. Certainly 
the child has indigestion, which is partly responsible for the rickets. 

Not Much Difference. — Mrs. L. A. R. writes: "From the viewpoint of 
the mothers regaining strength and of the child's well-being, which is the 
best time of year for a child to he horn? Will you also tell me if a child 
ever inherits a tendency to rickets?" 

Reply. — 1. I have read several discussions of the subject. They have 
been based on average weights and rate of growth of a large number of 
children. It has not seemed to me that there was much difference. Spring 
babies are pretty certain to be at the breast the first summer and with 
trained stomachs during the third. So they have but one cow's milk sum- 
mer. Therefore they are less liable to the baby's greatest hazard, summer 
complaint. 



190 



SCURVY— SCKOFULA— KICKETS 



2. Yes. Some children are born with rickets, 
disposition toward it. 



Some are born with a 



Treatment of Rickets.— J. A. V. writes: "Please tell me the best treat- 
ment for a child 17 months old who has symptoms of rickets/' 

Reply. — Vegetables, fresh food, fresh rich milk. However, if your child 
shows signs that you think mean rickets have your physician see it, make 
certain of the diagnosis, find out where the regimen has been wrong and 
tell you what to change. 

Might Be Rickets. — Mrs. J. E. A. writes: "My grandson, 1+ years old, 
sweats dreadfully, even on cold nights. Sleeps in a gown only and in room 





Fig. 90. — Bowlegs. 



Fig. 91. — Knock Knees. 



with open doors and windows. In half an hour after going to bed his 
pillow will be perfectly wet, or even the mattress, without a pillow. His 
parents are perfectly healthy, and he is well, though he has a delicate look. 
He is not a strong child. Can you suggest the probable cause and a rem- 
edy?'' 

Reply. — When a young child sweats profusely at night, especially if 
the pillow is made wet, one thinks of rickets. Is he bowlegged? Has he 
digestive disturbance? The cure for rickets is fresh air and sunshine, a 
diet rich in meat, meat juice, butter, fruit, and vegetables, proper atten- 
tion to diet, cold baths, followed by brisk rubbing and iron tonics. Have 
your physician decide whether he is rickety or scurvied. 



Curvature of the Spine. — E. S. writes : 
follow as a result of English disease? 2. 
ever have children?" 



"1, Does curvature of the spine 
Can a woman who has had both 



Reply. — 1. English disease is a name sometimes given to rickets. 
In a bad case of rickets the spine may curve. Bowlegs is a curving of the 
leg bones due to rickets. Pigeon breast and rosary chest are conditions 
resulting from unnatural curving of the ribs from rickets. Some years ago 
I saw spinal curving in some Lincoln park baby animals resulting from 



HOW TO KNOW BICRETS AND WHAT TO DO FOR IT 191 

rickets. However, little spinal curvature is due to rickets, certainly not 1 
per cent. The usual cause is bone tuberculosis. 

2. Women with spinal curvature, women who have had rickets, and 
women who have both conditions can conceive. Whether or not they should 
is dependent upon how strong and vigorous they are and how great the 
deformity is. The deformity is no bar to bearing children, provided the 
lower half of the trunk is roomy enough. That point should be decided on 
by good medical advice. 



CHAPTEE XVIII 

Contagion — Disinfection 

Time was when epidemics of contagious disease were charged to the wrath 
of God. Others thought they were due to devils. This was followed by the 
age in which epidemics were recognized as the material results of material 
forces acting in a material way. But the opinion and procedure even of that 
day were tinctured with mysticism. 



CONTAGION AND INFECTION 

The older dictionaries gave quite elaborate and finespun differences 
between these two groups of diseases. They went further and classified 

communicable diseases 
into the two groups. 
The later dictionaries 
have thrown those old 
classifications into the 
wastebasket. I hope 
the people have done 
the same. There are 
only a few of these 
communicable diseases 
and there is no par- 
ticular trouble in re- 
membering how each 
is communicated. Try- 
ing to classify them 
will not help any. 

Smallpox is spread 
by persons ill with 
smallpox or just re- 
covered from it. The 
rule is to isolate the 
smallpox patient and 
for every person to 
keep away from him. 
A person properly vaccinated is permitted to violate this rule. 

Chickenpox is spread by persons who have or very recently have had the 
disease. 

Diphtheria is spread by persons who are ill with diphtheria or who 

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New York State Board of Health 
Fig. 92 



Decrease of Contagious Diseases in New York 
State. 



ON EEPOETIKG CONTAGIOUS DISEASES 193 

have ordinary sore throat due to the diphtheria bacillus or whose throats 
harbor diphtheria, but who are not sick. The rule is to isolate not only 
those with diphtheritic membranes in their throats, but all who have diph- 
theria bacilli in their throats. 

Scarlet fever is spread by those who have the disease typically or 
atypically. As we do not know the germ of scarlet fever, a good deal of 
uncertainty prevails as to how long the disease is contagious. The shrewdest 
guess is that it is contagious as long as the throat is sore or the tonsils are 
swollen and boggy. The rule is to isolate the patient whether he is seriously 
ill or is not seriously ill. 

Measles is spread by those who have the disease. We must not forget 
that the disease starts when the fever, aching, and cough begins. The erup- 
tion is merely an incident. Some patients do not have it at all. The rule 
is to isolate and to begin the isolation early. In measles times every child 
with a fever, cough, and watery eyes should be isolated. If the disease turns 
out to be an ordinary cold not much has been lost. On the other hand, 
measles is most contagious before the breaking out appears. 

Typhoid fever is spread by those who have the disease and by carriers. 
We know a lot about the typhoid germ. Unlike some of the others it can 
be carried long distances. It can get on a fly and be carried a few blocks 
(by the wind) or a thousand miles (by a railroad car). It can get in milk 
and be carried as far as milk is carried. Eegardless of how far it is carried 
the trail started with a man who had the disease. 

The rule is to isolate, not absolutely but partially, to keep flies away from 
the patient and from his excretions, to see that no food, outside of the food 
for the patient, is prepared by the attendants or in the neighborhood of the 
sick man; to allow as many visitors as the patient cares to see or his doctor 
will let him see, but the visitors must be careful of their fingers. 



ON REPORTING CONTAGIOUS DISEASES 

Contagious diseases are preventable. They cannot be prevented after 
they have occurred, though a lot of people mistakenly think so. When a 
physician is called in at the onset of typhoid fever or scarlatina he is often 
asked, "Can't you give some medicine to stop it?" Once a disease, particu- 
larly a contagious disease, lias set in, it will run its course. It will not only 
run its course, but it will infect others and cause the same disease in them — 
unless its spread is checked. 

Before anything can be done to stop the spread of contagious diseases 
the health authorities must know where the cases now existing are. Without 
such knowledge nothing can be done. 

The city ordinances require that the physician in attendance, parent, 
guardian, or the owner of the house where such a case exists, shall report same 
to the health department. This is to be done just as soon as the diagnosis is 
made, by telephone, and within twenty-four hours in writing. 

The following diseases are to be thus reported: smallpox, diphtheria, 
scarlet fever, typhoid fever, tuberculosis, measles, whooping cough, chicken 
pox, infantile paralysis, meningitis, erysipelas, typhus, pneumonia, mumps 



Introduction of 
Antitoxin Treatment 




1900 '02 '04 '06 'OB '10 U '14 



1885 '87 189 '91 '» '95 '97 

iVeio York State Board of Health. 

Fig. 93. — The Decline in Diphtheria in New York State. 



194 



CONTROL OF CONTAGION IN SMALL TOWNS 195 

and any other disease of a contagious character. The penalty for not re- 
porting cases of contagious diseases to the proper authorities is from $10 
to $200. 

The prime importance of reporting contagious diseases was recognized 
and enforced by legal enactment many years ago, even before their contagious 
character was scientifically proven. In 1782 a law was passed in Naples 
fining any physician 300 ducats for the first offense, in a case of consumption. 
If the offense was repeated he was to be banished from the country for ten 
years. About the same time similar laws were passed in Spain and Portugal, 
making failure to report such cases on the part of physician or family punish- 
able by fine and imprisonment. 

If all cases of contagious diseases occurring were reported the matter 
would not need to be written about. The fact is that many of the most 
serious cases of diphtheria, scarlet fever, consumption, and typhoid go un- 
reported. Of the milder contagions, such as measles, whooping cough, chicken 
pox, and mumps, probably not more than one-fourth are reported. 

The harm done by the unreported cases is incalculable. Each case not 
reported and not properly cared for is the starting point for several other 
cases. Much illness and many deaths are due to this one factor. Most 
doctors do their duty in this respect — all of them would like to do it. 

The discharge from the family's service of an able, honest physician for 
no other reason than that of having reported a case of contagious disease 
in the family is an everyday occurrence. A less dutiful and usually a less 
able physician is called in. 

We know of many physicians who have gained notoriety and patronage 
because of the fact that they do not report cases of contagious diseases. The 
inconvenience of quarantine in most cases and perhaps some interference 
with business in others constitute the objection on the part of narrow-minded, 
ignorant people to having cases occurring in their families reported. Thus 
they sow the wind, and the community reaps the whirlwind. 

Stringent application of existing ordinances, sufficient hospitalization 
facilities for all contagious diseases, and the education of the public are the 
remedies. 



CONTROL OF CONTAGION IN SMALL TOWNS AND COUNTRY 

In large cities, measles, diphtheria, and scarlet fever are present all 
the time, and smallpox more than half the time. Small cities and country 
communities will go for a year or more without a case of these diseases, and 
then comes a sweeping epidemic. Therefore, the science of fighting con- 
tagion in the city is one thing, that of fighting it in the country is another. 

This coming and going, this intermittence, is the quality which makes 
it easy to control contagion in the country, when the community takes 
an interest in the welfare of its people. 

Closing schools, with all its expensive waste, is a procedure that they 
have abandoned; communities paralyzed in a business way by epidemics are 
something which they remember but no longer tolerate. The meningitis 
experience through which Texas has just passed might have occurred in 



6 

H 





■8 

3-1 



sisvo 



aiguniM 



196 



CONTROL OF CONTAGION IN SMALL TOWNS 197 

England a few years ago, but not now. In Germany and England travelers, 
pleasure and health seekers, and business men no longer shun great districts 
because of fear of uncontrolled epidemics. 

A country epidemic commonly begins with a case which seems to have 
dropped down like lightning out of a clear sky. We shall take diphtheria 
as an illustration. 

When a case appears inexplainably, those who argue that diphtheria can 
spring up spontaneously can make out a pretty good case (the believers in 
spontaneous generation are not all dead yet). 

Occasionally this first case will occur among people who are not very 
clean, and those who believe that diphtheria is a filth disease find support 
for their position. 

Both are wrong and fairly careful detective work will usually prove it. 
Occasionally, English health journals print accounts of diphtheria in rural 
England which show how careful detective work has marked out the train 
of the itinerant carrier of mild diphtheria, called sore throat. The New 
York authorities were able to follow the typhoid trail of one woman, and she 
not sick, over much of New England. 

In this way the Chicago Health Department trailed a typhoid carrier, 
by cases that formerly would have been called sporadic, from Chicago to 
Gray's Lake (Illinois) and back again to Chicago. 

Now, when a case of diphtheria, scarlet fever, or measles breaks out 
in Watseka, Illinois, or What Cheer, Iowa, it is because somebody who carries 
contagion has been in town recently. At the very earliest, ten days or two 
weeks elapses from the time the spreader arrives until the first case is diag- 
nosed. In that ten days, the spreader may have moved on. Therefore, the 
connection will not stand out plain and easy to see. 

However, if careful inquiry is made, the sick child can usually locate 
the harming contact as lying between a small number of people — say five. 
She will remember some person with some suspicious sign. 

Inquiry into the medical history of these, clinical examinations of their 
throats and skins will generally identify the carrier or a typical case, or will 
bring out information of a recent exposure of someone who was "a little 
sick," or had a. "little sore throat/' or a "cold," or a "stomach rash." 

Now, small towns and country schools should have no diphtheria, scarlet 
fever, or measles — ever. For years to come Chicago must have them always — 
there is no escape. But not so Pontiac, Illinois, or Edgerton, Wisconsin. 

A few places such as Valparaiso, Indiana, Summit, Illinois, and La 
Crosse, Wisconsin, have seen what they can do to give security to their people 
and increase the intervals between epidemics until such time as they can 
wholly eliminate them. 

How are these intervals to be made longer and the disease finally elimi- 
nated ? 

First, there must be a central health authority, a health officer who 
knows some rudiments of epidemiology. Where this is not a workable con- 
dition, the school principal is an intelligent agent, clearly in touch with 
the common channels for the spread of infection — the children — and, through 
them, in a position to know of conditions in the homes. He can be of great 
service pending a public demand for a special trained health officer. 



198 



CONTAGION— DISINFECTION 



Second, cases suspected of being contagious must be reported at 
once. 

Third, isolation or quarantine must be made as little burdensome as 
possible. 

Fourth, through the health officers, school teachers, and principals car- 
riers of infection must be located and controlled at once. 

Fifth, school inspection must be inaugurated and continued until the 
focus has been stamped out. 

This plan is much cheaper and much more effective than the present 
plan. In essence, it consists in early and quick action — nipping the weed 
in the bud, and then following down the stem to the root and digging 
that up, the plan which has been found necessary with Johnson's grass. 
i fcgsjw 1 1 1 11 it rv i, .j___jl 3 __j The method which it is sug- 

gested that this supersede is 
about as follows : A case of scar- 
let fever breaks out in a family. 
The well children continue at 
school. Presently a second case 
occurs, and the neighborhood be- 
gins to talk a little about scarlet 
fever being in town. In two 
weeks, the third crop of cases 
breaks out, and the neighborhood 
is getting badly frightened. 

Ten days later, new cases 
are developing every day. There 
are no longer crops of cases. 
New cases are appearing here and 
there, the disease is no longer sticking closely to neighborhoods. 

The local authorities call a public meeting; the state board of health 
is called in; guards are employed; schools are closed; the teachers get a 
vacation with pay; the town is badly upset; the country around is afraid 
to come to town to trade ; business is at a standstill. 

About this time the community is thoroughly awakened, and the epi- 
demic speedily dies out. 

It is always easy to control an epidemic in the country or a small town 
when effort is made. 

This plan — letting the fire burn until it gets to the business district — 
is effective enough, but it is too expensive. Ten dollars spent on the first 
case will accomplish as much as a thousand spent to care for a situation after 
it is bad. 

Another bad result from letting the first cases drift is that the contagion 
always spreads to neighboring towns. When smallpox traveled from a 
Wisconsin town to a farmhouse northeast of Marengo, Illinois, it was reason- 
ably certain to get to Marengo. When it reached there, it was reasonably 
certain that some cases would occur along the country roads leading from the 
infected town, even though the farmers' wives and children kept out of 
town, and the farmers hauled their milk to the factory and left for home 
without going uptown to the stores. 




Fig. 95.— How 



One School 
Fever. 



Spread Scarlet 



OXSET AND INCUBATION 199 

ONSET AND INCUBATION 

The incubation period is the time that elapses between exposure to 
contagion and the development of a disease. In the season of epidemics 
many people keep asking how long it will be after a case of contagion has 
been taken out of an office until those in the office may judge that they are 
safe. 

During this incubation period those who are due to get sick are carry- 
ing the germs somewhere in their bodies, though what is happening to 
either the germs or to the hosts is not known. 

The incubation periods of some of the more important diseases are as 
follows : 

(The figures in brackets are those furnished by Cornell, the others are 
by Hill.) 

Acute sore throat 2 [ 1 to 3] days 

Diphtheria 3 [ 1 to 10] days 

Scarlet fever 4 [ 2 to 7] days 

Measles 10 [ 7 to 18] days 

German measles 14 [11 to 20] days 

Chicken pox 16 [10 to 18] days 

Smallpox 12 [10 to 20] days 

Mumps 16 [14 to 20] days 

Whooping cough 8 [ 7 to 10] days 

Tuberculosis Indefinite 



The first figure given is the number of days that elapse between 
exposure and illness in the average case. But disease does not always 
run on schedule; sometimes it rolls in a day or two early, and sometimes 
a day or two late. 

The figures in brackets indicate the ordinary limits of these variations. 

If a case develops after a shorter interval than the minimum given, 
the probability is that there was a prior, though unrecognized, exposure; if 
later, that there was some other focus of infection. 

In this connection, it is well to know that some of these diseases are 
infectious during the period of incubation ; for instance, a man with diph- 
theria has been infectious since the day he became infected, through his 
three days of incubation as well as through his days of sore throat. 

All forms of contagion begin with fever and general aching. In measles. 
scarlet fever, and diphtheria there is sore throat in the early stages, about as 
early as the fever. 

Therefore, in the season of epidemics, a sore throat, fever, and aching 
should put one on his guard. 

The attack may be nothing more than a cold or a simple sore throat, but 
it is fairer to the office and fairer to oneself to go home with the first 
oncoming of the aching and there await a decision as to what the illness 
is going to be. 

Both measles and scarlet fever oreak out in the mouth before they 



200 



CONTAGION— DISINFECTION 



break out on the skin, and diphtheria usually shoivs a membrane on the 
throat and never, or rarely, any skin eruption. 

Therefore, when this group of contagious diseases is suspected, the 
mouth is to be watched. 

Smallpox is characterized by a violent aching and high fever, per- 
sisting for three days. Up to this point almost anybody would be liable to 
confound smallpox with nearly any fever. Then comes the turn that dis- 
tinguishes the disease — the fever drops, the aching ceases, and the eruption 
appears. 

DANGER FROM PETS 




The Montana Board of Health has issued a bulletin warning people 
against close association with pets. Nobody has arisen to warn animals 
against close association with people. 

Cy De Vry, in his lecture about the wild animals he has known, states 

that the food of the Lincoln Park 
(Chicago) animals is better inspected> 
in fact, averages better, than the food 
of the people. Anyone who knows 
Lincoln Park or who sees Mr. De Vry's 
pictures will know that the animals live 
in more sanitary homes. 

Why is it, then, that they some- 
times get consumption? Associating 
with the people. 

Having given the animals their 
day in court, we repeat what the Mon- 
tana authorities tell us. 

Dogs, cats, and parrots can pick 
up ordinary contagion from those sick 
with contagion, such as diphtheria, and 
then give it to others. The teaching is that when a child is sick with con- 
tagion the animal pets should be excluded from the room until quarantine is 
terminated, for a dog cannot be fumigated. The further advice is given that 
kissing dogs, cats, and parrots is liable to spread contagion. 

Animal pets have tapeworms which are frequently spread to man 
by close contact. A tapeworm requires two hosts, in each of which it 
passes a different cycle. The worms, which are rather mild tapeworms in the 
dog, pass through a much more harmful stage in man. 

The hydatid disease in man is due to the man cycle of a lower animal 
tapeworm. 

There are several varieties of these worms. I have often written that a 
tapeworm in a man's intestine is of no great consequence. A hog tapeworm 
or a dog tapeworm in a man's tissue is of great consequence. 

Itch is not nice to think about even when one thinks of catching it 
from his barber or his friend. It is worse to think of getting itch from a 
dog. Dogs and cats have several kinds of itch, each capable of transmission 
to man. 



North Carolina Health Bulletin. 
Fig 96. 



EASY TO CONTEOL CONTAGION 201 

When plague threatens, pets become of increased importance, for this 
disease is spread by a flea, which, while it prefers the rat, is willing to take 
up temporary residence on any domestic animal. 

Hydrophobia, would die out if it were not kept going by the lower 
animals, and especially by dogs. 

So far as consumption is concerned, the lower animals both sin and are 
sinned against. The dog that pines for its master who is slowly going down 
with consumption is slowly dying from consumption contracted from him. 
On the other hand, some cases of human tuberculosis that seem to come out 
of a clear sky have come from a dog or cat. 

Finally, there is anthrax, a terrible disease in lower animals, capable 
of causing a terrible disease in man. In fact, one of the names for human 
anthrax is "wool sorters' disease/' It is so named because men who handle 
wool and hides get it from what they work in. 

Human beings are not subject to lumpy jaw. If they were they would 
catch it often from animals. Occasionally glanders is contracted from a 
pet horse. 

EASY TO CONTROL CONTAGION 

In September, 1910, in East St. Louis, the Board of Education placed 
drinking fountains on the boys' side of the Horace Mann School. On the 
girls' side the public drinking cup was continued. The record for the 
session of 1911 shows 110 per cent more contagion amongst the girls than 
amongst the boys. In October, 1911, drinking fountains were installed 
on the girls' side. From that date to February 1, 1912, the records show 
this excess of 110 per cent has dropped to 20 per cent. 

It is not often that we can observe two groups of people so nearly 
parallel as these, and therefore the experience in East St. Louis is unusually 
convincing. 

Contagion is spread in more ways than by drinking cups used in com- 
mon, and to abolish that nuisance will decrease but not end contagion. 
Yet here we have a good illustration of what can be accomplished by even 
a halfway measure. 

Hill tells us that in controlling contagion 100 per cent efficiency of 
method, while desirable, may not be required; 50 per cent efficiency has 
often proven effective. Anyone who has had any experience with the rule 
of thumb, unscientific methods of health department work in the old days, 
knows that Hill knew what he was talking about. He has spent many 
years in controlling epidemics and he should know. 

What is the reason? In the first place very few of the bacteria thrown 
off by those infected survive for even an hour. They are killed by sunlight, 
by drying, by other bacteria, by numerous agents. It is a general law that 
bacteria capable of producing disease in man do not thrive outside the 
bodies of man or other animals. On the other hand but a small per- 
centage of the people who come in contact with contagion are affected by 
it. Most people are immune. Some immunity is natural. Most of it is 
acquired. 

If 100 babies are exposed to smallpox at least 95 will contract the 




202 



EASY TO CONTROL CONTAGION 203 

disease. But as most of the grown people have been vaccinated one or more 
times, if 100 adults are exposed not over 5 would get it. 

Or take measles. Expose 100 small children to measles and 95 would 
get sick. On the other hand 90 out of every 100 grown people have had 
measles and will not take it again. Change the proportions somewhat 
and you have the scarlet fever situation. Only about half the people are 
susceptible to diphtheria at any time of their lives. 

The great majority of people will not contract consumption from 
casual contact with a consumptive and a large proportion of them are not 
endangered by close contact with one. 

Most people are not in any danger of developing pneumonia from 
breathing pneumococci. The coccus does not seem to have that power 
for them. 

In a malarial country but a small percentage of the mosquitoes which 
bite people are infected with malarial parasites in just the right stage 
for transmission. It is for the above reasons that quarantine, disinfection, 
abolition of drinking cups and other health department methods which 
are but 50 per cent perfect accomplish such good results. 

The above statements do not mean that a poor health department is 
as effective as a good one or that any man should take a chance on breaking 
a health law. It does mean that he can take an occasional chance and escape 
the consequences. It does not follow that because you get good results 
from poor work you should not try to get better results from better work. 

Destroying Mold Germs. — H. M. T. asks, the best method of destroying 
mold germs in a pantry and also suggests that care be taken in wiping the 
tops of milk bottles before opening. 

Reply. — One of the best ways of preventing the growth of molds in a 
pantry is to have an abundance of sunlight. Frequently this is not possi- 
ble, and I judge that it is not in this instance. Another thing to have is 
cleanliness and dryness. 

All decaying and soggy wood should be removed. Everything should 
be made very clean. No water should be allowed on the floor or walls. No 
water, milk, or other liquid should be exposed in the pantry. The drip- 
ping from the ice box must not be allowed to accumulate; in the pantry. 
Unslaked lime in pans will help to dry the air. If you can get the air dry 
enough, mold will not trouble you. The pantry should be aired frequently. 
Dry days should be chosen for this. 

Disinfection is best done with formalin. Half a pint will answer for 
an ordinary sized pantry. Sprinkle the walls and floors with water. Soak 
up the formalin on a sheet, and throw the sheet over a line in the pantry. 
Shut the door. Using that quantity, it will not be necessary to strip the 
doors or windows. Leave the doors and windows closed for eight hours. 
Then throw everything open and air well. 

Your point about washing the milk bottle, including its cover, before 
opening, is well taken. Milk bottles get pretty badly soiled oftentimes 
before the milk comes to be used, even when they start out in good 
shape. If the bottle is carelessly opened dirt will get into the milk. 

How to Fight Epidemic. — X. writes : "Desplaines, Illinois, has a popu- 
lation of more than 2,000. There are at present thirteen cases- lof scarlet 



204 



CONTAGION— DISINFECTION 



HEALTH 



SICKNESS 




PUR& 

FOODS 

COOKED IN 

CLEAN KITCHENS 

OPEN TO PUBLIC 



INSPECTION 



J 



CJ.f. 



DELICATELY 
ADULTER AT £"0 

ANO 

H lO-HLY 
CONTAMlNATEO 

— FOOD — 

CMEAPE.R "THAN. 
THE OTHER KINO 



Fig. 



-At Which Shop Shall We But? 



fever in six different families, 
schools?" 



Would this justify the closing of the 



Reply. — No. The proper plan of controlling an epidemic of scarlet 
fever is to put on a school nurse and reopen the schools. The students 
should be passed upon each morning by the teacher, who sends the suspects, 
including those who have been absent from school two days or over, to a 
holding room. There they are seen by the nurse, who sends them back 
to the schoolroom or into quarantine or to the family physician, according 
to the circumstances. 

A school nursing service for such a town suffering from an epidemic 
should not cost more than $150 a month, which is far cheaper than closed 
schools. In addition it is much the better way to end the contagion. 

The controlled contact of this method is much better than the uncon- 
trolled contact of playgrounds and streets. 

Danger from Rooms Where Consumptives Have Lived. — I. M. F. writes : 
"Will you kindly tell me what precaution one should take in moving into 
an apartment where a tubercular child has formerly resided. Is there 
any danger?" 

Reply. — There is always danger in moving into an apartment that has 
been recently vacated by a person with tuberculosis. If the house is well 



EASY TO CONTROL CONTAGION 



205 



lighted and aired and is in a good clean condition, with dry walls, the 
danger is not great. If it does not come up to these requirements it should 
be avoided. The health department disinfects after tuberculosis. You 
should not move into a tubercle infected house until such disinfecting has 
been done. This disinfection should be followed by a thorough cleaning 
and airing. Certain cities, for in- 
stance, Asheville, N. C, require that 
a room that has been occupied by 
a case of tuberculosis should be dis- 
infected when the case moves, and 
that a notice should be fastened on 
the wall, showing the date of such 
disinfection. Certainly people who 
contemplate moving should have 
some way of knowing whether the 
room to be occupied is safe or not. 




Fig. 99. — Fly-speck Greatly Magni- 
fied, Showing Dangerous Germs. 



Contagious Diseases. — A. B. C. 

writes: "Why are children with 
whooping cough allowed to enter 
moving picture shows and other pub- 
lic places? Why isn't some method used to notify the public that children 
have this dreaded sickness or disease?'* 

Reply. — It is against the law and also against public policy to allow 
children in the actively contagious stages of whooping cough to go to 
moving picture shows. The suggestion has been made that children in 
the later stages of whooping cough should be tagged and allowed to go 
about doing necessary things. That, however, does not include attending 
shows. 

School and Contagious Diseases. — L. K. writes: "1. What diseases, 
contagious or otherwise, bar a child from attendance at school? 2. For 
what length of time, in each case, should the child be kept away from other 
children? 3. Should the child upon reentering school present a written 
permission from the doctor, stating that it is safe for the child to come 
in contact with other children?'* 

Reply. — 1. Smallpox, diphtheria, scarlet fever, measles, whooping 
cough, German measles, infantile paralysis, itch, impetigo, cerebrospinal 
meningitis, venereal disease, open tuberculosis, lice. 

2. Varies with each disease. 

3. Any child who has suffered from any form of contagion should pre- 
sent himself to the teacher in charge of the room, who refers the question 
of whether it is safe to allow the child to come back to the school physician. 
He passes on the evidence. A certificate from the attending physician is 
advisable, but not necessary. 



Rule of Quarantine. — Working Woman writes: "Is it customary, 
necessary, or required by the board of health for a working woman or man 
to stay at home if a young child in the same flat has measles?" 

Reply. — No. Workers are required to room elsewhere during the con- 
tinuance of quarantine. If the case is in a place where the patient can 



206 CONTAGION— DISINFECTION 

be kept entirely away from the members of the household, rooming away 
is not required. 

Danger of Contagion. — W. F. E. writes: "1. Kindly advise me what 
the danger of contagion is in regard to scarlet fever, diphtheria, and sim- 
ilar diseases? 2. Is there danger of contagion by taking money from an 
infected person, or touching anything which that person has handled? 3. 
How long would the germs live, or rather how long after being exposed 
to the disease in that manner can one assume that the danger is past? 4. 
Is there any danger of contagion from contact with clothes of party from 
the sicJc house, and is the danger considerable? 5. Is a person naturally 
cautious about such things apt to worry unnecessarily? 6. If a family has 
been immune from contagious diseases to date, may it be assumed that the 
immunity will to a reasonable degree continue, especially when there are 
young children in the house?" 

Reply. — 1. If ten susceptible young children are exposed in a school- 
room to scarlet fever or diphtheria, five will get it. If ten susceptible young 
children are exposed in a schoolroom to measles or smallpox, nine will get 
it. Contagiousness is greater in some diseases than others. 

2. The danger from passing money or touching objects that they have 
touched is very slight except in smallpox. 

3. Say two to three weeks. 

4. Some — slight. 

5. Some men worry too much, some are too indifferent — answer depends 
on the man. 

6. Vigilance is the price of safety. 



FUMIGATION 

In response to inquiries several methods of fumigation appear in this 
book. In addition, in places the advice not to fumigate is given, while 
in other places fumigation is approved of, at times by direct statement, at 
other times by implication. In order to avoid confusion a summary of views 
is here presented. 

Fumigation as a means of destroying bacteria is losing ground. There 
are certain communities where it is still employed quite generally. There 
are many, people who believe in it. There are others who are willing to 
take all other precautions and to fumigate besides. Under these circumstances 
it is wise to give methods of fumigating. 

The opinion is very general that formaldehyd is the method to be em- 
ployed when the purpose is to destroy bacteria. Therefore that is the only 
method given. Formalin is a trade name for formaldehyd. 

In using formaldehyd it is agreed that the gas is ineffective unless 
moisture is present. Therefore the instruction to sprinkle freely before 
using the gas and to have the air as moist as possible is given in all the 
methods. The old directions were to leave the gas-filled room unopened 
for eight hours. The tendency is to lessen this time requirement, some- 
times to as low as four hours. 

Three principal methods of generating the gas are employed: the per- 
manganate of potash method, the formalin candle method, and the sheet 




FUMIGATION 207 

method. Of these the permanganate of potash is 4he best. It has the dis- 
advantage of requiring some skill in the user. It at least appears more formid- 
able. The sheet and the candle methods are simpler and they are nearly as 
effective as the other. 

It will be noticed that the instructions as to the amount of gas to be 
used vary. Where all cracks are stuffed one pound to each 1,000 cubic 
feet of air is enough. But stripping paper costs some money and applying 
and removing it takes time. Stripping is far and away the largest element 
of cost. Some of the instructions 
specify that more than one pound 
per 1,000 cubic feet of gas be used 
and that the stripping of small 
cracks be not done. The extra 
formalin will cost much less than 
the cost of stripping and the 
money thus saved can be spent Fig. 100.— The Pot Method of Burning Sulphur. 

for nurses and inspectors. 

When it is a matter of killing insects formalin is ineffective. For 
that purpose the usual recommendation is that sulphur fumes be used. Sul- 
phur fumes differ from formaldehyd fumes in that sprinkling must not be 
done with the former. 

The dry gas is a better insect poison. In the presence of moisture the 
gas is converted from sulphurous to sulphuric acid, whereupon it destroys 
fabrics and greatly injures structures. 

In the use of sulphur fumes we have the choice between using less 
gas in rooms, the cracks of which have been stripped, or more gas where 
there has been no stripping. 

Hydrocyanic acid gas is very much more efficient than sulphur, but it is 
poisonous and can only be used by those who have had experience. To the 
experienced it is safe, simple and efficient. 

WHEN TO FUMIGATE 

It has been several years since Chapin of Providence began agitating 
against fumigation. The Health Department of Providence was courageous 
enough to stop fumigating, except after tuberculosis, about six years ago. 
Hill of London, Ontario, in his valuable booklet, "The Neiv Public Health," 
comes out strongly for the theory that ordinary contagion cannot be spread 
by the air; that if the secretions of persons sick with diphtheria and other 
forms of contagion are made sterile, the disease will not spread; that contagion 
is not due to filth; is not bred in filth; is not stimulated by filth, and that 
fighting contagion by fighting filth is wasting ammunition. 

In the Liverpool hospitals scarlet fever, diphtheria, and other forms 
of contagion have been treated for years in the general wards in beds 'side 
by side with pneumonia and rheumatism. The patients do not get cross 
infections, because, the nurses are supremely careful in keeping their hands 
clean, 



208 CONTAGION— DISINFECTION 



DISINFECTION 

For all infectious diseases disinfection should be done. It is important, 
however, to disinfect the right thing and in the right way. Nature has 
provided us with the best of disinfectants. When we fail to do our duty 
nature will supply the deficiency if given half a chance. 

Koch said: "Mere drying will destroy the germ of cholera." It will 
destroy other germs as well. Sunlight and air, including the drying that so 
frequently results from sunlight and air, are the common agencies by which 
nature disinfects. 

In typhoid fever and cholera the germs are carried in the excretions. 
In these diseases nothing is to be gained by efforts to disinfect the air 
or anything else except these excretions or things touched by these excretions. 

To disinfect the excretions chlorinated lime, bleaching powder or car- 
bolic acid solution will work. The solution must be strong enough and 
the contact must be long enough to accomplish the result. If carbolic acid 
is used the solution must be at least 5 per cent strength. That means 5 
per cent after the solution is mixed with excretion. It is well enough to 
make the solution overstrong and let it go at that. The mixture of excre- 
tion and disinfectant must stand for half an hour. 

In consumption, pneumonia, and diphtheria the disease is spread by 
the mouth secretions, including the sputum. To sterilize these secretions 
heat should be used. It is feasible to burn most of the cloths, handkerchiefs, 
and napkins that have been used. If it is best to save some handkerchief or 
other cloth it can be disinfected by boiling. 

If the sputum in cups is treated with a small quantity of concentrated 
lye and then heated in a moist chamber to the boiling temperature, it will 
be sterilized and can be emptied in the toilet. 

While the case of infectious disease is active double effort should be made 
to keep things clean. The air must be kept clean. The windows must be 
kept partly open all the time and at intervals the room must be aired. The 
blinds must be up to let in some sunlight. 

No disinfectant can disinfect a room wherein there is a patient. A saucer 
of disinfectant here and a pan there do no good. After the illness has ended 
and the patient has been moved the room should be scoured with soap 
and water, the woolen stuff aired and sunned, and the washable stuff boiled. 
If you feel you must fumigate use formalin. 

Prior to 1912 the New York City Health Department fumigated with 
formalin after contagious diseases according to the prevailing customs. In 
1912 they discontinued formalin disinfection after diphtheria but took the 
bedding used by the sick person to a central plant where it was disinfected 
by steam. 

In 1913 the practice of disinfecting bedding with steam after diphtheria, 
scarlet fever, measles, meningitis, and infantile paralysis was discontinued. 

In 1915 they discontinued the formalin disinfection after contagion. 
They now stand where Providence has stood for years, except that they 
do fumigate after tuberculosis only in rare cases. 

The position taken by Providence, New York City and some other up-to- 



DISINFECTION 



209 



date cities is that sunlight and air are effective disinfectants. Contagion 
is seldom spread by the air. Therefore, formalin disinfection of the air 
is not needed. Formalin gas is not an efficient disinfecting agent for 
bacteria located on surfaces and in fabrics — therefore, formalin is inefficient. 
Being unnecessary and inefficient it should not be used. In lieu thereof, 
sunlight and air supplemented by soap and water are recommended. Supple- 
menting but not replacing soap and water, disinfectants in solution can be 
used to wipe off floors and similar surfaces. The best of these is the group 
of creosote preparations. Of these none is better or cheaper than the com- 
pound solution of cresol. 

In London, nine-tenths of the contagion is cared for in the contagion 
hospitals, where there are 10,000 beds. Scarcely any attention is paid to 
measles. The reason is that measles is only contagious during the first 
few days. By the time the case is seen, a diagnosis made, the case reported, 
and the department inspector gets around, the case is no longer contagious. 
The authorities do not fumigate after measles. 

The position taken by the New York Health Department is that "dis- 
infection of most effective sort is performed by air and sunlight/' and that, 
in view of the tendency of contagion germs to die quickly when dried, formalin 
disinfection is seldom required. 



How to Fumigate. — J. H. S. writes: "Will you give a simple recipe for 
fumigating? Would it not be well to fumigate any filthy house recently 
vacated before reoccupying itV 

Keply. — To fumigate, buy one pint of formalin for each 800 cubic 
feet of air space. Close the large openings, such as doors, windows, 
ventilators, fireplaces. 
Sprinkle the floor, 
walls, and all furniture 
and bedding with an 
excess of water. Make 
things pretty sloppy. 
Open all closet doors. 
String clotheslines 
across the room. 
Wring sheets in hot 
water. Put the forma- 
lin on the sheets, one 
pint for each 800 feet 
of air space. Leave the 
room unopened for 
eight hours, then throw 
open the windows and 
air the house for sev- 
eral hours. Scrub and 
clean exceptionally well. 

This airing, scrubbing, and cleaning is the most important part of the 
process, which, taken together, is called fumigating. If the windows, door 
cracks, and keyholes are stripped you can use less formalin — say one pint 
to 1,000 feet of air space. The permanganate method is better, but it is 
more complicated and less safe. 




Fig. 101. — Room Prepared for Fumigation. 
(Johnson and Johnson.) 



210 



CONTAGION— DISINFECTION 



This fumigation does not kill insects or bugs. A little formalin or 
other antiseptic poured around does no good. 

Fumigating filthy houses where there has been no contagion is excel- 
lent, provided we remember that the airing, sunning, scrubbing, and clean- 
ing constitute the more important part of the process. 

The Grip and Fumigation.— Mrs. M. I. F. writes: "Enough cannot be 
said, it seems to me, about isolating cases of grip and effective fumi- 
gation following recovery. Would it not be possible for you to give an 
exact formula for the use of formaldehyd and permanganate of potassium, 
so that your readers might feel safe in using it? As it is, few people, save 
the medical profession and nurses, undertake complete fumigation." 

Keply. — Influenza (or grip) is undoubtedly contagious, particularly 
at certain seasons of the year. The wide spread of the disease, however, 







Fig. 102. — Formaldehyd Sterilizer. 



would make it impracticable to isolate those who are suffering from it and 
thus infect the houses. The contagion is transmitted by the air and by 
personal contact. It is doubtful whether houses and clothing carry it. 

Disinfection of houses with permanganate of potash and formaldehyd 
is done as follows: 

[a] Seal tightly doors, windows, fireplaces, and other openings. 

[b] Freely expose all articles on the premises. 

[c] For every thousand feet of air space use seven ounces of potash 
permanganate and sixteen ounces of formaldehyd. 

[d] Place a large vessel, one holding about eight gallons, in the center 
of the room ; deposit the crystals of the potash permanganate in the vessel 
and pour the formaldehyd over it. One such outfit should be employed 
for every thousand cubic feet of air space in the house. 

How to Fumigate Room. — H. E. B. writes: "Please tell me how to 
fumigate a room used by a person with an infectious disease so the pillows, 
mattress, and clothing will be perfectly safe." 

Reply. — Close all doors, windows, fireplaces, and other openings. Strip 
all cracks with paper. Strip paper in rolls, for the purpose, is on' the market. 



DISINFECTION 211 

Ordinary newspaper and ordinary paste will answer. Sprinkle everything 
in the room; saturate the air with moisture as thoroughly as possible. 
String a clothesline across the room; dip several sheets in formalin (use 
one pint for each 1,000 cubic feet of air), and hang on the line. Leave 
the room sealed tightly for eight hours. Open the windows and doors wide. 
Air the room thoroughly for from four to eight hours. Scour all the wood- 
work with soap and water. Sun the mattress, bedding, rugs, and other 
fabrics. Boil all towels and other washable fabrics. 

Fumigate the Book. — E. A. H. writes: "Do you think it advisable to 
take back a medical book that a family borrowed before being taken sick 
with scarlet fever? One of the children died. I have two small children 
myself." 

Keply. — You may take the book back with safety if you will leave it 
opened out in the sun for two days and have it aired well for another day. 
To feel entirely safe, fumigate it in addition to the sunning and airing. 
To fumigate: place the book in a tight box, a cubic foot or less in size; 
sprinkle the book and the inside of the box well; sprinkle two ounces of 
formalin in the box ; close tight ; leave for eight hours ; air well. 

Fumigation by Gas. — Constant Reader writes: "Is fumigation of house 
or room with hydrocyanic gas the best method of exterminating all insect 
life therein? If so, what in brief is the process?" 

Reply. — Do not use hydrocyanic gas for fumigation. It is much too 
poisonous. Sulphur fumes will kill everything except bedbugs, and it has 
the advantage of being safe. If the cracks are sealed, to burn two pounds 
for each 1,000 cubic feet is enough. If the cracks are not tight make it 
three. 

Fumigation Method. — Mrs. J. S. W. writes: "1. We intend to move 
into another house, and as a precautionary measure, mother is desirous of 
disinfecting it. 2. Will cloths saturated with formaldehyd and same evap- 
orated by placing over a gas heater be an effective method to accomplish 
this? 3. Or would better results be obtained by placing the formaldehyd 
in a dish on the heater and vaporizing it in that manner? J/.. Is it desirable 
to use any other chemical with it? 5. How much formaldehyd should be 
used for an average size room?" 

Reply. — 1. If there has been no contagion in the house recently you 
will gain nothing by fumigating. If there has been contagion recently, and 
there is any danger, the health department will fumigate for you. A good 
cleaning, airing, and sunning is better for an ordinary household condition 
than fumigation without these. 

2. Yes. 

3. The sheet method, as suggested in question 2, is the better. 

4. No. 

5. One pint at least for each 100 square feet of floor space. Moisten the 
floor, walls, and furnishings prior to using formalin. Strip the windows 
and doors. Leave the room undisturbed for eight hours after fumigating. 

Fumigation of Cars. — J. B. W. writes: "I am a resident of Chicago, 
passing the winter months in the South. It is almost a daily occurrence 
to see patients in various stages of tuberculosis arrive and depart, usually 
in the drawing-room of the Pullman. Have known of persons desperately 



212 CONTAGION— DISINFECTION 

ill, in a vain attempt to reach home in the North, dying en route. Witt 
you kindly inform me, as well as others keenly interested, if there is any 
law concerning the fumigation of the Pullman coaches, and if so how 
often is the fumigating done? In other words, what protection has the 
traveling public against infection from the germs of tuberculosis, typhoid, 
diphtheria, etc.?" 

Reply. — There is no law, nor is there any regulation of the Interstate 
Commerce Commission. I think this is a matter on which they could 
legislate through regulations having the same force as laws. The Pullman 
company disinfects its cars at frequent intervals, at least it does those 
which run into central points. What it does with cars making somewhat 
isolated runs I do not know. 

Fumigation after Consumption. — S. M. J. writes: "Please advise me 
about moving into a house that has been occupied by consumptives, one 
dying there." 

Reply. — If the authorities will fumigate, have them do so. If not, do 
the fumigating yourself. Proceed as follows: 

1. Close all large openings. 

2. Strip the windows, doors, keyholes, and all other minor openings. 

3. Open all drawers, disarrange all bed covers. 

4. Sprinkle everything thoroughly. 

5. Soak sheets in formalin and hang them on ropes. 

6. Use one pint of formalin for every ten feet square of floor space. 

7. Leave the rooms closed for eight hours. 

8. Open the windows and air thoroughly for a day. 

9. Scour all woodwork with soap and water. Boil all washable goods. 
10. Sun everything for a day or more. 



CHAPTER XIX 

Contagious Diseases 

SMALLPOX 

For smallpox as a community disease there are two methods of treat- 
ment: vaccination and hospitalization. 

For fires as a community ailment there are two methods of treatment: 
fireproof construction and fire engines. 

To prevent smallpox, most states use both methods. Minnesota and a few 
neighboring states say, if everybody is vaccinated, there will be no small- 
pox. It is unjust to make the vaccinated pay for expensive smallpox hospitals. 
The quickest way to get everybody vaccinated is to make it impossible for the 
unvaccinated to impose on the vaccinated. 

"We will not support smallpox hospitals/' A thoroughly logical posi- 
tion — one that will be tenable when knowledge is better diffused and human 
judgment is better. But as yet we have not reached the stage where 
all men are judicious enough to make it fit. The peculiarly minded 
minority so tyrannize the majority that few health officers deem the Min- 
nesota policy best. 

No one has yet proposed to do away with fire engines and thus force 
ever} r body to fireproof construction. 

Compulsory vaccination laws have been enforced in every European 
country for about a quarter of a century. With them this question has not 
been open for debate, except in England, for about a generation. In Cuba, 
Porto Eico, Panama, and the Philippines it is also demonstrated, proved, 
accepted, and no longer discussed. When, however, it is proposed to do as 
much for the children of Louisville as we have done for the Filipino, there 
rises up a small but noisy group, shrewd enough to cry out in the name 
of liberty. License would be a better term, but it is not catchy, and 
Bellamy has termed this a phrase-catching age. 

In this group there are no men who have had any practical experience in 
controlling smallpox. That all of those, whether engineers, nurses, or 
doctors of the different schools who have been charged with the responsibility 
of handling smallpox are firm believers in the efficacy of vaccination is a source 
of great concern to the anti-vaccinationists, and, in consequence, they seek to 
borrow some names to conjure with. Their prize package is Sir Alfred 
Wallace. 

Now, what are the facts about Sir Alfred that would lead anyone to 
think that his judgment on this point can be safely followed ? He was born in 
1823. In 1858 he dreamed out the theory of natural selection almost simul- 
taneously with Darwin. As soon as he got over the chills he went to 

213 



214 CONTAGIOUS DISEASES 

England, got into close touch with Darwin and for fifteen years fought 
the battle of Darwinism. 

In the middle seventies he renounced religion and in 1881 became a 
spiritualist and aligned himself against the material and in favor of spirit 
direction soon thereafter. 

In 1885 he wrote "Forty-five Years of Registration Statistics/' in which 
he sought to prove that the statistics showed that smallpox was not on the 
decrease from 1810 to 1885. 

He never had any experience with smallpox or vaccination, disease pre- 
vention, hygiene, or sanitation, and therefore the conclusions of this old 
man, honored though he justly was, represent nothing except the conclu- 
sions of an anti-materialist drawn from the somewhat imperfect statistics 
of a period when vaccination was 'quite imperfect. It would take more than 
Wallace to convince the man of the street that there is as much harm from 
smallpox as there used to be. 

HOW TO CONTROL SMALLPOX 

Controlling smallpox is easy. There is no other disease whose control is 
so easy. Health officials know exactly what to do. The epidemiology of the 
disease is so well worked out that any health officer who knows his business 
can guarantee results. There are a thousand men in the United States who 
would be willing to enter into a contract with any community to guarantee 
permanent freedom from smallpox and make the bond forfeitable on failure 
to make good. 

It has not been long since many people believed disease could be blown 
long distances. Now we know that disease stays put. Whenever it travels 
it must have a person, or animal, or insect to carry it. Persons are much 
the most important of these three carriers or distributors. 

Smallpox was the disease wherein the proof that air could carry disease 
seemed most convincing. Chapin's book, published in 1910, gives ten pages to 
a discussion of whether smallpox can be air borne or not. The proof that 
it is is largely based on observations made in 1881. Opinions based on 
work done thirty years ago are not of much value. Chapin sums up as 
follows : 

"The evidence in favor of the aerial transmission of smallpox from 
hospitals is so slight that it should never influence a municipality in Us 
selection of a hospital site. The success of Edinburgh, New York, many 
German cities, and the Pasteur hospital in Paris in caring for smallpox 
in connection with other diseases and even in the same building with 
other patients indicates that the theory of aerial infection has little basis 
in fact." 

Smallpox is spread by close contact with a person who has the disease. 
Contact such as that common on street cars and railroad trains is suffi- 
ciently close for some people, but not for all. An unvaccinated milkman 
delivering milk at the kitchen of the smallpox hospital in Chicago con- 
tracted smallpox once upon a time. It was never proved that he went into the 
hospital. 

What secretion spreads the disease we do not know. We have no in- 



SMALLPOX 



215 



formation proving it to be scabs or scales on the one hand or nose or month 
secretions on the other. 

The difficulty in controlling smallpox since 1898 has been the mild cases. 
When a man has smallpox he has some sort of a sore somewhere on the 




e Your Qioice 



One little 
V&ccin&iion mark 

OIL 

Ttious&nds Of 5maJlpox Iu5tule5 Like Iheee 





5mallpo}c — {lie mosl loathsome of all diseases. 

[From photograph 6j 

WTINATIGN prevents smallkk 

Irotect the little children, ^ 

De'partwent oj Hea,l1h, Chicago — Edi*e*ticm tX 6ertfc5. ^^ 



Fig. 103. 

body. Even the mildest cases have that. None of the cases end in "colds" 
or other mild, deceiving forms of sickness. However, the smallpox sores 
may be so few and the fever and aches which precede or follow them so 
mild that the man thinks his "blood out of order." It does not occur 
to him that so mild a disease could possibly be smallpox. He may have 



216 CONTAGIOUS DISEASES 

four days of fever and aches and then break out here and there. He 
feels much better than when he had fever, but his sores are a little too 
sore for him to go to work, so he visits around for the rest of the week. 

These mild cases are just as contagious as the more violent ones. In 
fact in the Middle West 90 per cent, of the smallpox is spread by these 
walkers. 

The incubation period of smallpox is twelve days. That means that 
the virus which has got into the susceptible man's body rests there for 
twelve days. What happens during that time nobody knows. 

On the twelfth day the disease starts with a severe chill, high fever, 
headache, and a bad backache. If it is a malarial country the chances are 
that the diagnosis will be chills and fever and the treatment will be quinin. 

At the end of the third day or on the fourth day the fever goes 
down, the headache and backache stop, and the sick man thinks the quinin 
has broken his chills. 

He may get up and go down to the drug store for a soda or go out and 
call on his friends. Some friends will call his attention to a little breaking 
out probably on his forehead; or maybe there is some itching and he 
notices the eruption when he scratches. 

The eruption feels like a shot under the skin. By the end of the 
third day the small, red, bullet-like mass is capped by a little water blister. 
The blister part gets larger each day. 

The blister seems tied down in the middle. By the sixth day of the 
eruption the blister is full of matter instead of water as at first. 

In the old-style smallpox the eruption usually appears first on the 
forehead but in this mild disease that came to us from Mexico sixteen 
years ago the eruption is exceedingly light and may appear first anywhere 
on the body. Bumps appearing on the scalp, on the soles of the feet, or in 
the palms of the hands after several days of fever and backache always sug- 
gest smallpox even though but one or two shotlike spots are present. 

There is not much treatment for smallpox. Good care in a good, airy 
hospital is the only treatment required. The nurses will see to it that the 
blisters are not broken and that scratching does not cause secondary in- 
fection. 

Smallpox is of all diseases the most contagious for unvaccinated people. 
The vaccinated come and go in a smallpox hospital without thought of 
contracting the disease. The only persons who contracted smallpox in 
the Chicago smallpox hospital in twenty years were three unvaccinated 
boys who got in "unbeknownst." 

One hundred years ago there were people who thought that if a person 
would keep clean he would not contract smallpox. Nobody who has ex- 
perience with smallpox has believed this doctrine during the last fifty years. 

LESSON OF AN EPIDEMIC 

The city health authorities advise us from time to time. The organized 
opposition from time to time advises us to disregard the health department. 
The man of the street would like to know whose advice to take. 

On November 13, 1913, I read that twenty years ago, on November 13, 



SMALLPOX 217 

1893, Health Commissioner Eeynolds of Chicago prophesied: "We shall no 
doubt have a great deal of smallpox this winter/ 5 

I thought my readers would like to know whether Dr. Eeynolds knew 
what he was talking about. It might help them to decide whether to accept 
or reject present day advice. 

Turning to the records I found that a case of smallpox came to Chicago 
on June 12, 1893. There was one death in June, one in August, one in 
September, four in October, and two in November. 

On November 14 Dr. Eeynolds wrote to Albert Lane, superintendent 
of Chicago schools, of the impending storm. On November 17 Archbishop 
Feehan sent out a circular letter advising vaccination. 1893 closed with a 
record of 140 cases and 23 deaths. 

In December, 1893, the mayor and health commissioner began com- 
municating with the council about the condition. The council did not 
act until April, 1894. 

The record for 1894 is awful. The department treated 2,332 cases 
of smallpox in the hospital that year. There were 1,033 deaths from the 
disease. During the year forty people dead from smallpox were found 
in abandoned houses. Whether the unfortunates were deserted while still 
alive there was no way of knowing. 

The official report says that for a while in May the cases came so 
fast that the clerks could not keep the record straight. The record for the 
first portion of the year was : 

January — 176 cases, 29 deaths. 

February — 219 cases, 55 deaths. 

March— 276 cases, 100 deaths. 

April — 321 cases, 157 deaths. 

May — 518 cases, 253 deaths. 

By May the town was in a wild alarm. The health department was 
given a free hand. The council voted it 500 vaccinators. Additional hospital 
facilities were secured. Provision for the present smallpox hospital was 
under way. In May alone 586,500 free vaccinations were done. In all, 
1,200,000 free vaccinations were done on Chicago's 1,500,000 people. Seventy 
thousand free vaccinations were done on the 185,358 children of the public 
schools. 

By June the wave had reached its crest. The record of its gradual sub- 
sidence is as follows : 

June — Cases 191, deaths 171. 

July— Cases 82, deaths 57. 

August — Cases 112, deaths 53. 

September — Cases 82, deaths 31. 

October — Cases 105, deaths 40. 

November — Cases 120, deaths 51. 

December — Cases 130, deaths 42. 

The 1895 report shows that the disease was still exacting toll in that year. 
In January, February, and March there were 112 deaths; in April, May, 
and June, 31 ; in July, August, and September, 12. 

The epidemic ended twenty-seven months after the first case occurred, 
twenty-two months after Dr. Eeynolds issued his warning, seventeen months 



218 CONTAGIOUS DISEASES 

after the city council had heeded the warning. One thousand two hundred 
and eleven lives had been lost. 

Going back to the reports issued in the beginning we find that the com- 
missioner was horrified when he discovered so large a proportion of the 
people unvaccinated. He said that the proportion of unvaccinated was 
greater than at the beginning of the great epidemic in 1883. That epi- 
demic began in April, 1880, ended in June, 1883, and cost 2,561 lives. 

The only hope of shortening that record and lessening the rate was to 
excite public interest. This Dr. Reynolds went at in earnest. In spite of the 
help given him by the pulpit and press interest commensurate with the 
need was not excited until April. By summer the backbone of the epidemic 
was broken but, snakelike, the tail lived on for more than a year. 

Lord God of Hosts, be with us yet, 
Lest we forget! Lest we forget! 



HOW PUNISH THE WEAK SISTER? 

In April, 1912, smallpox appeared at Niagara Falls, New York. A study 
of the reports of the Public Health Service and of reports of the State Board 
of Health shows that the disease has been continuously present there since. 
The report of the Public Health Service shows that for the week ended May 
31, 1913, five cases were reported. 

When a town or city with an organized government continues to have 
smallpox developing during the hot weather it is a sure sign that the govern- 
ment is failing to make use of some of the measures for control that succeed 
elsewhere. 

The same government reports showed that smallpox was present in 
Evansville, Indiana, early in the summer of 1912. During the summer and 
fall new cases were appearing from time to time. The public health report 
dated June 20, 1913, says that "during the week ended June 14, 1913, nine 
cases of smallpox had been notified in Evansville, Ind., making a total of 818 
cases reported since October 1, 1912." 

In January, 1911, I was traveling in southern Illinois on an Illinois Cen- 
tral train running to Evansville. I overheard the brakeman telling of a case 
of smallpox which had been in his next door neighbor's home for ten 
days or two weeks. They had taken the case out the day before. He did not 
think much of the brand of protection used in Evansville. 

At the present day the control of smallpox is so satisfactory that when 
a community continues to develop cases, particularly when a hot season passes 
without letup in the cases, it is certain that something is wrong. 

I am informed that the anti-vaccinationists are the public enemies 
who are giving Evansville a bad reputation and endangering communities 
within railroad reach of Evansville. I am informed by the secretary of the 
State Board of Health that the opposition has made use of injunctions and 
other obstructive legal machinery. 

I have before me clippings from the Evansville papers that show 
where the reason for Evansville's disgrace lies. 

A Dr. Kunath writes about "this smallpox 'scare' sent out by the 



SMALLPOX 219 

Board of Health, their false representations and threatening dictations." 
Another is headed : "Protest at Board Order — Delegation of Anti-vaccina- 
tionists at Mayor's Office; Members of the Physio-mental and Anti- vaccina- 
tion Society Called on Mayor Heilman, Demanding the Eesignation of the 
Board of Health." 

It is plain that these communities are not suppressing smallpox, because 
they are not making use of all the necessary measures. They are not doing 
so because of the obstructive tactics of well meaning but misguided people. 
They are to be pitied. Perhaps to pity them is punishment enough. 

THE TWO NIAGARAS 

Smallpox was imported into Xiagara Falls, Xew York, on April 5, 1912. 
There is no compulsory vaccination ordinance in that town. There is a 
good deal of anti-vaccination sentiment extant. The percentage of unvac- 
cinated people among their population is above the average. 

There are two methods of controlling smallpox — isolation and vaccination. 
Niagara Palls officially depends on isolation alone. The vaccination done 
is on individual initiative. 

Let us see if Xiagara Falls, Xew York, has shown efficiency in handling 
smallpox. The records of the Xew York State Health Department show that 
cases of smallpox have been reported from Xiagara Falls each month since 
April, 1912. 

The highest number of cases was 18 in February, 1913, the lowest 1 in 
October, 1912. The total number of cases up to Xovember 8 was 113. The 
state record shows 132 cases up to October 1 and the government record for 
three weeks in October and one in Xovember shows 11 additional cases. 

It will be noticed that the epidemic kept up straight through two hot 
seasons. Smallpox disappears in hot weather under any effort at suppression 
worth while. 

As Xiagara Falls, Xew York, has only 30,000 inhabitants, we get a better 
idea by saying that had Chicago had the same rate it would have meant 
14,000 cases but in order to form an intelligent judgment it is advisable 
to have a city for comparison. 

Immediately across the river from Xiagara Falls, Xew York, is that other 
summer resort, Xiagara Falls, Ontario. Smallpox was imported into this 
city in February, 1913. It developed in the Tremble House near the Michigan 
Central depot. At first the health authorities tried isolation and vaccination 
by moral suasion. The city council voted down a compulsory vaccination 
ordinance. 

The provincial board of health made its arrangements to quarantine all 
Canada against Xiagara Falls, Ontario, whereupon the city general council 
voted the proclamation for vaccination. Seventy-five per cent, of the popula- 
tion obeyed the proclamation. The school children were vaccinated. The 
epidemic was speedily stopped. By May Xiagara Falls, Ontario, was free from 
the disease. In all they had had 45 cases. 

In one town the epidemic lasted three months in all. About one month 
after vaccination got under way in earnest the epidemic was broken. In 
the other town the epidemic is at the present writing in its twentieth month 



220 CONTAGIOUS DISEASES 

and still hangs on. They will either change their method or the disease 
will hang on indefinitely. 

Twenty years ago smallpox epidemics in cities of 500,000 inhabitants 
kept up for several years. In the last ten years no large city has had 
an epidemic keep up through the hot weather. Towns of 30,000 find it easy 
to end a smallpox epidemic in two or three months. And yet here in this 
twentieth century, in the Empire State, is a community which has had this 
millstone around its neck for some time including two hot seasons and 
which seems helpless. 

The disease is very mild. It is costing no lives but it must be costing 
business something. Such a record of inefficiency among thinking people 
is a reflection on the business acumen of the business people. What's the 
use of building spotless show factories in such a place ? 

The figures cited above were obtained from the United States Public 
Health Service, the New York State Department of Health, and the Ontario 
Provincial Board of Health. 



COST OF PROTECTION 

An expert in the handling of smallpox would willingly enter into a 
contract with any community to protect it against smallpox. 

The terms of a contract for a city of 100,000 inhabitants would be 
about as follows: The community would require that every child be vac- 
cinated before reaching two years of age and should be revaccinated once every 
ten years. In case a person with smallpox enters the town every person 
brought in contact with the case would be required to be revaccinated. 
The community would pass the laws and compel their observance. The 
expert would do the vaccinating, diagnose, treat and care for the cases. He 
would figure the cost of the vaccine at $500 a year. Properly organized 
the service could be rendered for $2500 a year. A city thus protected would 
require no hospital. If we figure $2000 as the hazard in view of his 
guarantee we would say that the cost of guaranteed protection against small- 
pox would be $5000 a year or 5 cents an inhabitant. 

VARIOLOID 

In earlier years the term "varioloid" was used to denote an attack of 
smallpox that had been modified and rendered mild by a vaccination that did 
not fully protect. The term is one that works mischief because it leads to 
the belief in the uninformed that the disease is something different from 
smallpox and not contagious. 

Varioloid is nothing more or less than smallpox. It is now known that 
neither smallpox nor so-called varioloid occurs in the vaccinated; and the 
scar noticed in the old days in varioloid cases was not from vaccination but 
from infection of the site of vaccination. 

Finsen Method Has Failed.— W. G. K. writes: "I remember reading 
some years ago that the late Dr. Finsen claimed to have discovered 
that if a smallpox patient was kept in a room lighted by a nonactinic 



SMALLPOX 221 

light he would not be sick much, would recover quickly, and not be pock- 
marked. In other words, he claimed that it was the actinic qualities 
of white light (that acts on the salts of silver) that make practically 
all the trouble to the person sick with the disease. I have asked several 
physicians at different times, but they have seemed to know nothing 
about it. The fact that a persons face, which is not protected from the 
light, is worse marked than other parts of the body, would incline a 
person to think there is something to it. If the theory has been proved 
correct, it should be given wide publicity" 

Reply. — The method was tried extensively in Chicago. It has failed. 
Smallpox is now so mild that there is not much need of improving the 
methods of treatment. In December, 1912, 769 cases with twenty-one 
deaths were reported. Twenty of the deaths were in Texas ; Hunt County, 
Texas, had sixty cases and eighteen deaths. Until the Texas type gets up 
this way no treatment, except rest and care, seems to be needed. 

No Smallpox Danger. — A. H. writes: "Is it perfectly safe to har- 
vest and distribute promiscuously for use ice from a body of water that 
receives the sewage from a city that has had from twelve to twenty 
cases of smallpox for a year past? From November to March there is no 
current except what runs from the sewers/' 

Reply. — Smallpox is not spread in that way. Therefore danger from 
smallpox would be no reason why the ice should not be used. There 
would be danger from typhoid unless the body of water is large. Aside 
from the danger, people do not enthuse over eating frozen sewage. 

Mild Form of Smallpox. — A. M. writes: "Please state if there is a 
rash called Cuban itch and a home remedy for it. Our doctor seems to 
know nothing about it and his remedies do no good. Is it contagious?" 

Reply. — Soon after the Spanish War smallpox came in from Mexico. 
It was a mild form and was called Cuban itch by some people. The 
Cubans do not know of Cuban itch. What is sometimes called Cuban 
itch is smallpox. 

Two Distinct Diseases. — M. M. C. writes: "There is trouble with 
smallpox in my city, caused largely by the fact that doctors are first 
diagnosing it as chickenpox, especially cases in children. Are these two 
distinct diseases, or the same? Is smallpox so contagious that it can be 
carried in the clothes of one well person from the bedside of the patient 
to another person, or does it take actual contact with the patient himself 
to contract the disease?" 

Reply. — 1. Smallpox and chickenpox are not the same. It is a safe 
bet that the children referred to had smallpox. 

2. Rather close contact is required. A person who had not been in 
contact with a case of smallpox cannot be infected by a well person who 
has been in such contact. 

If the town will enforce universal vaccination the disease will be 
under control reasonably soon. 

VACCINATION 

In 1901 the Chicago Health Department issued the following vac- 
cination creed: 



222 CONTAGIOUS DISEASES 

After many years of experience with Smallpox and Vaccination, the Chicago 
Department of Health hereby declares: 

FIRST. — That true Vaccination — repeated until it no longer "takes" — 
ALWAYS prevents smallpox. NOTHING ELSE DOES. 

SECOND. — That true Vaccination — that is, vaccination properly done 
on a CLEAN arm with PUKE, potent lymph and kept perfectly CLEAN and 
UNBKOKEN until the scab falls off naturally— never did and NEVER WILL 
make a serious sore. 

THIRD. — That such a Vaccination leaves a characteristic scar, unlike 
that from any other cause, which is recognizable during life and is the ONLY 
conclusive evidence of a Successful Vaccination. 

FOURTH. — That no untoward results ever follow such Vaccination. On 
the other hand thousands of lives are annually sacrificed through the neglect 
to vaccinate— a neglect begotten of LACK OF KNOWLEDGE. 

Although cases of smallpox come to Chicago frequently the disease has 
never made any considerable headway since the health department began 
actively using this creed to educate the people. In the fifteen years 
since this creed was promulgated no scientist has disproven any part of it. 
No community which has followed it has had any serious trouble with 
smallpox. Certain communities that have had smallpox and have tried 
to control their epidemics by other means have had to come to vaccination 
methods as embodied in this creed before they were able to control their 
epidemics. 

Discovery of Vaccination. — Dr. Edward Jenner of Berkeley, England, 
had heard that dairymaids were liable to catch "a certain sore called 
cowpox found occasionally on the teats of dairy cows/' Furthermore, he 
heard that a dairymaid who had had cowpox could not have smallpox. 
He investigated the subject. By experimenting he proved that one who 
had recently had cowpox could not be inoculated with smallpox. 

Jenner told Hunter his opinion in 1770 and in 1798 he published it. 
The experience of the last 116 years has proven that Jenner was right. 
Everywhere in all lands where people study and know the fact is appre- 
ciated. 

As a good shower of rain renders dead grass non-combustible and 
thus stops a prairie fire, so vaccinating the population ahead of smallpox 
stops the epidemic by rendering the people immune. 

Jenner's discovery was made before the days of bacteriology. In recent 
years the bacteriologists discovered the scientific basis for vaccination against 
smallpox. Applying the same principles they have discovered effective methods 
of vaccination against other diseases — for example, typhoid fever and lock- 
jaw in man, cholera in hogs and blackleg in cows. 

Production of Smallpox Vaccine. — A sound calf proven free from all 
forms of disease is inoculated with cowpox vaccine. The side of the belly is 
cleaned, made aseptic and shaved. It is then scarified and inoculated with 
vaccine. The vaccinated area is kept free from dirt. When the vaccina- 
tion begins to take the exuding lymph is gathered up, ground in sterile 
mortars and mixed with glycerin. The glycerinated lymph is generally 
marketed in sealed glass tubes. Before it is used it is proven free from 
lockjaw and ordinary pus bacteria by laboratory tests. Glycerinated vaccine, 



Before ^ After 

S^IALLP 





Criminal negligence defaced 
this beautiful child for life. 



A lit+k 5C^r 
on +he &rnrz 
will prevent 
ihous&ndsof 
sc^rs on the 
fa.ee. 




A pock-marked 

T&CCZ is 2xO- 

ineffaceable 
b&dge: of - 
i^nor&nce or 
nec^Iech, 



VACCIMTIOA 1 p P fl^j5 5/1ALLP0X 

Profed - the Children — 

Proteci Yourself* 

KATHERINE HELD WHITE -I9f4 



Chicago /fea/£fr Depart/neat, ^ducationaS 'Poster tSercef. /Y£ £0<9' 

Fig. 104. 



223 



224 CONTAGIOUS DISEASES 

properly ripened and kept in a cool, dark place, will remain potent for several 
months. 

Properly inoculated into a person susceptible of having smallpox it 
will cause a vaccination sore. It will not cause tuberculosis, syphilis, lockjaw 
or blood poisoning. Tubercle bacilli cannot live in glycerin. Syphilis is not 
possible because cows do not have syphilis. If the vaccinated man develops 
lockjaw or blood poisoning it is because the bacteria responsible got into the 
vaccination wound from his clothes. If the arm becomes very much in- 
flamed and the sore suppurates it is because of pus infection after vac- 
cination. 

The vaccination blister is typical in appearance. Suppurating wounds 
do not protect against smallpox. Very bad arms do not protect against 
smallpox. 

A vaccination scar shows typical pits. These pits can be made out for 
years. Unless the scar shows them there is no way of knowing that the 
person is protected against smallpox except by trying to vaccinate him again. 
If he has a typical scar less than ten years old he will not have smallpox. If 
he has a scar without pits he cannot be certain that he is immune unless 
several attempted vaccinations have failed to take. 

Between 1899 and 1914 the Chicago Health Department observed 
2,588 cases of smallpox; 2,218 of these had never been vaccinated. Of the 370 
remaining a few had typically pitted scars but the vaccinations had been 
done years before and there had been no revaccination. In most of the 370 
the scars were atypical as well as old. None of the 156 persons who died of 
smallpox had ever been vaccinated. 

When to Vaccinate. — Vaccination may be done at birth or any time 
thereafter except when suffering from an acute disease. It may be done 
after exposure to and infection by smallpox. One so infected will not come 
down with the disease before twelve or fifteen days, as vaccine works much 
faster than that. A vaccination soon after exposure to the disease, if well done, 
will take and protect the patient against the disease. 

Every child should be vaccinated before it is weaned, for it is as much 
the duty of parents to protect their child against smallpox as it is to 
protect it against the evils of cold or hunger. 

One vaccination will frequently protect for a lifetime, but it is found 
that vaccination will generally take twice in a lifetime, once in childhood and 
again in adult life. 

As there is no way to measure immunity to smallpox except by vac- 
cination, it is well to try a vaccination again, especially if exposed to the 
disease. If the vaccination will not take smallpox will not take. 

Where to Vaccinate. — As most people are right-handed, vaccination is 
generally done on the outside of the left arm near the shoulder. 

It is well to keep the arm reasonably quiet while it is sore and any 
limitations to the use of the arms causes less inconvenience in the left arm than 
in the right. 

Before the days of pure vaccine and antisepsis there were many large 
scars on vaccinated arms due to infections that were eyesores to the ladies and 
consequently there sprang up a desire for vaccination on the leg. These vac- 
cinations are objectionable because the wound cannot so easily be kept 



SMALLPOX 225 

quiet or clean, as the swish of the skirts is apt to infect it with the dirt 
of the streets. 

How to Vaccinate. — First, clean the arm with soap and water and then 
sterilize with alcohol. Then scratch the outer skin with a dull needle making 
a place about an eighth of an inch in diameter. It is not necessary to draw 
blood in vaccinating. A little oozing will do no harm but bleeding may 
wash away the vaccine lymph. 

After the scarification is done the vaccine is put on the denuded sur- 
face and allowed to dry before the arm is covered. The wound should not be 
handled at any time and will rarely need to be covered. Sometimes a 
clean, loose piece of linen or gauze may be fastened to the sleeve to act as 
a cushion over the wound but at no time should the arm be bandaged or have 
adhesive straps to hold a shield or covering over the wound. If the wound 
should become infected it must be treated as any other infected wound. 
If a shield is placed over the vaccination it should be removed within twelve 
hours. The only object of a shield is to save time. Glycerin dries slowly. 

Smallpox, before the days of vaccination, was a very common disease. 
Those persons whose features were not pockmarked were the exception. 
No class was exempt. Queen Mary of England died of smallpox in the 
year 1694. 

Perhaps the most striking and forceful comment ever made upon 
the disease and its prevention was by Lord Macaulay when discussing the 
death of Queen Mary in his History of England. He said : 

"That disease over which science has since achieved a succession of glori- 
ous and beneficent victories was then the most terrible of all the ministers 
of death. The havoc of the plague had beerj far more rapid; but the 
plague had visited our shores only once or twice within living memory; 
and the smallpox was always present, filling the churchyards with corpses, 
tormenting with constant fears all whom it had not yet stricken, leaving on 
those whose lives it spared the hideous traces of its power, turning the 
babe into a changeling at which the mother shuddered, and making the 
eyes and cheeks of the betrothed maiden objects of horror to her lover/' 

Anti- vaccinationists. — In spite of the facts that are open for the 
perusal of all, there are still people who style themselves anti-vaccinationists, 
and who from time to time get into the limelight. They are always people not 
willing to learn the facts or not capable of understanding, and some of them 
may be quite normal in other respects. It is probable that there will ever 
be some of their kind, for there is always someone to take the opposite side 
of every question. The anti-vaccinationists can only flourish where there 
is no smallpox in a community, and, thanks to vaccination, that is most 
of the time. An outbreak among those who have neglected vaccination 
always puts the anti-vaccinationists to flight until the sad occasion is for- 
gotten. 

Vaccination is not compulsory in the Ignited States except that it is 
generally required of children before admittance to the public schools and 
of men before admission to the army. 

In times of freedom from smallpox communities neglect vaccination, there 
is no propaganda continually preaching it, doctors neglect to urge it and medi- 
cal colleges become slack in teaching it with the result that in time there is 



226 CONTAGIOUS DISEASES 

a large number susceptible to smallpox. Then the disease is somehow 
introduced. Everybody gets vaccinated and the disease is eradicated. There 
is rarely any serious objection to vaccination when smallpox is present. 
Indeed it can safely be said that vaccination is more broadly accepted than 
is religion, for there we have dissenters, too. 

How to Vaccinate. — Z. writes: "A friend lives in the country, where 
she and her children often meet neighbors, but where it is difficult to 
see a doctor. If fresh vaccine points were sent to her, would it be 
advisable for her to vaccinate her family? She is intelligent, but with- 
out special training as a nurse or in medicine. What is the process?" 

Reply. — 1. If the danger of smallpox is imminent, yes; otherwise she 
had better call a doctor. 

2. Scrub the skin clean with soap and water and then with alcohol. 
Sterilize a needle in alcohol. Scratch a place one-third the size of the 
nail of the little ringer. Scratch deep enough to cause oozing, but not 
bleeding. Break the ends from the vaccine tube. With the small bulb 
express the lymph on the oozing area. Keep the sleeve up until the 
lymph has dried. Wrap a clean handkerchief lightly around the arm. 
Keep the clothes extra clean, keep the skin extra clean for two weeks. 

If the vaccination is taking, the arm will get sore five days after the 
scarification. Unless it does, the vaccination has done no good. Vac- 
cinate on the arm. Use one tube for each person. The cost of vaccine to 
large purchasers is three to five cents a point. At retail price it should 
not exceed ten cents. Some people never take but once; some once every 
twenty years; some once every ten years. Occasionally a person is found 
who will take again after five years. 

Experts and Theorizers. — W. A. B. writes: "England passed a com- 
pulsory vaccination act in 1853, insuring the vaccination of 98 per cent, 
of all children born. Nevertheless, twenty years afterwards the country 
suffered the worst epidemic in its history, in which 8,000 vaccinated 
children under five years of age died of smallpox." 

Reply. — It is unsafe to draw any conclusion from experiences of 
thirty-eight years ago. I know of no health officer anywhere in the 
world, charged with the responsibility of preventing smallpox, who does 
not use vaccination. These men have had large experience. I do not 
believe that anyone would hesitate to give his opinion greater value 
than the opinions of men who, so far as this proposition is concerned, 
are merely speculators and theorizers. 

Blood Test for Vaccination. — E. F. P. asks: "Has the blood ever been 
examined after vaccination against smallpox has taken effect? If visible 
changes are produced are they the indication for how long a time vaccina- 
tion is a preventive of smallpox?" 

Reply. — The blood has been carefully examined after vaccination 
against smallpox. There are no visible changes. There is no way known 
at the present time to measure immunity against smallpox except the 
clinical way. 

The clinical way is to try vaccination. If it fails, say twice, in a 
person previously successfully vaccinated, immunity can be inferred. This 
is the method of testing immunity employed by health departments. 



SMALLPOX 



227 



Anyone immune as shown by this test is allowed to visit in the wards 
of the smallpox hospitals. This does not tell how long the immunity will 
last. Nor is there any way of telling except by clinical experience. Seven 



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Fig. 105. — Localized Epidemics of Typhoid Due to Milk; 1910 and 1911. Each 
small circle represents a case. 

years is a safe limit of trust in immunity from vaccination. Some people 
will remain immune for, say, twenty years. Most people will be immune 
for ten years. But the safe assumption is that immunity from vaccina- 
tion does not last more than seven years. 



228 CONTAGIOUS DISEASES 

Smallpox and Vaccination. — V. A. M. writes: "Some parts of the 
Illinois valley have the misfortune to have threatened epidemics of 
smallpox. Are there any serious objections to vaccination? Can it be 
the source of other diseases? At what distance can the contagion be 
transmitted — that is, how close to an affected person can one venture 
with safety? Do fresh air and sunshine kill the germ? What precau- 
tions are advised in addition to vaccination or to those who object to itf 
What constitutes 'exposure' to it?" 

Eeply. — 1. No. 

2. No. 

3. If successfully vaccinated recently he can sleep in the bed with 
him with safety. If not, he should stay at least two hundred feet from a 
case, or from anyone who has been in contact with a case, except that 
the person in contact knows how to disinfect his hands and his clothes, 
and has done so. 

4. Yes. 

5. No precautions are required except vaccination. 

6. Contact with a case, touching him or his clothes or getting within 
a short distance (say five feet) of him. Two hundred feet is an extra 
precaution. Unvaccinated communities sooner or later pay the price. 

Amputation and Vaccination. — E. T. writes: "My little boy was suc- 
cessfully vaccinated a year ago. A few months ago he had an accident 
and lost his left arm (where the vaccination scar was). Shall I have him 
vaccinated again? If so, where?" 

Reply. — A successful vaccination changes the entire body so that 
it is protected. He need not be vaccinated again for six years. He is 
in no danger from smallpox. Get a certificate from the vaccinator. 
Use this as your proof. 

SCARLET FEVER 
HOW SCARLET FEVER SPREADS 

Scarlet fever spreads from mouth to mouth and the mouths cannot be 
very far apart either, in point of time or in distance, else the disease will 
not spread. 

Every hour that elapses from the time the secretion leaves the mouth 
of the sick and until it gets to the mouth of the catcher gives sunlight, 
air and drying a chance to kill the contagion. Every hand, every cloth, every 
table that it touches bars it away from its chance of getting to the mouth 
which it can harm. It is no aeroplane or flying machine; it must be bodily 
carried from sick to well. 

In some German and English hospitals which treat scarlet fever in the 
same large room with children convalescent and sick from other diseases, 
there is a wall six feet high between the scarlet fever and the other cases. But 
what gives the result is that no hand, no thermometer, no towel, nothing of 
any sort which touches a scarlet fever case touches any other case until 
it has been sterilized. The isolation, from the scientific standpoint, is com- 
plete^ — and complete scientific isolation is what is essential for the control 
of scarlet fever. 



SCARLET FEVER 223 

The death rate in hospitals is always lower than in homes. It gives 
the well children a chance to escape catching the disease. But it is a waste 
without warrant to have a hospital for scarlet fever alone. 

When a community with a smallpox hospital has no smallpox, but does 
have scarlet fever, let the hospital be used for the disease they have. It is 
safe. The hospital will not spread scarlet fever, smallpox, diphtheria, measles 
or whooping cough. The building, the room, the bedding, can be used first 
for one and then for another. It may be necessary to change the nurses, 
physician and attendants, but not the building. 

DEVELOPMENT OF SCARLET FEVER 

Six days after exposure a child in whom scarlet fever is developing 
will have a rise of fever and a sore throat. One day later a fine scarlet 
rash appears in most cases. Usually the rash fades in seven days and scaling 
of the skin begins in eight days. The throat is red and sore while the rash is 
out and it continues red, swollen and boggy for days after the rash has dis- 
appeared. 

The great mistake which we make in handling scarlet fever is in paying 
too much attention to the rash and too little to the throat. Many of the 
cases never develop a rash at all, but they do get the sore throat. The throat 
is the thing to watch. 

When the patient is recovering again we have judged by the rash and the 
scaling as to when the quarantine should end. Again the throat's the thing. 
Watch the throat. 

In trying to decide what spreads contagion, we have searched the 
"scales." Again the throat's the thing to watch. Recent moist mouth dis- 
charges, mouth spray, sputum, and "droolings" convey the contagion. 

We know little about the germ which causes scarlet fever. We know less 
about experimental scarlet fever than we do about experimental measles. But 
from the practical standpoint we know this much: 

A patient having scarlet fever is infectious from the first sore throat 
to the time when the tonsils are no longer boggy and swollen and all discharges 
from the nose, ears, and throat have stopped. 

People who have been in contact with cases can occasionally spread the 
disease through their mouth and nose secretions. 

Cases with sore throat and without rash can spread the disease as readily 
as those who have had it. 

Dried secretions are not very apt to spread the disease. 

SCARLET FEVER AND HOT HOUSES 

About the first of January a man told a friend he was going south for 
the remainder of the winter. The friend casually asked, "Are you going 
away to escape the cold ?" "No," replied the first speaker, "I am going away 
to escape the heat. Houses in New York in winter are too hot to live in. 
I am going to Florida where the outside air and the rooms are cooler 
than the rooms in New York." 

The business man in Chicago spends more than three-quarters of each 



230 CONTAGIOUS DISEASES 

twenty -four hours inside a house — and houses are warmer in winter in Chicago 
than in Xew Orleans. 

School children in Chicago live in air which is several degrees warmer 
than that of school and living rooms in Xew Orleans. 

When we know this we do not wonder that there are few deaths from 
scarlet fever in Xew Orleans,, Richmond, or any southern city. 

I wonder if the public generally knows that the scarlet fever death 
rate mounts as we go north from Mobile with a rate of 3 per 100,000 to 
5.3 in Memphis, to 9.6 in Louisville, to ISA in Chicago, to 30.2 in St. Paul, 
and possibly a higher rate in Canadian cities. 

Scarlet fever is a cold weather disease, because houses are hot when the 
scarlet fever weather is cold. 

It is a cold climate disease, because children are closely housed in the 
cold climates. The moral is that when living rooms are as cool in the upper 
Mississippi valley in February as they are in Richmond, the scarlet fever 
rate will begin to drop and as the number of foci of the fever decreases the 
drop will continue. 

The moral, so far as the individual child is concerned, is that it be kept 
out of hot rooms. 

The moral for a child sick with scarlet fever is that it be kept in a cool, 
well ventilated room. 

In the spread of scarlet fever the throat secretions are of great importance. 
Possibly scaling skin is of some importance. But do not forget hot rooms 
and staying indoors. 

MYSTERY OF SCARLET FEVER 

Scarlet fever is a disease of mystery. Strange to say, its cause re- 
fuses to be discovered in spite of the large amount of money that has been 
spent on it and the great amount of brains and energy employed in scarlet 
fever research. Xo bacillus has been found which is the cause in diphtheria 
and no filterable virus as in measles. 

That the infection gets into the nose and throat, that poisons circulate 
in the blood and thereby reach the skin and kidneys as well as structures 
which react less to them, that after a certain time the disease ceases to be 
active whereupon the badly poisoned cells are shed — these observations 
are so easily made that they are not disputed. That the disease belongs in 
the group of contagions of the type caused by microorganisms is but little 
questioned. 

For some reason atmospheric temperature plays a prominent part in it. 
It abounds in winter and decreases in hot weather but enough lingers 
to carry the seed over from winter to winter. In climates where the outside 
air is cold and the room air is hot. the scarlet fever rates are high. In 
those such as Xew Orleans, where the outside air is balmy and the room 
air is frequently too cool for comfort the scarlet fever death rates are not 
high. The mothers of Kentucky. South Carolina, and Mississippi know 
nothing of the dread of scarlet fever felt by the mothers of Wisconsin 
and Minnesota. 

It has been suggested that in the gulf states the people have scarlet fever 



SCAELET FEVER 231 

so mildly that it is not called scarlet fever. It is only the rare and highly 
exceptional case that develops symptoms that mark it plainly as scarlet fever. 
It is only the rarer epidemics in which the cases are typical. 

Scarlet Fever Incubation. — JR. W. S. writes: ''Would you kindly 
state the period of incubation for scarlet fever? Is scarlet fever con- 
tagious during the first stages of the disease? Can dogs or cats act as 
carriers of the disease?" 

Eeply. — 1. Usually three to four days; occasionally one day; occa- 
sionally one week. 

2. Yes. 

3. Possibly. 

Definition of Scarlatina. — J. W. W. a: rites: "Will you please tell me 
the difference between scarlet fever and scarlatina?" 

Reply. — The first is the English name, the second the Latin name 
of the same disease. There is absolutely no other difference. One does 
not describe a mild and the other a severe form of the disease, a wrong 
belief that leads many to neglect proper quarantine precautions in what 
they think is the milder form. 

Reporting Scarlet Fever. — Anxious Mother writes: "My baby has 
had scarlet fever for the last three weeks and has started to peel very 
slightly on his head, feet, and knees. Let me hnow where the contagion 
lies, because I have another child o 1 * years old. I keep him- out of the 
house, but he comes every day and begs to be let in. Would I do any- 
body harm if I should take a walk in the evening and talk to people 
standing a little distant from me? My doctor has not reported the case. 
Should I report it now to the board of health and must I be locked in 
for six weeks more?" 

Reply. — You should insist upon your doctor reporting the case to the 
health department, or you should report it and the department will send 
out someone who will tell you just what to do, and will also disinfect 
your house when the child is well. The quarantine generally lasts from 
four to six weeks from the beginning of the disease. If you report it 
now your quarantine will last but a short time and you will know that you 
have not been the means of spreading the disease. If you keep away 
from your other child and do not let him come home until the house has 
been disinfected the chances are he will not get it. 

Obey Health Board. — Mrs. W. P. C. writes: "My family has been in 
quarantine for seven weeks, owing to scarlet fever, and the child who 
had it is still scaling off on the feet and on the hands. She has scaled off 
three times already. I wish to know if this last scaling is dangerous, 
and if it would be all right for the family to get out of quarantine." 

Reply. — If the throat and nose are well, if there is no discharge from 
the ears, the peeling may be disregarded. By all means obey the in- 
structions of your health board, charged as it is with the responsibility 
of protecting your community. But call its attention to the more recent 
writings on the subject; for instance, Chapin's "Sources and diodes of 
Iniection/' or Hill's articles in the Canadian Public Health Journal, 



232 CONTAGIOUS DISEASES 

Scarlet Fever in School. — "Interested Neighbor' writes: "At the 
Langland school there have been several cases of scarlet fever, and it 
seems to be spreading more every day. There have been cases of children 
peeling in school. This is from the doctors own lips. Now, if you go 
to a house where there is a scarlet fever case, you tack a sign on the 
door, and all but those in attendance must leave or you quarantine them. 
Since there have been three cases found in school, I propose the closing 
of the school and having it thoroughly fumigated/' 

Reply. — To close a school and disinfect it as a method of preventing 
the spread of scarlet fever is not good practice. When it has been tried 
it has failed. Scarlet fever is spread by people, not by desks and walls. 
Children "peeling" in school are the spreaders. A good quarantine and 
close inspection will control the epidemic. 

Hot Baths in Scarlet Fever. — H. M. B. of St. Louis writes us advo- 
cating the use of almost continuous hot baths in the treatment of scarlet 
fever. He illustrated its benefit by relating many severe cases, some in 
his own family, which rapidly improved and subsequently recovered 
following the repeated use of hot baths. The baths are given as hot as 
the hand can bear. He concludes by asking how can a better, surer 
treatment be devised? 

Reply. — Hot baths in scarlet fever will be of great service. It will 
remain one of the best agents until the scarlet fever germ is discovered 
and some form of specific treatment is worked out. That will be a better 
way — it is not yet in sight. 

Scarlet Fever Danger. — J. R. W. writes: "Is there any danger of a 
child contracting scarlet fever from another child with whom it has 
played in the open for several days before the disease was known? Is 
there a safe treatment to immunize the child if there is any danger of 
contracting the disease?" 

Reply. — 1. If you mean before the child was feverish and "broken 
out," no. If you mean that the throat was sore, the eruption out, the 
patient with fever and pains but no diagnosis made, yes. 

2. No. 

Scarlet Fever Contagion. — S. F. writes: "Would there be any danger 
of taking scarlet fever by passing through the entrance of a flat build- 
ing when the family in the lower flat have the disease?" 

Reply. — No. 

Disinfection After Scarlet Fever. — F. J. H. writes: "What is the 
latest and most approved method of fumigation, particularly where 
scarlet fever is prevalent? That the use of formaldehyd is not effica- 
cious has been many times demonstrated in families where one or more 
children — not exposed originally — were taken away from home until 
after the disease had run its course in the case of the patient quaran- 
tined and then brought home after the quarantine had been lifted and the 
premises pronounced thoroughly fumigated, only to come down with the 
disease within ten days after returning home. Will any method of fumi- 
gation which will destroy the fever germ or render it innocuous be harm- 
less to insect life confined in the same room or rooms?" 



DIPHTHERIA 233 

Reply. — Formalin is the best disinfectant. It does not kill insects. 
Sulphur fumes do kill insects, but are not so effective as a fumigating 
agent. The fact that cases of scarlet fever have developed after children 
had come back does not mean that the houses were not properly disin- 
fected. It means that the houses were disinfected before the patients 
were safe. Sometimes the patients were still scaling. Usually they still 
had running ears or nose discharges or swollen tonsils. It is the partly 
cured patients, not the houses, which spread disease. 

Contagiousness of Scales and Disinfection. — S. T. 0. writes: "(1) Is it 
generally accepted that scarlet fever is not contagious during the desqua- 
mation period? (2) What is now considered the test way to disinfect a 
room after a contagious disease?" 

Reply. — (1) No. The better posted physicians hold that the scales do 
not spread the disease. By reason of throat secretions the patient may 
be, and often is, infectious during the scaling period. 

(2) Thorough washing, sunning, and airing. Now that New York has 
stopped fumigating, other cities will probably stop also. 

Scarlet Fever Aftermath. — G. M. writes: "(1) Does scarlet fever leave 
any ill effects and, if so, what? (2) How long after recovery may a patient 
play tall, swim, or dance safely?" 

Reply. — 1. Yes. Some of the more important are deafness, Bright's 
disease, heart disease, and rheumatism. Bright's disease and infection 
of the ears generally follow promptly; rheumatism moderately so, but 
heart disease is generally not recognized for several years afterward. 

2. Let him be guided by his feelings. Have him start easily and in- 
crease the task as fast as his soft, mushy muscles will allow. 



DIPHTHERIA 

Diphtheria is due to the diphtheria bacillus. This bacillus was discovered 
by Klebs thirty years ago. Seven years later von Behring discovered anti- 
toxin, and eleven years later, in 1894, Roux made practical use of this sub- 
stance in treating the disease. 

We know the cause of the disease and its every habit. We know the 
remedy, how to make it, and how to use it. We have had this information for 
from nineteen to thirty years. Yet there is some diphtheria. 

We think there is an appalling amount, and maybe there is; but 
the middle aged people will tell you that the present amount is trivial as com- 
pared with that in the '80s and '90s. Why diphtheria is still with us 
will be told later on. 

The diphtheria bacillus enters the body at some one of the openings. 
It does not belong in the human body, and it ventures in with great fear 
and trembling. __ 

There are four openings into the body. The diphtheria bacillus rarely 
enters any except the nose and mouth. The nose as the port of entry is of 
little importance as compared with the mouth. The bacillus can be carried 
in with the inspired air. 

The usual method of entry is from the fingers, pencils, toothpicks, spoons, 



234 CONTAGIOUS DISEASES 

toys, handkerchiefs, and towels to the month. The bacilli that stop in the 
front part of the month are washed ■ out by the saliva. Those that get 
into decayed teeth, into folds in the lining membrane, and into the pits 
in the tonsils stay where they locate. 

The bacillus rarely gets farther in than the tonsils. Occasionally it gets 
into the windpipe ; rarely it gets into the bronchial tubes ; still more rarely it 
gets into the lungs. It may travel down the esophagus or gullet to the 
stomach, but that is exceedingly rare. 

We see that the bacillus does not venture far into the body. It can only 
travel a few inches down or up these natural tubes. Of course, a diphtheritic 
patient is swallowing bacilli constantly, but those swallowed are killed by 
the body juices. 

The bacilli do not get into the blood. They secrete poisons which are 
absorbed, but the bacillus itself never gets into the blood stream. The bacilli 
do not travel far in the lymphatics. It is rare for them to get into the lym- 
phatics at all, but those that get in are stopped by the nearest lymph glands. 

One of the ways of telling diphtheria is the swelling of the glands on the 
outside of the face and neck. 

These glands swell because they are working hard to neutralize the diph- 
theria toxin and to filter out the pus cocci that get in through the diphtheria 
wound. 

We have said that there are four gates into the body. The gates having 
been passed, there are three routes beyond — the tubes, the blood vessels, and 
the lymphatics. 

We have said that the bacillus has no capacity to travel up or down 
the tubes. When it starts toward the blood vessels and lymphatics it is 
quickly stopped. What is the reason? 

The diphtheria bacillus is a most virulent germ. It se.ars as a red hot 
iron whatever surface it touches. When it locates in a pit in the tonsil it 
kills every cell in its neighborhood. 

When a red hot iron sears a surface a healing serum quickly oozes 
out. When the diphtheria bacillus sears the surface a healing serum also 
oozes forth, but the bacillus cooks and coagulates this serum as well as the 
cells. 

This coagulated, gray, dirty, bleeding membrane, called the diph- 
theritic membrane, is composed of coagulated serum and cells. This clot 
stops up the lymphatics and blood capillaries and walls off the diphtheria 
bacilli. 

That is the reason why the diphtheria bacillus stays on the surface where 
it locates and does not travel far. But, though caught in this net, it does 
not die or become inactive. 

The diphtheria bacillus secretes a poison called diphtheria toxin. This 
poison enters the lymph channels. The lymph glands remove as much of 
it as they can. The blood dilutes it. 

The solution of toxin as it circulates in the blood is not so violent 
because not so concentrated as where it entered. By the blood it is carried 
to the different parts of the body. 

It poisons whatever it touches, but it poisons certain cells more than 
others. It markedly poisons the heart, its nerves, and its nerve center. 



DIPHTHEEIA 235 

In consequence the pulse is rapid out of proportion to the amount of fever, 
and paralysis of the heart is an occasional result. 

It poisons the nerves, and in consequence the weakness is out of pro- 
portion to the fever. Paralysis due to neuritis, or an overpoisoned nerve, is 
an occasional result. 

The amount of poisoning not only depends on the patient and on the 
bacillus, but it is also greatly influenced by the location of the bacillus. 
If it is on the tonsil that gland protects the balance of the body. The 
tonsil is one of the best places to have diphtheria. 

On the other hand, the nose is a bad place to have it. The poison 
is poured right into the blood when the disease is in the nose. 

The windpipe is a bad place to have diphtheria, not because of the 
large amount of poison absorbed but because of the danger of choking. 
The space between the vocal cords is so small that not much room is left 
when a diphtheria membrane is present. 

The diphtheria poison is moderately hard on the kidneys. Acute 
Bright's disease is occasionally present, but it is not of as much importance 
as it is in scarlet fever or pneumonia. . 

In diphtheria the disease generally starts within two days of the 
exposure. There is pain in the throat. This pain is much less than in 
ordinary follicular tonsillitis. There is some fever, 99° to 101°, but it also is 
much less than in follicular tonsillitis. There is some general aching, but 
that also is less than in the less severe forms of sore throat. 

When the tongue is pressed down the back of the throat is red and a 
gray membrane is seen. A little later the glands of the neck around the 
ear and the angle of the jaw are seen to be swollen. The pulse is ten beats 
higher than one would expect with a fever of that degree in a child of 
the age of the patient. If the disease extends into the windpipe the child 
will show signs of obstruction to breathing. 

This is about as much as can be said about the way to know diph- 
theria when one sees it. 

When eighteen years ago it became the rule to make a microscopic 
examination of the throat the microscope commonly showed that these 
"sensed" diagnoses were right. It was not for some years that the other 
side of the picture began to show up. 

That other side was this: A large part of the sore throats that the 
clinical diagnosticians had said were not diphtheria the microscope showed 
to be diphtheria. 

When the physicians began to run down the cause in every case of diph- 
theria they soon came to the conclusion that sewer gas, garbage dumps, leaky 
drains, and bad gutters could not cause the disease. When these causes were 
ruled out they were left hanging in the air. 

The day of mysteries was past. A cause must exist. To find that cause 
they began to examine the throats of all the people who had been in con- 
tact with the sick one for several days before the illness began. 

This search led to a discovery. The discovery was that the diphtheria 
bacillus often caused follicular tonsillitis, the tonsillitis with the white 
patches in the throat. 

Soon it was found that the diphtheria bacillus could cause the simple 



236 CONTAGIOUS DISEASES 

sore throats without any membrane or patches of any sort. Soon aftei 
this it was found that the diphtheria bacillus could be present in the throat 
without causing any soreness or any symptoms of any sort. 

The conclusion was that the only test that could be depended on was the 
bacteriological test. 

This does not work the hardship that one might think. To make a 
throat culture is easy. Laboratories to examine these cultures are every- 
where. The states now provide laboratories with branches in different places. 
The cities now provide laboratory facilities with branches scattered every- 
where. 

In addition a large percentage of the physicians are equipped to examine 
for this bacillus. If a town has not an equipment at the city hall it could 
easily and inexpensively provide one in the public school. 

Some would object to doing this work in the public school on the 
ground that it would endanger the pupils. The objection is theoretical. A 
few epidemics among laboratory workers are on record, but the number is 
small and the deaths have been few. 

I think it was Havelock Ellis who wrote of the disadvantage of having 
a cure for a disease. It had sometimes operated to cause a spread of the 
disease. The knowledge that one could be cured made people less careful 
to avoid it. 

The people of today cannot understand the dread of diphtheria that 
prevailed up to ten years ago. They are still afraid of it, but the fear has 
diminished to the point where it has ceased to be much of a deterrent. 

Antitoxin has been reducing the death rate, but it has been pulling 
against a fearful load. There are more cases of diphtheria now than 
there were twenty years ago. 

Several years ago health departments inaugurated a policy that has 
made the control of diphtheria more difficult. For several years it has been 
the policy to inject the children in the family with about 1,000 units of 
antitoxin each. This makes it impossible for them to contract diphtheria for 
about a month or perhaps for six weeks. In the meanwhile the sick child will 
be well and the danger will be past. 

The plan works all right so far as that family is concerned, but it works 
all wrong so far as the neighborhood is concerned. 

Antitoxin prevents the child from getting sick with diphtheria. It 
does not prevent diphtheria germs from getting into his throat and stay- 
ing there for six weeks or more. 

Antitoxin, as its name implies, is an antitoxin and not an anti-bacterial 
substance. 

In the old days the family tried mighty hard to keep the well children 
away from the sickness. They sent them away at considerable expense or 
got some neighbors to take them, or kept them well away from the sick 
children even for weeks after the illness. 

They did not need watching to see that they carried this out. They 
knew that if it were not carried out it meant other sick children. 

Now they give a prophylactic dose of antitoxin, and they know the 
children to be fairly safe. They are therefore less careful in carrying out 
quarantine. 



DIPHTHERIA 237 

Within the last year or less von Behring, the man who discovered anti- 
toxin in 1890, discovered a way of vaccinating against diphtheria that 
he claims protects not only the children in the family but the children 
of the neighborhood. 

When the health department inspectors get out to run down a diphtheria 
epidemic now they examine bacteriologically the throat of every person 
who has been thrown with the sick one. They have been doing this now 
for several years. 

They have discovered several things. One is that after diphtheria has 
been diagnosed and quarantine has been established the sick person rarely 
gives it to anybody. So long as he is lying in his bed violently sick he 
does not infect anybody. 

Another is that those dead of diphtheria do not infect anybody. The 
present method of embalming and of conducting funerals in deaths from 
contagion amply protects the community. 

Another discovery is that diphtheria is spread by convalescents. The 
most important discovery is that the great bulk of the diphtheria is spread 
by persons who are but mildly sick, and especially by persons whose sore 
throats look just like ordinary, everyday sore throat. 

So far as the treatment of the disease is concerned, there is but one 
procedure of any consequence. That is to give plenty of antitoxin. The anti- 
toxin is given to neutralize the toxin. 

As' the amount of toxin increases each day of the disease, the dose of 
antitoxin must vary with the stage of the disease, not the size or age of 
the patient. 2,000 units may be enough and usually is enough if the throat 
has been sore less than a day. 

It would be much too little for the second day and would be of no serv- 
ice on the third day. 

5,000 units is little enough on the second day, and 10,000 on the third. 
If the patient is choking it will be necessary to use a tube in the larynx. 

ALMANAC TALK ON DIPHTHERIA 

On diphtheria, the Virginia Almanac speaks as follows: "Thirty 
Years Ago and Now. Around the tea table, after the custom of the sex, 
they had been discussing the maladies of their children. 

" 'It's simply wonderful,' said the distinguished authoress, 'what science 
has done to overcome diphtheria. I remember, thirty years ago, when I 
was a child — yes, quite small, thank you — one of my sisters had membranous 
croup. It came very suddenly and brought terror to our hearts. In twenty- 
four hours my sister was dead. 

" 'Now — just think of the contrast ! My little boy had diphtheria last 
winter, and. when the doctor said it was a very bad case, my heart sank. 
I had not forgotten that other tragedy in the family. But he gave the 
child antitoxin at once, and, in a few hours, the boy was practically well. 

" 'Of course, ladies, much depended on giving the antitoxin promptly, 
but to tell you the truth, I had far rather for my child to have diphtheria 
than measles or whooping cough/ 

"Diphtheria is an acute, contagious disease, due to a germ which 



238 CONTAGIOUS DISEASES 

comes from patients who have the disease. Within three days after the 
patient is exposed the nose, the throat or larynx becomes inflamed, and 
is gradually covered by a 'membrane/ or grayish patch. Without anti- 
toxin the course of the disease is very severe, and may be accompanied by 
heart failure or paralysis. The mortality varies much, ranging as low 
as 50 per cent, in very severe forms. 

"Antitoxin is a sure cure for diphtheria, but its efficiency is directly in 
proportion to the promptness with which it is used. Any delay means danger; 
long delay means death. 

"Isolation is necessary to prevent the spread of diphtheria. Mild cases 
and cases which show no outward symptoms spread the disease. No case 
is allowed under the law to leave the premises until an examination shows 
the germs to have disappeared from the throat. 

"Antitoxin is to diphtheria what sunshine is to snow. 

"A syringe of antitoxin is better than volumes of advice. 

"The physician who delays giving antitoxin b'elongs with the man who 
waited till the house burned down to put out the fire. 

"A sore throat in diphtheria season is as suspicious as a strange negro 
in a hen house. 

"Great epidemics from little sore throats grow. 

"Take no more chances with diphtheria than with a coiled rattler." 

Carriers of Diphtheria. — B. B. of Flat Bock, III., writes: "We are 
having an epidemic of diphtheria. Babbits are found dead in many 
places. It is charged that rabbits carry the disease. Is there anything 
in this?" 

Reply. — From time to time it has been claimed that the lower 
animals, and particularly chickens, spread diphtheria. Bacteriological 
studies have not confirmed these claims. My advice to you is to have a 
local physician inoculate a test tube from the throat of a dead rabbit 
and then send the rabbit and the tube to the State Board of Health, 
Spring-field, 111. But the chances are at least 99 out of 100 that the 
diphtheria in Flat Rock is being spread by people. Quarantines should 
be established at once. Every person found with diphtheria bacilli in 
his throat should be quarantined whether sick or well. Probably as 
much diphtheria is spread by "carriers" — that is, people who are well but 
who have bacteria in their throats — as by people who are definitely sick. 
If, say, ten people came in contact with a case of diphtheria somewhere 
about four of them would get the disease, about four would be "carriers" 
for a few weeks, and about two would wholly escape. Concentrate your 
control on people. Incidentally investigate rabbits. 

What Croup Is. — F. B. writes: "I am one of nine children, none of 
whom ever had croup, so I know nothing of it. My wife is always warn- 
ing me about what to do if our children get it. Does the eating of heavy 
food at night have anything to do with itf" 

Reply. — Croup is an ordinary cold located in the windpipe, with 
some swelling and some nervous spasm as a complication. The air 
tubes are irritated by the "cold," and they contract and become smaller 
in certain places. 

Certain nervous children develop this feature when they catch cold. 
Other children do not. It is often a family peculiarity. 



CROUP IN CHILDREN 239 

The eating of heavy food at night might have some indirect effect. 

Croup should not be confused with diphtheria, which it often re- 
sembles. Many children die with diphtheria because their disease was 
called croup for the first few days. 

To Get Rid of Bacilli. — L. B. writes: "Please inform me how to 
get rid of diphtheria bacilli. We have a case in our family" 

Reply. — Various methods have been used. One is to apply some 
violent antiseptic to the crypts of the tonsils. Nitrate of silver, iodin, 
and carbolic acid have been used for the purpose. A wash of antitoxin 
and a dry antitoxin powder have been used. 

Either the health department or your family doctor can help you. 
A good discussion of the subject can be found in the Journal of the 
American Medical Association. The paper was read by Professor Albert 
of the University of Iowa. Professor Ravenel of the University of Wis- 
consin and a gentleman from the University of Minnesota reported cures. 



CROUP IN CHILDREN 

Time was when we spoke of membranous croup as a separate disease. 
It is now known that membranous croup is due to diphtheria. The term 
"croup" is now used to mean an ordinary cold — nose, throat, or bronchial 
tube cold — accompanied by an element of spasm. The very important point 
to determine is whether the croupy child has diphtheria. If it has diphtheria, 
antitoxin must be given quickly and the child must be isolated. 

If it is an ordinary croup, antitoxin should not be given; isolation need 
not be strict. The tendency will be to overmedicate, overnurse, and overcare 
for the sick one. Pretty important point to decide, then, is it not? The 
important questions to answer quickly are these: 

Is there diphtheria in the neighborhood? 

Is there much sore throat among the child's playmates? 

Are there kernels in the neck? 

Can anything be seen on the tonsils ? 

Is the child subject to croup? 

Is this attack of croup acting like other attacks? 

Ordinary spasmodic croup is not so serious as it seems. A good 
dose of salts followed in four hours by a dose of castor oil should be given. 
Ordinary care for a common cold, carried out in a well ventilated, well 
warmed room, will be all that is needed for the ordinary case. 

Croup is usually overtreated. The children are made worse by being 
fussed with too much. They are wrapped up too much and the sick room 
is sealed too tightly. 

If the breathing gets very tight give a teaspoonful of sirup of ipecac. 
This can be repeated if necessary. The important point to decide is which 
of these cases is suspicious enough of diphtheria to make it imperative 
to have a throat culture. We will make headway when parents can and 
do make throat cultures. 



240 CONTAGIOUS DISEASES 



MEASLES 



Bulletin 109 of the Census Bureau tells us that in 1910 measles caused 
a death rate of 12.3 per 100,000 population in the registration area. It 
further says it is true that many deaths assigned to other causes are due 
to the unfortunate consequences of this disease. 

In nursing babies it is more fatal than diphtheria or scarlet fever. 
Health officers have more trouble holding a measles epidemic in check 
than one from any other disease, simply because people are not afraid 
of measles. If fear does harm in some directions, lack of it does harm in 
others. 

Whether it be measles or money, diphtheria or riding on the train, 
scarlet fever or running a store — fear that leads to intelligent precaution 
is to be applauded. Fear that leads to useless worry is to be condemned. 

Measles begins with a fever and the other symptoms of a severe cold. 
Four days later the eruption comes out; after two days it fades away, the 
fever goes, and convalescence is established. When this, the normal course, 
is interfered with it is because, secondarily, an infection of the lung 
(pneumonia), or of the kidney (acute Bright's disease) has come on. The 
germ gets into the nose and from there goes into the blood. The germs 
are spread from the time the first symptom starts until the fever drops. 

The important point to remember is that it is contagious before there 
is any symptom which is clearly distinctive — during that four days before the 
breaking out comes. Therefore, all children with colds and fevers should be 
excluded from the schoolroom and isolated at home. 

Dr. Chesley of the Minnesota Health Department says that when an 
epidemic of measles is on the children of the public schools should be 
superficially examined each day. Children in the incubation stage of measles 
will show measles patches in the back of the mouth in advance of any eruption 
on the skin. 

The superficial examination which he recommends consists of observa- 
tion as to red eyes, coryza and patches in the mouth. 

Perhaps a still better plan in time of measles epidemic would be to 
exclude all children with acute colds from schools for four days. 

To close the schools is a bad method of controlling measles. 

Measles Not Universal. — Anxious Mother writes: "Why does Chi- 
cago go to the expense it does, if the measles is a universal disease and 
all children should have it? What is there to this disease or its after- 
effects to make the city so careful?" 

Reply. — Measles is not a universal disease. Most careful' mothers, 
living in towns with good government and good public sentiment, raise 
part of their children and some raise all their children without their 
having had measles. The measles death rate in the North is about 
two-thirds as high as that of scarlet fever. In the South it is higher. 
These are two sufficient reasons. 

In Cases of Measles. — W. H. W. writes: "1. In case of measles in a 
school, but one case being found, what procedure would you follow to 
prevent an epidemic? 



MEASLES 



241 



"2. In case of measles in a home, is it necessary that the children 
be kept in the house, that is, off the sidewalk about the house and away 
from adults or other children who have had the measles? 

"3. May children who have had measles and are in the second week 
of convalescence take walks about the residence part of the town pro- 



!!T 




1111 



km 



;""""M'-ininn 







Fig. 106. 



vided these children are not allowed to come in contact with or associate 
with anyone who has not had the measles?" 

Eeply. — 1. If it is the first case in town or in the neighborhood 
exclude the child. Exclude all children who have ordinary colds during 
two weeks following the exclusion of the case. If a crop of cases devel- 
ops after this first contact close the school. If the epidemic has run 
beyond this stage closing the school accomplishes nothing. 

2. Yes, except as to the nurse. The nurse must keep away from 
everyone except the sick child. The isolation must start with the first 
sneezing, the onset of the disease, and be kept up until the fever has 
gone. 

3. Yes. 

Conveying Measles. — C. H. S. writes: "1. Can a third person who 
has had measles convey the disease to others if living in a home where 



242 CONTAGIOUS DISEASES 

the disease exists? 2. Is it safe for children (who have had measles) to 
continue attending school from a home where younger children are suf- 
fering from this disease where no isolation is observed? 3. Is a dis- 
charging ear ever caused by teething in the child?" 

Reply. — 1. Yes, if he comes in contact with the case. 

2. No. 

3. No; a discharging ear means infection has traveled from the 
throat to the ear. Discharging ears in children is the usual cause of 
deafness in old people. 

Susceptibility to Measles. — S. H. writes: "A young woman who 
grew to womanhood without having the measles, although she was ex- 
posed many times to the disease, thinking she was immune, visited a 
house where there was a case of measles. Later her throat became sore, 
but no rash broke out. A doctor said she had measles. Do you think 
his judgment was correct?" 

Reply. — Probably, yes. Occasionally a person has measles a second 
time. Occasionally a person seems to be immune to measles for years 
and then becomes susceptible. More frequently the reverse is true. I 
have known of persons never vaccinated failing to contract smallpox on 
one exposure and later contracting it from a less intimate exposure. 

Time of Contagion in Measles. — M. writes: "After the eruption in a 
case of measles has disappeared, how long is there danger of contagion 
(1) from the patient; (2) from the attendant or nurse; (3) from the sick- 
room where ordinary cleanliness is observed but no fumigating is done?" 

Reply. — (1) The present day teaching is that the danger is greatest 
before the eruption, in the fever and coughing stage; is not very great 
after the eruption appears; is slight after the eruption fades; and has 
disappeared entirely by three days after the fever and breaking out has 
gone. 

(2) The nurse who covers her clothes with a gown and washes her 
face and hands as she leaves the sickroom is not dangerous during the 
illness and certainly not after the illness has subsided. Unless she fol- 
lows this plan scrupulously she is about as dangerous as the patient. 

(3) Ordinary cleanliness does not accomplish much. If the room 
and its contents are scoured with soap and water and then thoroughly 
aired and sunned the danger will be ended as soon as the process is fin- 
ished. 

Open Window No Danger. — L. M. writes : "(1) If a person visits a house 
where there is a case of measles and comes in contact with the case, how 
long afterward would that person be likely to spread contagion? (2) 
Would he be safe after a month? (3) Does the health department insist 
on fumigation after a case of measles? (k) M Are people in quarantine 
allowed to have windows open, and [fr] is there any danger of contagion 
as in cases of scarlet fever, etc., in passing a house where the window is 
open?" 

Reply. — 1. A day or less. 

2. Yes. 

3. Some do; some do not. 

4. [a] Yes. [b] No. 



WHOOPING COUGH 243 

German Measles. — L. S. L. writes: "1. Have German measles any 
connection with common measles? 2. Are they contagious? 3. If so, 
after what period is danger from contagion passed? Jf.. Can they he 
spread by others than the person affected? 5. Are cases quarantined in 
Chicago, or are persons living in same house prevented from going 
about?" 

Reply. — 1. No. 

2 and 3. Yes, about seven to ten days from first symptoms. 

4. Possibly also by "close contacts." 

5. If they are not in contact with the sick, no. 



WHOOPING COUGH 

A Harvard professor has found the germ of whooping cough. That 
discovery by itself is of no more importance than the discovery of the 
South Pole. What will make the discovery worth while will be for scientists 
to grow this germ and watch it as a farmer does his pigs. Presently the 
scientists will be able to tell us all about the habits of this germ; then 
some simple, working, everyday methods of microscopic diagnosis will be 
published. 

When these methods come into general use we will, no doubt, find that 
many cases of whooping cough never whoop and that some of the cases that 
now develop like lightning out of a clear sky will be explainable on the 
ground of contact with carriers or with atypical cases. Then the scien- 
tists will inject the germs into some susceptible animals and, next, they 
should get a curative serum, and, eventually, a preventive vaccine. 

In the meanwhile, the methods of controlling whooping cough all 
down the line are crude and unscientific. If it is cure, there is nothing 
to do but let them whoop it out. If it is diagnosis, the only certain sign 
is the whoop. When that is present anybody can diagnose the disease, and, 
when it is absent, nobody can. One man's guess is as good as the next man's. 
When it comes to handling the disease from the standpoint of prevention, 
the same crudity and uncertainty prevails. 

Fortunately, practically all the grown people have had it either in a 
plain or a masked form and they are not susceptible to it. Children after 
babyhood are not endangered by it. 

The disease is a monumental bluffer. An affected boy may be whoop- 
ing so as to frighten his mother stiff one minute and the next he will be 
turning a handspring. But nursing babies are killed by it, and by the 
thousand. 

Out of this difference in the susceptibility of various groups of people 
has grown a suggestion that should prove of great value in controlling 
this disease and of some value in controlling other diseases. It is to tag the 
patient rather than the house. Say tag both the patient and the house 
from the time the diagnosis is made until ten days later, then let the child 
go out with the tag conspicuously displayed. 

In old Bible times they followed that plan with the leper. A con- 
spicuous card reading: "I have whooping -cough" in these days should be as 



244 CONTAGIOUS DISEASES 

efficacious as the cry of "Room for the leper" in the days when men could 
not read. Under such a plan the babies could be kept away from the 
"whoopers" and the "whoopers" would get well quicker by reason of air 
and exercise. Under this plan attention would be concentrated on the 
person and taken from the house. All experience demonstrates the advan- 
tage of such a shift of attention in controlling smallpox, scarlet fever, 
diphtheria, infantile paralysis, meningitis, and measles, as well as in whoop- 
ing cough. 

The Census Bureau reports that the whooping cough death rate in 1910 
in the registration area was 11.4 per 100,000 people of all ages. It further 
says that, as with measles, these figures give no idea of the real harm 
from whooping cough, since the deaths of children from whooping cough 
are frequently recorded as from pneumonia and other complicating dis- 
eases. When we remember that whooping cough kills none excepting nurs- 
ing babies, and then compute how small a part of the total population is 
under two years of age, we can understand the mothers' dread of this 
malady. 

It starts as an ordinary cough and, for ten days, cannot be told 
from a simple bronchitis. About the sixth day the cough gets worse and, 
by the tenth, whooping begins. 

The germ is found in the nose and throat secretions from the first 
coughing spell until the whooping gets under way. After that state (whoop- 
ing) is established, it is not possible to find the germ which is held to be 
specific. 

Since it is not very dangerous to any except nursing babies the first 
essential is to keep nursing babies away from it. Whooping cough quaran- 
tine is usually pretty poorly carried out. There is little hope of a good 
quarantine. This is all the more reason why a nursing baby should be care- 
fully shielded. The epidemiologic points to be noted are : 

1. All children with coughs should be kept away from all coughing 
children. 

2. All babies should be scrupulously kept away from all coughing 
children. 

3. The isolation (quarantine) of cases of whooping cough should begin 
as soon as the cough starts (ten days before the whooping begins) and be 
kept up for two weeks and sometimes three. 

4. It is doubtful if it is necessary to continue the quarantine until 
the whooping stops — at least the latest literature is to the effect that 
quarantines can be terminated before the whooping stops. 

In measles there are cases that never break out, and in whooping cough 
there are cases that never whoop. However, these cases are just as "catching" 
as any. 

Quit listening for the whoop. It is just a detail. It kills no child. 
Medicines to stop it do not succeed and would do no good if they did. 
Attention should be concentrated on saving the child from secondary pneu- 
monia or other secondary effects. 

Whooping Cough Contagious. — Mrs. E. L. J. wishes to be enlightened 
concerning contagion of whooping cough. 



WHOOPING COUGH 245 

Reply. — Whooping cough is extremely contagious during certain 
stages. It is moderately contagious when the cough starts and up to the 
time when the whooping starts. It is highly contagious during the 
whooping stage. It is moderately contagious for about one week after 
whooping stops. Occasionally there is danger of contagion for a few 
weeks after whooping has stopped, say four weeks. These delayed in- 
fections are difficult to provide against. It is not reasonable to confine 
the sick person until all danger of delayed infection is past, ^specially 
is this true in scarlet fever and whooping cough. The quarantine should 
be continued so long as contagion can be reasonably expected. 

Authorities are pretty well agreed that persons who have been in 
close contact with a case of whooping cough can transport the con- 
tagion. A whooping child spreads secretion rather more actively than 
a child with any other form of contagion. Nevertheless, remember that 
the sick child as a spreader is first in importance. Those in close con- 
tact form a bad second. 

Whooping cough does not persist three months. A child with a cough 
persisting three months after a whooping cough started has had, say, 
six weeks of whooping cough and six weeks of some other infection. 
The child is not capable of spreading whooping cough then. But the 
family doctor should determine why the cough persists. 

Incubation Period. — Mrs. I. B. E. writes: "Will you please tell me: 
(1) Is it possible for a child to get whooping cough in four or five days 
after being exposed? Also, do you think it possible for a child to get 
the disease by playing in the open air? (2) When a child just across 
the street has it also, if the child with whooping cough is playing in his 
yard? (3) Do they cough up a thick yellow mucus? (4) Sow long is 
the disease considered contagious?" 

Reply. — (1) The usual time is a week to ten days. Four to five is 
too short a time. (2) If the child stays on his side of the street there 
is no danger, provided the people and the things in contact with the 
child also stay on their side of the street. (3) Yes. (4) For about a 
week or ten days. The contagion is pretty well over when the whooping 
starts. 

Whooping Cough Danger. — J. R. K. writes: "Is there no way of 
preventing heartless people from traveling with children — of their own — 
who are suffering from whooping cough? When I boarded a Fere Mar- 
quette railroad train at Holland, Mich., last month a minister of the 
gospel, wife, and two small boys also got on the train and occupied four 
seats in a parlor car. The younger of the two boys, k or 5 years old, had 
as severe a case of whooping cough as I have ever seen or heard. The 
older child had had it, was still coughing, but not whooping. There were 
no less than six other children passengers in that car. One young 
woman, about 20, had never had the disease, and when the mother sug- 
gested that they find seats in another car, the mother of the whooping 
child laughed aloud as though it was a huge joke. 

"The colored porter told me that he had never had it and that he 
had two babies at home who would be exposed, should he contract the 
cough. It seems to me that such criminal selfishness and thoughtless- 
ness are absolutely inexcusable in anyone, but especially so in one call- 
ing himself an apostle of all that is highest in life." 



246 CONTAGIOUS DISEASES 

Eeply. — The laws prohibit people with contagion from traveling. 
The case is covered by the municipal ordinances of most of the towns 
through which the road runs; also by the state laws of the three states 
traversed and by the national laws. Furthermore, the conductor of a 
train has a certain amount of police power over persons on his train. 

I suggest that you report the facts, including the name of the parents, 
to the Health Department of Chicago. 

Should you have a similar experience appeal to the conductor at 
once. Whooping cough ceases to be contagious before the whoop ceases. 
You may be safe. 

Shouldn't Go to School Yet. — J. C. K. writes: "My little boy has 
had whooping cough for several weeks. There will be days when 
he does not cough at all, but a cold, or dampness in the weather, seems 
to affect him, and he will cough almost as hard as ever, throwing up his 
food and spitting up white mucus. He will whoop at such times also. 
Now, please tell me how long shall he be kept out of school. Until the 
cough stops, or has he passed the time when he can give it to others'?" 

Reply. — The regulations of the Health Department provide that he 
must stay out until he quits whooping. As he vomits when he coughs, 
clearly he should not go to school. Most authorities say the danger of 
contagion has ended at eight weeks. 

Whooping Cough and Quarantine. — S. A. E. writes: "1. Is whooping 
cough a quarantine disease in Illinois, and is there a penalty for not 
placing such cases in quarantine? 2. Should such cases be allowed on 
the street and in school in any case? 3. How long is the disease con- 
tagious? What are its dangerous aspects?" 

Reply. — 1. It is. The state board leaves the details to local health 
departments. If the local department fails to control a situation the 
state board will step in to assist or to take charge if circumstances 
warrant. 

2. Children with whooping cough should not be allowed on the 
streets or in school when the disease is starting before the whoop begins. 
After the whoop stage has developed the contagiousness of the disease 
rapidly decreases. The practice of health departments with respect to 
this stage varies. Some demand from one to two weeks' quarantine in 
the house after the onset of the whoop stage. Some departments tag 
the whooping children and then permit them on the streets. 

3. The chief danger is from pneumonia. The death rate from this 
disease is high in children under 2 years of age. 

Duration of Whooping Cough. — A. J. L. writes: "1. Kindly advise me 
what to use to cure or check the whoop of a child 5 years old with 
whooping cough. 2. Can one catch whooping cough more than once? 
S. How long does it usually last?" 

Reply. — 1. Nothing is of much service. 

2. Yes, it is possible, though very improbable. 

3. The contagion is greatest before the whooping begins. The evi- 
dence is that there is not much danger of contagion after the case has 
run three weeks, 



MUMPS 247 

Whooping Cough Treatment. — M. K. writes: "Will you kindly let me 
know if there is any way to prevent a child from getting whooping cough, 
and also what will help one -that has it already?" 

Reply. — If a child is kept away from whooping cough in its early- 
stages he will not have the disease. A child having whooping cough should 
be kept away from other children, should have plenty of fresh air, should 
be kept clean, and should be otherwise kept in good condition. Many 
remedies for the cure of whooping cough have been proposed; none has 
been proved. 

City Will Fumigate. — L. writes: "A family with two children, who 
have whooping cough, moved from the apartment adjoining ours a week or 
ten days ago. The apartment is to he occupied next week, and it has not 
been fumigated. Ought this to be done? Will the City of Chicago do it?" 

Reply. — Yes and then cleaned and aired. The city will do it. 



MUMPS 

Health departments do not regard mumps as of much importance. 
Mothers are not so certain about that. Superintendents of children's homes, 
asylums, and hospitals and principals of boarding schools and academies 
know that the disease at intervals is a source of great worry. 

Early in the year 1911 an epidemic of mumps developed in the New York 
Hebrew Infant Asylum. Dr. Hess thought perhaps a method of protection 
which had been used to cure certain diseases and to prevent others might 
be made use of; at least it was worthy of trial. 

The method consists in the injection of one or two teaspoonfuls of blood 
from a person recently recovered from mumps into a person who has been 
recently exposed to the disease. 

Mumps is a highly contagious disease. It has a long incubation period. 
About eighteen days elapse between exposure and the onset of the disease. 
Therefore, when any person who has never had mumps is exposed the 
chances are that he will have the disease, but that it will not show itself 
for eighteen days. If the injection can be given, therefore, within a short 
time after the exposure, there is ample time for it to get in its work as a 
protector. 

At the time the test was made there were 153 children in the home. Of 
these 135 were susceptible to mumps. 20 of the susceptibles were injected. 
None of the 20 susceptibles developed mumps, although all were exposed to 
it. Of the noninjected children 44 got the disease. 

This test shows that under the conditions which prevail in children's 
homes, mumps, once it gets a foothold, may be expected to attack about 
half the children who have not already had it. But by this injection 
method the disease can be stopped at once. 

The method consists of injecting about one-half to two teaspoonfuls 
(6 to 8 c. c.) of blood under the skin of the child to be protected. The 
blood is drawn from one child and immediately injected into the other. 
It can be drawn from a child in whom the mumps swelling has not completely 
subsided without harming either the sick or the well child. Perhaps it is 



248 CONTAGIOUS DISEASES 

better to draw it from children who have been convalescent for ten days or 
two weeks. 

Perhaps the blood of children who have had mumps two years before 
is protective. On that point Dr. Hess was not certain, nor could he say how 
long the protection lasted. 

I am sure that this method of protection will not be of interest to the 
average mother. It will be of great interest to those in charge of children's 
institutions. Perhaps some physicians will use it to protect other children 
of a family in which a case of mumps has developed. 

Dr. Hess suggests that the same method be employed against measles. 
Health departments regard measles as of much importance. 



CHICKEN POX 

Chicken pox is essentially a disease of child life, although no age 
is exempt. It affects babies at the breast and is rarely met with after the 
tenth year. Grown-ups are seldom attacked even when they have escaped the 
disease in childhood. 

Chicken pox is the mildest and least important of the eruptive fevers, 
usually with no complications, although the kidneys are sometimes affected 
and sometimes erysipelas appears. 

The disease may occur in one family only but is usually epidemic, spread- 
ing rapidly through families, schools, and institutions. The fact that it 
spreads so rapidly shows the contagion is readily diffused through the air to 
all parts of the room and that personal contact of the well with the sick usually 
means transmission of the contagion. 

That the contagion is short lived is shown by the fact that the disease 
is not readily transmitted from home to home and from school to school. 

The period of incubation is generally fourteen to sixteen days. 

Chicken pox begins with a marked rise in temperature, headache, 
nausea and, in some instances, chilly sensations. The temperature may rise 
to 103, or in severe cases even to 105. There is generally loss of appetite. 

The rash, which is the characteristic symptom of the disease, appears 
about the same time that the fever does. In some cases it may even precede the 
appearance of the fever. It usually appears on the head, face, and trunk. 
The rash looks like small water blisters with red areas about them. 

It is important that the child should not scratch, as scars may result. 
Washes to allay the itching should be used. The child's hands should be kept 
clean, and the nails trimmed short, or, better still, white muslin mittens 
should be worn. 

In the treatment of the disease care should be exercised to control 
carriers. To accomplish this those who come in contact with the disease 
should always wash the hands thoroughly after coming in contact with the 
infection. 

Carriers are not of much more importance than such conveyers as spoons 
and towels. Sunlight, air, and drying will help much to destroy the in- 
fection; hence the importance of keeping the room in which the patient 
is being nursed in hygienic condition. 



INFANTILE PAEALYSIS 



249 



The medical treatment consists in controlling the symptoms with such 
simple remedies as are necessary to keep down the fever and prevent con- 
stipation. Children should be kept in the house until the rash begins 
to dry and form scabs. They should not be allowed to go to school or be with 
other children until the skin is perfectly clear. 



INFANTILE PARALYSIS 




Anterior Portion 
of Cord 



The statement made by Dr. Eosenau at the Congress on Hygiene, that 
he had succeeded in infecting monkeys with infantile paralysis by means 
of flies, increases our interest in this insect. 

The virus of infan- 
tile paralysis is excep- 
tionally resistant. In the 
sick person it is found in 
the brain substance, the 
nose secretion, in the 
mesenteric glands — the 
lymph glands near the 
intestines — and some- 
times in the blood. 

Its presence in the 
mesenteric glands is ex- 
plained as follows : It is 
secreted by the mem- 
brane of the nose and 
mouth and becomes a 
part of the saliva. It is 
swallowed into the stom- 
ach whence it passes into 
the intestines. The di- 
gestive juices of the 
stomach and intestines 
have no power to destroy 
the virus — therefore it 
passes through their 
walls and can be recov- 
ered from the mesenteric 
glands. 

When these glands 
are macerated the virus 

prepared from them will cause the disease when injected into well monkeys. 
This proves that the virus is exceptionally resistant, for, it will be remem- 
bered, snake poison and many other poisons are made harmless by the 
stomach and intestinal juices. 

The virus of infantile paralysis passes through the smallest pored filter 
used. It stands heat, drying, sunlight, and chemical disinfectants much 
better than does the ordinary disease-causing organism. When a child has had 




Iowa Health Bulletin. 
Fig. 107. — Atbophy of the Spinal Cord After Infan- 
tile Paralysis. Zones a and b show shrinking of the 
horns and general lessening in size of affected half of 
the cord. 



250 



CONTAGIOUS DISEASES 





the disease, the nose secretions remain capable of causing the disease for 
weeks and sometimes as long as for six months. 

The fly which Dr. Eosenau found capable of spreading the disease is 
the stable fly. This fly breeds in stable manure and lives in it and around 
animals. It will not eat ordinary food under ordinary circumstances. 
Eosenau noted that he had been unable to get them to eat anything but 
blood or to drink any water. Nuttall of England said he had succeeded 
in getting them to eat grape juice. 

The practical significance of this observation is that it will prove diffi- 
cult to poison or to catch this fly. Fly paper and fly poisons do not appeal 
to its palate and it may prove suspicious of fly traps. Eosenau suggested 
that this fly might get, and probably did get, its dose of virus by sucking the 
blood of the sick and that the infection by it of the well 
may be by biting or by regurgitation on human food. 

That the fly does not serve as a simple mechanical 
carrier of germs, as flies do for typhoid and consumption, 
was proved by the interval of time between cases. From 
the time the sick monkey was bitten by a fly until the 
bitten monkeys got sick was three weeks. The virus dur- 
ing some of that three weeks was living, changing, develop- 
ing, in the fly. When the right time comes the fly belches 
up the virus as a cow belches up her cud. This habit of 
belching up the contents of the stomach belongs to flies 
as much as it does to cows. 

There is greater danger that a milk wagon driver 
will spread infantile paralysis than that one will spread 
scarlet fever when a child has that disease, since scarlet 
fever is seldom spread by well people and infantile paraly- 
sis frequently is. 

If one hundred people are brought in contact with 
infantile paralysis fifty of them will go to bed sick with 
the disease. The other fifty will keep well themselves, but 
they will spread the contagion right and left through their 
nose and mouth secretions. The contagion having got into 
the nose secretions, it remains there for two to four months. 
Infantile paralysis is visually a disease of small cities, 
towns, and country neighborhoods. It does not often cause 
much trouble in the large cities. 

So much as a basis for suggestions as to what must 
be done to prevent its spread. First, it must be made a 
quarantinable disease. The quarantine must be enforced. Nobody in contact 
with the sick person should be allowed out of the quarantine. Nobody in 
contact with the sick person should be allowed to sell, distribute, or handle 
milk or any other food. Children from the affected homes should not be 
allowed to attend school. The convalescents and the contacts must be quaran- 
tined for four months after the disease or the exposure. After death or after 
convalescence has terminated in a case the house should be disinfected, but 
no one should lose sight of the fact that contacts and not infected houses are 
the chief sources of contagion, 






owa Health Bulletin. 

Fig. 108. — Diagrams 
Showing Areas in 
Cord Most Af- 
fected by Infan- 
tile Paralysis. 



INFANTILE PAEALYSIS 251 

Flies should be killed, especially around stables. 

A state board of health fearing an epidemic should send a communication 
to every physician and newspaper asking that cases of infantile paralysis be 
reported at once. Upon the receipt of the report of a case an officer of the state, 
except when the local health department is active, alert, and well informed, 
should go at once to the locality and institute proper measures of control. 
School principals should see to it that no convalescents and no contacts, no 
children from infected homes, come to school until it is safe for them to do so. 

It is always easy to end a local epidemic promptly, but the measures 
of control must be efficient and compelling. A white-livered quarantine leaves 
the community afraid and uneasy for months. A school principal who is 
firm can make his school safe. A state administration can protect the 
people of its state. All down the line the question is : Will they? 



116 



4 and under 


Age Periods 




5-9 




10-19 




20-29 


■nsm 16 




30-39 


HBBHH 12 





Over 40 

Vermont Bulletin. 
Fig. 109. — Age Distribution of Cases of Infantile Paralysis. 

The Chicago Department of Health has issued a valuable leaflet contain- 
ing "information in case of infantile paralysis." As safeguards against 
spreading the disease it suggests : 

"The windows and doors of the room in which the patient stays should 
be screened against flies and other insects. 

"Allow none but the necessary attendants in the patient's room. 

"Allow no visitors in the house. 

"Other children in the family must stay at home; must not go to 
public places such as school, church, parks, or theaters. Isolation must be 
maintained for four weeks. 

"Flowers brought to the sick should not be thrown out, but placed in 
disinfecting fluid or burned. 

"The nose and mouth of the nurse or others who are compelled to come 
in contact with the patient should be thoroughly washed out before leaving 
the sickroom, using freely a 2 per cent, solution of peroxid of hydrogen or 
1 per cent, menthol in oil. 

"Disinfect all dishes, utensils, bedding, towels, napkins, clothes, hand- 
kerchiefs, clothing, books, papers, and remnants of food before removing 
them from the room. Sweep and clean room with a cloth wet in a disin- 
fecting solution. Do not use a broom unless frequently dipped in a disin- 



252 



CONTAGIOUS DISEASES 



fecting solution, and use while wet. Avoid dust in the sickroom. It is 
believed that dusty rooms, dusty houses, dusty streets are important factors 
in spreading this disease." 



INFANTILE PARALYSIS EXERCISES 

For the treatment of infantile paralysis by exercise of the upper ex- 
tremities, upper arm and shoulder muscles, Dr. Wright recommends the fol- 
lowing : 

"Shoulder region: 

1. The patient lies on his back with the arm at the side and shrugs 
the shoulders, bringing them as nearly up to the ears as possible. 



January 


■ 


1 






February 










March 










April 










May 


■ 


i 






June 

July 














8 




August 








September 




October 










8 




November 








December 


m 


2 





Vermont Bulletin. 
Fig 110. — Seasonal Distribution of Infantile Paralysis. 

a. With the assistance of the physician, who grasps the patient's arm 
above the elbow and uses it as a lever to raise the shoulder while the 
patient aids the movement by trying to contract the muscles. 

b. Without outside help. 

c. With resistance from the physician, who pushes down on the point 
of the shoulder with one hand. 

2. The patient sits erect with the arm hanging at the side and raises 
the shoulder as high as possible. 

a. With the resistance of gravity alone. 

b. With the added resistance of the physician's hand pressing down 
on the point of the shoulder. 



INFANTILE PAEALYSIS 



253 



Upper arm: 

1. The patient lies on his back with the arm at the side and moves 
it sideways upward along the table until it stretches above his head. 

a. With assistance under the elbows. 

b. Without outside help. 

c. With resistance above the elbows. 

2. The patient sits erect with the arm at the side and raises it straight 
sideways until it is stretched vertically above his head. 

a. With the resistance of the weight of the arm. 

b. With the added resistance of the physician's hand pushing down 
just above the elbow. 

Forearm : 

1. The patient sits with the inner side of the whole arm resting on the 
table and bends the elbow by sliding the forearm along the surface of the 
table. 

a. With assistance on the back of the wrist. 

b. By unaided contraction of the muscles. 

c. With resistance on the front of the wrist. 

2. The patient sits with the elbow resting on a cushion and raises the 
forearm until the hand touches the shoulder. 

a. With the resistance of gravity alone. 

b. With added resistance on the front of the wrist. 

Other positions than those above referred to can be worked out for the 
special parts and the muscles exercised after the same general plan. The 
main thing, when practicing the exercises, is to see to it that the patient 
does not cheat himself and that he does the actual work. The exercises 
should be gone through with at least once each day." 

Causes of Physical Disability of 721 Crippled Children, Birmingham, Eng- 
land, 1911 




Tubercular disease . . 
Infantile paralysis . 

Rickets 

Congenital deformity 

Apoplexy 

Birth palsy 

Accident 

Scoliosis 

Scattering 

Total 



Cripples 



Number 


Per Cent. 


285 


39.5 


175 


24.3 


73 


10.1 


71 


9.8 


33 


4.6 


25 


3.5 


25 


3.5 


13 


1.8 


21 


2.9 



721 



100. 



WHAT THE MOTHER OF A CRIPPLED CHILD OUGHT TO KNOW 



Dr. Orr of Nebraska estimates that there are 250,000 crippled children 
in the United States. Beeves in his "Care of Crippled Children" quotes a 



254 CONTAGIOUS DISEASES 

Birmingham (Eng.) estimate that 25 per cent, of the crippled children are 
crippled as a result of infantile paralysis. As a matter of fact, the percentage 
varies from year to year and in different portions of the country. 

If the estimates are correct (and infantile paralysis has been unusually 
active during the last fifteen years), the number of children in the country 
crippled as the result of this disease is 62,000. 

It is important that mothers should know that infantile paralysis starts 
with a fever, and that no signs of paralysis show in the early stages of the 
disease. It oftens happens that mothers do not suspect infantile paralysis 
to be the cause of their children's mild symptoms, even when infantile 
paralysis is in the neighborhood, until the muscles begin to shrink. 

It is more important that the mother know that the great wasting 
of the muscles after infantile paralysis is not necessary. The disease is 
located in the spinal cord and not in the muscles. The muscles waste after 
the disease, not during it. By beginning passive motion, manipulation, and 
electricity just as soon as the fever goes down and while the child is still 
sick and by keeping it up steadily wasting of the muscles can be prevented. 
Good medical care in the height of the disease is of some service. Good 
care as the disease subsides is of very great service. 

To my mind it is important that the mothers know that, after the 
limbs have wasted, they cannot be restored. The best that can happen is 
that by braces in most cases and by operation in others some control of the 
limbs is possible. For this service there are good hospitals, dispensaries and 
schools. A list of these is to be found in Beeves' "Care of Crippled Children." 

The reason for putting stress upon this phase of the subject is that I hear 
from so many mothers who, grasping at straws, carry their children long dis- 
tances and spend much of their money because of letters of solicitation in 
which wild promises of impossible cures are made. 

It is important that the mothers of children crippled by infantile paralysis 
know the importance to their children of play in the open air. 

The figures from Birmingham show that 10 per cent, of the cripples 
are such by reason of rickets. The percentage seems higher than in the 
United States, unless we count the cases of bowlegs and knock-knees and 
very thin chests as crippled from rickets. 

It is important that a mother know that mild degrees of deformity 
from rickets will pass away under good food and good hygiene. A thin 
chest can be flattened out by exercises begun early and persisted in. Bob 
Fitzsimmons is an illustration of what a knock-kneed, "wabbly-legged," prob- 
ably rickety person can develop into. None other of the cripples responds 
so well to good food and good hygiene. Some of the worst cases can be 
straightened out by operation. 

Whether or not a crippled child is to suffer from neglect rests very 
largely with the mother. 

Infantile Paralysis. — A. L. writes: "What is the cause of meningitis 
in a child one year old? A child was nursed by its mother, who was in 
good health. This child was apparently well until about eight months old. 
It lived until fifteen months, but did not do well after eight months, always 
refusing food of all kinds/' 



INFANTILE PARALYSIS 255 

Reply. — This child probably had meningitis or infantile paralysis. 
These diseases are due to germs. The germs are different from each other, 
but they spread in the same way and cause diseases that are a good deal 
alike. 

Infantile paralysis is the more probable in the case of a baby eight 
months old. This disease has been spread rather widely in this country 
during the last five or six years. There has been a good deal of it in Eau 
Claire, Wisconsin, Mason City, Iowa, and in certain parts of the East. 
Fortunately in Chicago there has not been much. It is contagious. The 
germ gets into the nose. Usually it does not do any harm, but occasion- 
ally it gets through the nose and into the nervous system. 

The preventive measures to take are: First, to keep away from all 
children having the disease or having been in contact with those having 
had the disease; to see that all children that have been in contact with it 
have their noses carefully looked after and kept very clean. 

It is wise to be on your guard against very mild cases just as much as 
against severe ones. 

Infantile Paralysis Infectious. — C. W. writes: "Is infantile paralysis 
either contagious or infectious? How long after commencement of the 
disease is it until it is safe to let other children associate with the patient?" 

Reply. — 1. It is. 

2. Usually the nose secretions are infectious for several months. 

Clothing and Infantile Paralysis. — A. B. writes: "Is there danger of 
contagion if one child should wear clothing of another who has had infan- 
tile paralysis?" 

Reply. — If the clothing has been properly fumigated, cleaned, sunned, 
and aired, it is permissible; otherwise, not. Investigation of flies as car- 
riers of infantile paralysis has not gone far enough to warrant anyone in 
abandoning fumigation and cleaning as means of control. 

Spread of Infantile Paralysis. — J. H. writes: "Can you offer any ex- 
planation of the increase of what is known as infantile paralysis? Is it 
possible that the prevalence of the disease is in any measure due to the 
now common use of the low, springless vehicles, known as go-carts, some 
of them collapsible, which have almost superseded the high cabs in which 
the little ones used to be taken on their outings? It always has seemed 
to me that the so-called go-carts, because the occupants ride so near the 
ground, inhaling, as they must do, the dirt and dust, and because this class 
of vehicle is rarely fitted with springs and must shake up the babies merci- 
lessly, could not be otherwise than bad for the young child. Am I right?" 

Reply. — Infantile paralysis is a germ disease. It has been quite preva- , 
lent for several years. 

The main factor in its spread is the nose secretion of those who have 
had it and who have been in contact with it. Few of those who have had 
their noses infected with the organism get the disease. They go about 
feeling well but capable of spreading it. They are known as carriers. It 
has been held that their nose secretions get into the dust, and in that way 
dust causes it. Thorough street sprinkling is one of the methods used to 
stop epidemics of the disease. 

Nevertheless, I do not think your suggestions are very good. Shaking 
from lack of springs on the buggy can have no effect. There is practically 
no difference between the amount of dust two feet above the ground and 



256 



CONTAGIOUS DISEASES 




four feet above, particularly where the vehicle in question raises as little 
dust as a baby carriage. 

The cause of the 
increasing f r e- 

quency of infantile 
paralysis is an in- 
creasing number of 
carriers. By the 
way, infantile par- 
alysis — so called — 
affects people of all 
ages. 

The statements 
relative to infection 
of the nose and car- 
riers apply with 
equal truth to cere- 
brospinal menin- 
gitis. 

Care of Infantile 
Paralysis. — A. A. L. 
writes: "There are 
two cases of infantile paralysis in our town. Should such cases be quar- 
antined? Are there any other measures that can be followed by the public 
to prevent an epidemic?" 

Eeply. — 1. Yes. The quarantine should include not only the patients 
but all well persons in contact with the sick ones. The difficulty in han- 
dling epidemic infantile paralysis is due to the large percentage of persons 
who become carriers — that is, well themselves, but capable of infecting 
others. The quarantine should be long continued. 

2. Keep flies away from the sick especially. Kedouble 
the efforts to screen out flies. The theory that biting flies 
spread infantile paralysis has lost ground in the last year, 
but play safe by guarding against flies. Report the con- 
ditions to the state board of health and ask it to get an 
inspector in the field. Infantile paralysis epidemics come 
to an end speedily when a vigorous board of health gets 
busy. 



Massachusetts State Board of Health. 



Fig. 111. — Braces to Prevent Deformity After Infan- 
tile Paralysis. 




Massachusetts State Board of Health. 
Fig. 112. — Shoes to Prevent Deformity after Infantile Paralysis. 



CEREBROSPINAL MENINGITIS 257 

CEREBROSPINAL MENINGITIS 

HOW CEREBROSPINAL MENINGITIS IS SPREAD 

Cerebrospinal meningitis and infantile paralysis are a good deal alike 
from the clinical standpoint. Meningitis affects the covering of the spinal 
cord. Infantile paralysis affects certain nerve cells in the cord itself; that 
is, the main effects of the germ are spent on these structures. At the same 
time the poisons of each germ in some measure poison all the cells of the 
cord in each instance. That is the reason so many symptoms of infantile 
paralysis are also found in meningitis. 

From the epidemiologic standpoint also they behave a good deal alike. 
Nevertheless, they are separate diseases having different germs. 

Cerebrospinal meningitis is usually due to a coccus much like the pneu- 
monia coccus in its shape, size, and general behavior. Inflammation of 
the coverings of the brain and cord not infrequently results from the pneu- 
mococcus. In some epidemics of meningitis they find the pneumococcus to 
be the cause. In most of them the meningococcus is responsible. 

The disease is spread by the nose secretions. Sneezing, coughing, speak- 
ing, even breathing, throws the secretion into the air from which it speedily 
settles on everything around. From the nose the bacteria get into the mouth 
and thence are spread by the mouth secretions. The germs get into the body 
through the nose, where they lie. 

It is but a short distance, much less than an inch, to the covering of 
the brain. If the germs make this journey they cause meningitis; others 
wise not. 

Most people who take in meningitis germs do not have meningitis. 
Some do not get sick at all; some call their illness a cold; some, rheuma- 
tism; some, sore throat; some, malaria. 

There is little in the sickness to make anyone — patient, family, friends, 
or, doctor — think the case one of meningitis. 

Other cases have some nerve symptoms but they are not prominent. A 
quick witted, alert physician might be able to diagnose meningitis in these 
cases but if he does he is called an alarmist. 

The proportion of atypical cases of meningitis to typical cases is about 
five to one. The large number of atypical infections is responsible for the 
general uncertainty as to what to do in an epidemic. 

A case will be treated in a hospital ward and no one catches it; the 
nurses, internes, doctors, and other patients escape. One is sick in a family 
of children; it does not spread to the other members of the family. 

The explanation is that the others have had the infection but it has 
caused no disease or it has caused some minor sickness that was overlooked. 

Persons spread meningitis; things do not. 

EPIDEMIC MENINGITIS 

About every so often a case of epidemic meningitis occurs in every 
community and at long intervals it breaks out into a regular epidemic. 
Meningitis does not behave just as measles does. It will jump about in a 



258 CONTAGIOUS DISEASES 

town skipping whole blocks. As a matter of geography it is hard to under- 
stand. If a health officer takes a map and on it spots the cases in a scarlet 
fever epidemic it is easy to show the effects of contacts. Meningitis skips 
from one place to another so that a spot map shows nothing of foci infection. 

The reason is that meningitis is a good deal like pneumonia in some 
particulars. In each of these diseases the germs get into the nose and 
throat. In each of them the average person who gets the germ does not 
get the disease; in each of them well persons carrying the germs can com- 
municate it to others; in each of them recovery from the disease does not 
mean that the germ disappears from the throat and nose. All of which 
means that it is much more difficult to isolate cases of meningitis than cases 
of smallpox or scarlet fever. 

The epidemiologic rule is that in times of epidemic all people should take 
especial pains to keep the nose and throat clean. All cases should be well 
isolated not only during the attack but subsequently until the coccus dis- 
appears from the nose secretion. 

Why the coccus in one instance stays on the surface and in another 
gets through and into the blood or into the membranes which cover the 
brain we have no idea. 

We have a few observations as to why the pneumonia coccus in one 
man stays on the membrane and in another gets into the blood and is 
carried to the lungs; but we do not know enough about it to be of any 
practical service. With meningitis we are still poorer in exact knowledge. 

There is a practical point that grows out of the little we know and 
that is that when a person has meningitis or pneumonia or has recovered from 
either, the nose and throat secretions for years thereafter should be burned 
or boiled — otherwise the carrier may harm his family or friends. 

CEREBROSPINAL FEVER 

In the popular mind this disease and infantile paralysis are commonly 
confused. For this confusion two facts are responsible. The two diseases 
affect the central nervous system and both are spread by carriers and aborted 
cases rather than by the out and out sick. 

In cerebrospinal fever there is fever, vomiting, unconsciousness, stiff- 
ness of the neck, bowing of the back, and sometimes an eruption. In in- 
fantile paralysis wasting of the muscles is liable to follow the acute disease. 
In cerebrospinal fever an eye is liable to shrivel up or some other special 
sense organ will lose its power to work. 

Generally an epidemic begins in the autumn with some case that has 
been infected in some unknown and undiscoverable way. Soon there are 
other cases and still others until the community is peppered with them. 
No connection between these cases can be discovered. 

When health officers begin active work to control the disease they com- 
monly examine the nose secretions of every person who has been in contact 
with the cases. They examine the nose secretions of every school child. If 
the community is very much alarmed the officers may examine every nose 
in town. 

The disease is due to an easily discovered coccus. This coccus secures 



EEYSIPELAS 259 

entrance to the nose. It multiplies in the nose secretions. Sometimes some 
of these cocci travel from the nose to the covering of the brain. The distance 
is less than an inch and the paths are not difficult to travel. 

The persons in whom this happens have the disease. As they quickly be- 
come violently sick and as the coccus dies quickly on towels, sheets, and 
other articles the sick persons do not spread the disease to any extent. 

If the coccus does not spread to the brain the infected person walks around 
infecting others. He may think that he has a cold. He may be entirely well 
so far as he can notice. 

Eosenau says that 70 per cent, of the exposed have meningococci in 
their noses. Thayer found in the Texas epidemic that 60 per cent, of the 
persons with cocci in their noses were well people and most of the other 40 per 
cent, were but slightly sick. 

Fliigge found that ten cases were caused by healthy carriers for every 
one that was caused by a case of cerebrospinal fever. Cases of fever have 
cocci in their noses for the first fourteen days of the disease. Park 
could not find them there after the sixteenth day. 

When the disease appears in a community the cases should be promptly 
reported to the health department. The department should isolate and quar- 
antine them. It should make a systematic examination of the nose secretions 
of the people, starting with the families of the sick, then taking the physicians, 
then the school children and finally examining the community generally. 

The carriers should be kept under observation. The people generally 
should be advised to keep their noses and throats clean. 

ERYSIPELAS 

The pain of erysipelas is described as burning. The infected areas of 
the skin are fiery red. Quite naturally the disease was thought by the 
ancients to be a form of fire. Involving the skin, plainly in view, easy to see, 
and burning like fire, it was one of the first diseases to be noted. Be- 
ginning with Hippocrates every medical writer of antiquity knew erysipelas. 
Beference to it is found in Arabian, Egyptian, Greek and Eoman literature. 
It was doomed to be named for some saint and the doubtful honor fell to 
St. Anthony. 

As the disease had so many of the earmarks of a visitation of anger, it 
followed that in the days when the gods and men were supposed to be 
constantly mixing in one another's affairs erysipelas was held to be a visitation 
of the wrath of the gods. 

When this era of thought gave way to that of even more vague specu- 
lation nearly every condition of climate, race, sky, earth, and environment 
in every sense was at one time or another accused of being the cause of 
erysipelas. At last with the development of the germ theory of disease there 
came the discovery in 1883 that the cause of erysipelas was a coccus. 

When Justinian began his work in the Eoman forum no library was 
large enough to hold the Eoman law. When he left it the libraries were 
useless, for Eoman law was a matter of a single book. When Fehleisen's dis- 
covery had been established it was in order to burn the shelves of books con- 
taining the speculations about erysipelas. What makes the difference worth 



260 



CONTAGIOUS DISEASES 



while is the difference between the disease now and prior to 1883. Fifty years 
ago erysipelas was one of the scourges. Now it is a disease of no special im- 
portance. 

In Hirsch's "Handbook' ' there is a record of sixty-seven severe epidemics 
of erysipelas in the United States between 1822 and 1880. 

In 1854 Oliver Wendell Holmes wrote: 

"We suppose smallpox or cholera would not cause greater consternation 




(Cross Section through Living Room.) 

Fig. 113. — Massachusetts Hospital School for Crippled Children. Cross section of 
two-story monitor roof cottage, showing false roof and ceiling ventilation transoms in both 
stories, which prevent drafts and defy storms. (Reeves' "Care and Education of Cripple 
Children.") 



in many neighborhoods than the appearance of that violent type of erysipelas 
known from a prominent sign as black tongue, but even when unaccom- 
panied by this feature the disease is much dreaded in the western states. 
From what we have seen and read and heard of it no part of the earth has 
suffered more from epidemic erysipelas than Illinois, Indiana, Missouri, and 
parts of Tennessee and Iowa. It has raged with great violence on the 
plains on the route to California, has been very common and of grave type 
in Santa Fe, and in California it is a frequent and much dreaded disease." 
Hirsch says: "Just as it has been met at all periods in the history of 
mankind, erysipelas occurs in all parts of the world," To which should 
be added, in all races and in every environment, 



EBYSIPELAS 261 

Even when speculation as to its cause was most vague, when every 
circumstance of soil and climate was being accused of being the cause of 
erysipelas, there was one observation on which everybody was agreed that 
should have led the way out of the wilderness. It was that hospitals were 
great foci for the disease. 

It was observed that "the headquarters of the disease have always been 
found in self-contained places occupied by a considerable number of per- 
sons, most of all in hospitals, and next to them in lying-in hospitals, found- 
lings' hospitals, lunatic asylums, educational institutions, and the like." 

Certain wards in the Hotel Dieu (general hospital) in Paris were notori- 
ous as wards from which erysipelas radiated, as well as St. Bartholomew's at 
London, Frederick's Hospital at Copenhagen, the University clinic at Mar- 
burg and Bellevue at New York. In that day if a hospital was known 
at all it was known as an erysipelas center. 

In the Lyons hospital prior to 1867 "the severest operations had been 
performed without erysipelas occurring, but from that date onward the 
larger number of cases operated on were attacked with erysipelas." 

Conditions were so bad that the medical wards fought shy of the surgical 
wards lest the infection spread to them and maternity hospitals had to keep 
as far away as possible. 

In the Civil War it was found that the wounded cared for in tents 
and improvised hospitals got on better than those housed in the best hos- 
pitals in the country. The authorities sought the explanation in overcrowd- 
ing and in lack of cleanliness. 

In the Middlesex Hospital it was noticed that nearly every case placed in 
either of two beds in a ground floor ward developed erysipelas. It was 
found that these two beds were placed one on each side of a window which 
opened out on the "common dusthole of the hospital, so that the effluvia from 
it entered the window and traveled directly to them." 

I remember when a professor in Bellevue reported that there was 
no way to disinfect certain erysipelas wards in that hospital, that the in- 
fection was in the walls, and that the only remedy was to tear down the 
building. 

However, then it began to be observed that there was some erysipelas in 
clean hospitals. Pujos, reporting upon St. Andre's at Bordeaux, a model 
institution, said that even the cleanest and best constructed wards did 
not escape erysipelas entirely. Volkmann reported that hospitals salubrious 
to the point of luxury had epidemics of erysipelas. 

It was plain that while dirt had to do with erysipelas it was a secondary 
and not a main factor. In that day everything around the hospital was 
charged with responsibility for spreading the disease. The essential was 
overlooked — the people themselves. 

Soon after Fehleisen's discovery was accepted attention began to center 
on people. ISFow we know that erysipelas is spread by people, not by things. 
Acting on this information, a line of precedure is followed which has ended 
the terrors of the disease. The statements of Oliver Wendell Holmes 
sixty years ago have a Munchausen flavor to the man who cannot remember 
beyond 1880. 

At the present time there are no erysipelas wards in the old sense. 



262 CONTAGIOUS DISEASES 

Contagious disease hospitals have erysipelas wards to which are carried cases 
of erysipelas for safekeeping in order that the community may be spared. In 
these wards the attendants are careful to sterilize their clothes and their 
hands. The ward is kept clean and the ventilation is good. In conse- 
quence the ward never infects other wards or the neighborhood of the 
hospital. 

The surgical wards never develop erysipelas. A case of erysipelas in a 
maternity ward would cause a trial of the attendants by the proper au- 
thorities. No longer do the medical wards of a hospital shun the surgical 
and obstetrical wards. The case is reversed. The attendants in the surgical 
and maternity wards are always on guard to prevent erysipelas or any 
other form of sepsis from overflowing from the medical wards to them. 
To surgeons and obstetricians erysipelas is no longer a bogy. 

The medical man has not mastered the situation so well. Epidemics are 
few and individual cases are rare. The expectation is that a person having 
erysipelas will get well. In 1909 there were but 130 deaths from erysipelas 
among Chicago's more than 2,000,000 people. 

The disease has lost practically all of its terror. Nevertheless it can- 
not be said that the medical man has met his problem as well as the 
surgeon and the obstetrician have met theirs. 

Erysipelas is due to a chain coccus called the streptococcus of erysipelas. 
This coccus gets through the skin through a wound. A wound barely large 
enough to be seen is amply large enough to allow the entrance of the coccus. 
The most frequent site of the entrance is the edge of the nostril and the 
most frequent wound is a small chap-fissure. The rule is that the fissure does 
not attract attention until it begins to burn from the erysipelas infection. 

The chance that one will become infected is low in summer. In Septem- 
ber the number of cases begins to increase. As the cold weather comes on and 
people are herded closely together, the chance of erysipelas increases. The 
increase mounts markedly in February and continues through March and 
April. In April the maximum is reached, and the spring and summer decline 
begins. 

If a person has had the disease once his liability to it is somewhat 
increased. 

The cocci, having found entrance through the wound, locate in the lymph 
spaces immediately below the skin. They spread rapidly in these lymph 
spaces. A patch on the nose the size of a clime can spread to involve 
the entire head within a day. 

Generally speaking, the spread is slower. It is easy to note the rate 
of spread as the irregularly raised red line travels across the skin. 

The poisons from the coccus are carried to all parts of the body. These 
poisons cause headache, general aching, fever, rapid pulse, and delirium. 

White blood corpuscles are charged with the task of fighting the in- 
fection. A blood examination shows a great increase in these white cells. 
The physician who wants to know what sort of a fight his patient is putting 
up examines the blood and forms his opinion largely on the number and 
variety of the white blood cells found. 

Strange to say, the cocci have not much tendency to travel into the 
deeper parts of the body. Occasionally they get into a joint causing what 



YELLOW FEVER 263 

formerly was called rheumatism, but they do not go much beyond that. 
They do not travel to the heart to cause heart disease nor to the kidney to 
cause Bright's disease. 

When a person recovers from erysipelas he recovers completely. No 
trace of disease is left behind. 

The fever may be high, the pain great, the delirium considerable. The 
person may appear to be gravely ill and yet complete recovery can usually 
be expected. The skin may be so swollen that the features are obliterated 
and yet no suppuration occur. 

The lymphatics open into the blood vessels. They are designed to pick 
up material from the tissues and discharge it into the Hood stream. 

Why is it that these lymph vessels do not discharge the streptococci into the 
blood stream ? Why does not heart disease follow erysipelas, as so frequently 
happens after scarlet fever, pneumonia, and some forms of rheumatism? 

The reason is that the cocci are different. Because they hang together in 
chains, they are called streptococci. Many of the cocci which cause rheuma- 
tism are streptococci. The pneumonia coccus may form chains. The germ 
of scarlet fever may be a streptococcus. This means that, because a group of 
bacteria is alike in that they hang together in chains, it does not follow 
that they are alike in other particulars. Erysipelas, though due to a 
streptococcus, is not usually followed by heart disease. 

Recovery after erysipelas may be expected. There is no specific treat- 
ment for the disease. Some day we shall have a remedy which will kill 
off the cocci in the lymphatics, but that time has not come. 

If the opinion be formed that a man with erysipelas can get along 
without medical attention harm will result. Symptoms demand treatment. 
There is need for counsel as to how to sterilize the hands and clothes of at- 
tendants, as well as how to conserve the vitality. 

Diseases of this group are more in need of skilled medical service than 
those diseases for which specifics are known and no special skill is required 
to administer them. 

YELLOW FEVER 

LAST YELLOW FEVER REGION 

Yellow fever is a memory with us. If by chance it were to come to 
this country few physicians would know it from malaria and other fevers. 
Probably not one physician in a thousand ever saw a case of yellow fever. 
Yet at one time it went up the Atlantic seaboard to Maine and up the 
Mississippi Valley to Cairo. 

In 1693 the disease was in Boston and the New England states. On 
October 16, 1749, Benjamin Franklin wrote from Philadelphia to his mother 
in Boston: 

"Pray tell us what kind of a sickness you have had in Boston this 
summer? Besides the measles and flux, which have carried off many 
children, we have lost some grown persons by what we call yellow fever, 
though that is almost, if not quite, over, thanks to God, who has preserved 
all our family in perfect health." 



264 CONTAGIOUS DISEASES 

In 1900 Guiteras wrote that yellow fever was never absent from Havana, 
Vera Cruz, and Eio. Each one of these places is now free. The only fever 
foci left lie just below the Panama Canal Zone. However, from these places 
the disease is liable at any time to reach the United States. 

Yellow fever is caused by the bite of a mosquito that has been in- 
fected by previously biting a person suffering from yellow fever. 

About five days after the mosquito bite yellow fever comes on with a rush. 
In its beginning there is nothing of the gradual stealing on of typhoid fever. 
The fever is highest at the start. There is usually a chill and the aching in 
the head and back is fearful. The pulse is not so rapid as the fever would in- 
dicate and it gets slower day by day even though the fever is staying nearly 
the same. The face is flushed and note this: a little jaundice comes within 
the first twenty-four hours. 

Another point of importance is that early in the disease the urine con- 
tains albumin. 

The disease is called yellow fever because of this peculiar lemon-yellow 
jaundice. After about three days there is a let-up for a day and then 
comes the second stage of fever — the stage of collapse, of shock, of black 
vomit. 

It is not an easy disease to diagnose. Some of the most violent fights 
I have ever known were fights over the diagnosis of yellow fever and that, 
too, by well trained men of broad experience with yellow fever. At autopsy 
the boxboard liver is so characteristic that the contending diagnosticians 
generally let the autopsy liver settle the argument. 

I hope that we may never again have yellow fever in this country. We 
have kept cholera out of the country since 1873 and we have been almost as 
successful with plague. Our influence has been great enough to banish the 
disease from all Central American countries. Eio and the eastern portion 
of tropical South America have been cleaned up. 

The little fringe of infected country along the north and northwest coast 
of South America is the last stronghold of yellow fever in the world. If 
that can be cleaned up simultaneously yellow fever will disappear for all 
time. As it is, we know just how to control the disease, just what to do and 
what not to do. 

In the light of all this the only chance for yellow fever to disturb us is 
for it at some time or other to get a good start on us because our young and 
middle-aged physicians have never seen yellow fever and our old ones have 
forgotten it. 

Cause of Yellow Fever. — F. R. K. writes: "Will you publish the facts 
about yellow fever? First, is it contagious without the bite of the mos- 
quito? Second, give the name of the army surgeon who demonstrated that 
the mosquito was the carrier of the disease, and the conditions connected 
with the surgeons death." 

Eeply. — 1. Yellow fever cannot be contracted except through the bite 
of an infected mosquito. 

2. The army surgeons who made this demonstration, using their own 
persons as well as the persons of other volunteers for the purpose, were 
Prs. Reed, Carroll, Lazear, and Agramonte. Dr. Lazear died from yellow 



MALARIA 



265 



fever due to experimental infection by the bite of an infected mosquito. 
The theory that mosquitoes conveyed yellow fever had been advocated for 
several years prior to the demonstration referred to above by Dr. Carlos 
Finlay of Havana. 

MALARIA 

CAUSES OF MALARIA 



The word "malaria" means bad air, and the disease was so named because 
it was supposed to result from miasmas which exuded from the soil into 
the air. 

We now know that the disease is caused by the bite of a mosquito that 
has previously bitten a person sick with malaria. 

Only one variety of mosquitoes can carry malaria, the anopheles. Only 
the female anopheles is a ma- 
laria host. In the spring the 
percentage of infected mosqui- 
toes is small. At the height 
of the season not over 25 per 
cent of the anopheles are in- 
fected. 

If a man is bitten by a 
mosquito at night there is more 
than an even chance that the 
mosquito is not an anopheles; 
in the day the chances are 
fifty to one. If the night 
biter were an anopheles, 
there are four chances to one 
that the female was not in- 
fected. 

The reason is not far to 
seek. A man with violent 
malaria has one parasite to 
about 100,000 red cells. If his 
malaria is not violent, he does 
not have one parasite to 10,- 
000,000 red cells. 

There is a pretty good 
chance that Mrs. Mosquito will 
fill up with blood drawn from a malarial man and not get a single parasite. 

Then, many of the parasites taken in by mosquitoes die without evolving. 
Many infected mosquitoes die in less than ten days. The great majority of 
infected females which live longer than ten days after infection never get a 
chance to bite a susceptible man. 

In Ross's "Prevention of Malaria" the probabilities of each phase of in- 
fection are worked out mathematically in a most interesting way. It is his 
opinion that not over one twenty-fourth of the female anopheles stand any 




Fig. 114. — Adult Female Mosquito, Showing Parts. 



266 



CONTAGIOUS DISEASES 



chance of infecting men. Nevertheless, proper planning to control malaria 
includes procedures to prevent mosquitoes from biting sick people, and also 
to prevent infected mosquitoes from biting well people. 

Infected people must stay behind screens during the night hours. The 
screening must be eighteen to twenty meshes to the inch and free from holes. 
Gorgas tells us that an ordinary carpenter will not put a screen in so that it is 
mosquito proof. Men have to be especially drilled before they will take the 
pains necessary. 

The well may take some risks from leaky screens ; the malarially infected 
must be kept behind screens that work. 

Fortunately, after gorging, mosquitoes do not try so hard to get out as 
they tried to get in. If the screens have leaked the. blood-gorged females can 
be killed the next morning. This is early enough, if the person bitten is sick 
and the mosquitoes are the newly infected parties. If the person bitten was 
well and the mosquitoes biting were infected, the next morning is not early 
enough. The deed was done, the chapter closed at the time of biting. 

Mosquito repellants are of little service against malaria mosquitoes. Doty 
tells us that to smear the face and hands with oil of citronella, one ounce, and 
liquid vaselin, four ounces, will keep the pests away for a while, but that it 
will not last through the night. 

A good community policy is one that encourages the people with malarial 
fevers to come into the hospitals. The community can be certain of the screen- 
ing in the hospital. The chances are that the poorer people sick at home will 
be in unscreened rooms. 



DAY-BITING MOSQUITOES 

Fortunately for us, the mosquitoes that carry disease are a timid lot. The 
bold buccaneers, the day biters, the loud singers, and the awe-inspiring, ele- 
phantine gallinippers, none of these carries disease. They 
are nuisances; they cause irritating bumps; they even lay 
the foundation for blood poisoning through skin scratched 
raw, but they do not transmit either malaria or yellow fever. 
The yellovj fever mosquito is a city cousin, but as timid 
and diffident as a "sissy" The malarial fever mosquito is 
insistent and bold enough in the hours of darkness, but 
harmless as an owl in the daytime. But even an owl, when 
half starved, will try to kill in the day sometimes. 

All winter anopheles (malarial mosquitoes) have been 
hibernating in cracks around houses and barns, under floors, 
anywhere to rest unobserved, asking only to be kept fairly 
warm and let live. Now that the warmer weather has 
come, their blood runs warm and hunger quickens. They 
fly out of their hiding places and search for food. Hunger 
makes them bold. 

During the first month of mosquito time, anopheles 
are day biters. As they are numb from cold at night they 
are practically exclusively day biters. 

They bite some people who have been having chills occasionally through 
the winter. The malarial organisms in the blood of those people have been 




Fig. 115. — Larva. 



MALARIA 267 

having a hard time keeping alive. Their blood home for the winter has been 
about as "poor pickings" as mother mosquito has had. 

However, once those parasites get into mother mosquito they quicken into 
life; they take on snap and ginger; they are full of fight. 

Mother mosquito will live to see only a few warm spring days. Death is 
waiting for her around the turn. Ten days are required for those parasites 
to change into young, vigorous, aggressive fellows. Can it live out the ten 
days ? There is one chance in ten it will. 

Can it live on a few days more and bite some in whom these parasites 
can live vigorously? There is one chance in twenty of that, say a combined 
chance of one in two hundred. So there is danger from day-biting mosquitoes 
in the spring, in the first month of mosquito weather. 

For the continuance of the malarial succession, two brood ovens have been 
run during the winter. The one is the poor, neglected man, white or black, 
who has been chilling occasionally all winter. He is much the more important 
of the brood ovens. 

The other is the mosquito stock, the few that crawled into cracks last 
fall and that now pour out, crazed by hunger, by hunger made bold. 

TO CONTROL MOSQUITOES 

Malaria can be controlled without controlling mosquitoes. The yellow 
fever mosquito abounds in the Mississippi Valley as far north as Cairo, Illi- 
nois, but there has been no yellow fever for years because the mosquitoes are 
not infected. All through Illinois and Indiana, all along the Wabash, malaria 
mosquitoes (anopheles) abound, but there is little 
or no malaria, because the mosquitoes are not 
infected. 

Routing malaria is much easier than rout- 
ing mosquitoes. Let him who croaks that routing 
malaria is an impossible task, because of the 
difficulties of controlling mosquito breeding, 
learn another song. 

Mosquitoes constitute the right wing of the 
battle line. The fight against that wing must 
be strenuously waged, but, when the colors have 

been captured, the wagon train burned, and the war brought to an end, it 
will be found that the right wing, broken and scattered, will be engaged in 
an irritating guerrilla warfare — no longer a malaria war, just a lot of bandit 
and freebooter gangs. 

The methods to prevent mosquitoes are several : 

1. Drainage, particularly tile drainage. 

2. The emptying of all buckets, barrels, and cisterns, small accumulations 
of stagnant water, such as puddles in hoof prints, collections in tin cans, etc. 

3. The emptying of shallow pools, such as reservoir and stock pools in lots 
and pastures. 

4. Proper sloping of ditches. 

5. Proper tending of brush and grass in and around the ditches within 
300 yards of the house. 




268 CONTAGIOUS DISEASES 

6. The application of oil to all breeding places after the following plan : 
Mix 100 gallons of stove distillate and 5 gallons of crude oil. Spray with 

a special spray every fifteen days from April to November. In July, August, 
and September spray every twelve days. Crude oil is 12° to 18° Baume, stove 
distillate, 28° to 32° Baume. In hot weather the proportion of crude oil may 
be increased somewhat. The effort should be to cover the water with an un- 
broken oily film. The method of applying recommended by Herms is with a 
five-gallon knapsack spray pump. 

7. Treating waters where green scums grow with sulphate of copper, not 
over one grain to a million of water. 

8. Encouraging mosquito killers. Of such are dragon flies, snake doctors, 
bats, bullbats, and leather wings, and possibly some birds. 

9. The encouragement of fish which live on wiggletails. Of such are 
minnows, shiners, and goldfish. In foreign countries several varieties of fish 
have been found efficient. The probability is that the imported fish will not 
prove so satisfactory as native fish. The minnows found locally will be more 
apt to live and multiply, if given a chance, than will species brought in. 

HOW TO KILL THE MOSQUITO BREED 

Dr. Darling of the Board of Health laboratory on the Canal Zone advises 
the following mixture to kill the young in their breeding places : 

"One hundred and fifty gallons of crude carbolic acid (sp. gr. 97 contain- 
ing not less than 30 per cent tar acids). 

"Two hundred pounds of finely crushed and sifted resin. 

"Thirty pounds of caustic soda. 

"Six gallons of water. 

"The carbolic acid is heated in an iron tank with steam under fifty pounds 
pressure. Then the resin is added and finally the soda, dissolved in the water, 
is poured into the mixture of acid and resin. The mixture fills three and one- 
half barrels. It costs 14 cents a gallon, including heat and labor. One gallon 
in 5,000 will kill mosquitoes, larvae, pupae, and eggs. 

"On a smaller scale: Mix one gallon crude carbolic acid, one and one- 
third pounds of resin, one-fifth pound caustic soda, and one-third pint of 
water." 

With ordinary mosquitoes the egg period is thirty-six hours, the larvae 
seven days, the pupae two days or a total from mosquito to mosquito of ten 
and a half days. 

Darling says this "dope" should be used every seven days. If there is 
much growth in the water, particularly green scum, this takes up a good part 
of the larvacide, but enough remains to be effective for about seven days. 
When the mixture is fresh, the eggs and larvae are killed in a few minutes. 
If there is much growth of algae (green scum), the larvae are destroyed within 
forty-eight hours, that is, during the first seven days after the mixture has 
been used. 

Of course, where it is possible, the proper plan is to get rid of the breed- 
ing place. In a city this is easier than it seems at first thought. The usual 
breeding place in a city is some such container as an oyster can, or a slop jar, 
pr the reservoir for the toilet in the bathroom, or the tank on the house. 



MALARIA %m 

Mosquito repellants are not of much service. They work when freshly 
applied, but they speedily lose their efficacy. One is kept about as busy smear- 
ing his hands and face with "dope" as he would otherwise be in fanning mos- 
quitoes away. 

Where mosquitoes are not infected they are still objects of interest.. 
To prevent mosquitoes from biting, Howard recommends: 

Oil of citronella 1 ounce 

Spirits of camphor 1 ounce 

Oil of cedar J ounce 

A few drops of this on a towel at the head of the bed will answer if the 
mosquitoes are not especially hungry. To rub some on the face and hands is 
better. If the mixture has evaporated before morning and the mosquitoes are 
no longer kept at bay, substitute for it the following : 

Oil of citronella 1 ounce 

Liquid vaselin 4 ounces 

Or 

20 drops of oil of citronella to an ounce of vaselin. 

To ease the hurt of a lite, use soap. Moisten a cake of toilet soap and 
touch it to the bite. Ammonia is a fairly good substitute. 

Gorgas tells us that, as a rule, mosquito bars and screens do not keep 
rooms wholly free from mosquitoes. In a malarial country enough will get 
through ordinary screening to infect. Mosquitoes are persistent and they are 
certain to find imperfections in the screening. Howard tells us to use bars 
and screens with twenty mesh to the inch and not to try anything less than 
fifteen. 

But the great shortcoming is in the cracks around the screen. Gorgas 
says that an ordinary carpenter will never make things mosquito proof. 
Howard advises that where bars are used one should not retire until 
he has gone over his mosquito bar with needle and thread and patched the 
holes. 

To catch the mosquitoes in the room the following method is used: A 
cup is nailed through its bottom to the end of a broom handle. A teaspoonful 
of kerosene is put in the cup. It is easy to catch the mosquitoes resting on 
the ceiling with this. A glass tumbler fastened to a stick has been used in the 
same way. 

Mosquitoes are not travelers. Rarely do they go, or are they carried, more 
than 800 feet. If a wind storm is brewing, the mosquitoes will seemingly 
sense it early and get into cracks and under leaves. 

The man who keeps his premises free of mosquito breeding places for a 
distance of 300 feet from his house will have little trouble with mosquitoes. 
To keep pools free from wigglers, sprinkle with oil about once every two weeks 
in hot weather. Use a mixture of four parts of heavy crude oil and one part 
light. The oil on the surface must remain unbroken. A spray is the best 
method of applying. A sprinkling can will do. If there is a fountain or pool 
in the yard, keep goldfish or top minnows in it. 



Thi 



Pitchers ™ e 



fare Room 




MAY BREED ENOUGH MOSQUITOES TO INFECT THE 
WHOLE NEIGHBORHOOD. 

Florida Health Notes. 
Fig. 117. 

270 



MALAEIA 



271 



If a neighborhood or village wants to know how to run a mosquito cam- 
paign, let some one get Herms' "Malaria" and read how some California 
communities campaigned. 

HOW MALARIA SPREADS 

This is the child who had a chill. 

This is the mosquito that bit the child who had a chill. 
This is the man who was bitten by the mosquito which bit the child 
who had a chill. 



To stop the sequence cure the man who infected the mosquito which bit 
the child who had a chill. 

The malarial parasite gets into a blood cell, where it grows until it is 
full size, whereupon it divides into a 
dozen young ones. The chill occurs 
when the young ones are formed. A 
single dividing germ in a man's blood 
will not cause a chill. One and a half 
millions are needed. When one gets 
in it multiplies for a while without any 
chills; when there get to be one and 
a half millions of them there is a chill. 
So long as the number keeps over that 
figure the chills and fever keep com- 
ing; when it drops below the chills and 
fever stop. 

The man may be "no account" 
and weak, or he may even be feeling 
well. A malarial mosquito biting him 
during this time is fairly liable to 
draw in one or more malarial organ- 




isms, even though they are scant. 



Fig. 118. — Anopheles. 



After ten clays this mosquito can trans- 
mit malaria just as well as one that had bitten a man having chills and fever. 

This tendency of the malarial parasites to remain in an infected man, 
few in number and not extremely active, makes the greatest obstacle to the 
eradication of the disease. Such cases are called cases of chronic malaria, 
relapsing malaria, etc. They are half cured cases ; cases cured enough to stop 
the attacks but not cured enough to do away with the danger of an attack 
next month, not cured enough to prevent mosquito infection. 

The remedy is to take quinin enough and to continue to take it long 
enough to cure the disease wholly, not half cure it. In mild cases thirty' 
grains a day for a week, then twenty grains a day for a month, then arsenic 
and iron for three months will do it. 

Most people know how to stop chills. Some of them go to doctors, some 
of them do not. Whether they treat themselves or go to physicians, they take 
twenty grains of quinin a day for three days. That method stops the chills 
for that week, or maybe for three weeks. If they stop at that they are liable to 



272 CONTAGIOUS DISEASES 

chill again after a month or so. The malarial mosquitoes biting them will 
become infected and may spread the disease. 

The only fair policy is to continue the quinin until the cure is completed 
and then to build up on iron and arsenic. Koch thought this one the most im- 
portant of the three methods of preventing malaria. 

In Italy efforts at mosquito control cut the malaria rate from 70 to 16. 
There it hung until they added a quinin policy to their mosquito policy, where- 
upon it speedily dropped from 16 to 1/.. 

The quinin policy consisted in giving quinin free to everybody who could 
not buy it and fixing a cheap price by law for those who could buy. 

HOW TO END MALARIA 

When the temperature of the atmosphere remains below 65 degrees for a 
while mosquitoes become inactive. Those females that are infected with ma- 
laria become harmless, for the malarial plasmodia within them fail to develop. 
This being true, nobody will be infected with malaria until next spring. 

The malaria to keep the disease going is now stored away within human 
bodies. If the malarial people could become nonmalarial it would not matter 
how many mosquitoes or frog ponds we had next spring. 

When the malarial parasite gets into the blood it begins to develop young. 
These young are now in the asexual form of the malarial plasmodia. This 
asexual form causes chills and fever. 

In about two weeks, when left to itself, in addition to the asexual or chills 
and fever form the plasmodium also begins to develop sexual forms. The 
sexual forms infect mosquitoes. 

The chill and fever producers, the brothers to the sexual forms, cannot 
infect mosquitoes. This being true, if a man would start taking quinin 
quickly, as soon as he got malaria, he could never infect mosquitoes. 

This sexual form, when taken into a mosquito, develops into a form 
capable of infecting man. If it remains in the body of a man, is not sucked 
into a mosquito, after a few days it locates in the liver or spleen or bone mar- 
row, where it lies dormant. Many of them die off from old age when they get 
to be six weeks old. These old, hardened sexual forms are not easily killed 
by quinin. 

Now that the temperature is below 65 much of the time, the mosquito is 
out of it. Can anything be done to clear up the mosquito foci before spring ? 

Bass says: "All that is required for the complete eradication of malaria 
is for everybody who had malaria during a warm season to take the proper 
amount of quinin on each of two consecutive days in each of six consecutive 
weeks during the following cool season/' 

Suppose every person who had an attack of malaria last summer would 
begin in the middle of November and take twenty grains of quinin a day each 
Saturday and Sunday until the first of January. 

If Bass is right — and Bass knows malaria as well as anybody in the world 
— there would be no malaria next spring and summer. There might be a few 
ague subjects too much malaria-soaked to be freed of the parasites by twelve 
treatments. Some of these would need iron and arsenic tonics and quinin 
continued over more than six weeks. 



MALARIA 



273 



However, even if a moderate number of ague case people were not cleaned 
up, the chance that the disease would disappear would be great. The history 
of malaria teaches that when the foci have become few the disease tends to 
disappear. 

HOW TO CONTROL MALARIA 

The method of controlling malaria consists of three parts. Each is im- 
portant. No one can be omitted without increasing inefficiency, increasing the 
ultimate cost and prolonging the time required for results. 

1. To prevent the breeding of mosquitoes. 

2. To prevent the infection of mosquitoes by people. 

3. To prevent the infection of people by mosquitoes. 
To prevent the breed- 
ing of mosquitoes, it is 
proposed: (a) To drain 
the land ; (b) cut out the 
grass and underbrush ; 

(c) catch mosquitoes 
with bats and birds; 

(d) catch the larvae with 
fish; (e) catch the mos- 
quitoes in the houses, 
particularly the last crop 
in the fall and the first 
crop in the spring; (f) 
to kill the larvae with 
oil, nicotin, and other 
compounds. 

As malarial mosqui- 
toes can only travel short 
distances, and as they only bite at night, all that is needed for results is to 
see to it that mosquitoes do not breed within 100 yards of human habitations. 
A man can protect his own household if he will look well to mosquito pre- 
vention in the 40,000 square yards around his own house, however careless 
his neighbors may be. 

To prevent the infection of mosquitoes by malarial people : 

1. Measures should be taken to keep down mosquitoes. 

2. Effective screening of the infected, especially at night. 

3. Complete cure of those who have malaria — the Koch plan of steriliza- 
tion of the blood by quinin. 

The third part of the plan is to prevent infected mosquitoes from infect- 
ing people. The measures proposed are : 

1. To prevent the breeding of mosquitoes. 

2. To prevent infected mosquitoes from biting people by (a) keeping 
mosquitoes uninfected; (b) preventing infected mosquitoes from having access 
to people; (c) using prophylactic doses of quinin. 

However, individual effort is no more satisfactory than is boiling the 
water by the individual successful in keeping a community from having 
typhoid. Not much will be accomplished until mosquito surveys are made, 




Fig. 119. — Deposit of Eggs of the Anopheles (Howard). 



274 



CONTAGIOUS DISEASES 



sanitary inspectors are employed, oiling squads are used — the methods proved 
in Havana, in Panama, and in California. 

Every part of this plan has been demonstrated. Just what to do and 
ways of doing it have all been tried out. 




Fig. 120. — Position of Anopheles Larva in Obtaining 
Air (Howard). 



ERADICATING MALARIA 

Treatment of malaria as a community disease is composed of three parts 
— the prophylactic use of quinin, the thorough cure of the infected, the Koch 
method, and control of mosquitoes. For a badly infected district all three are 
necessary. For a mildly and intermittently infected district, in the Mississippi 
Valley, say, north from an east and west line through Cairo, and in most of the 
country south of there, only the second and third procedures are advisable. 

Not much of value 
relating to the control of 
malaria came out of the 
Washington meeting of 
the International Con- 
gress on Hygiene and 
Demography. In one 
warm informal discussion 
the success of mosquito 
eradication in Panama 
was brought into ques- 
tion. Proof that the 
mosquito work in Pan- 
ama was effective was 
overwhelming, and the English doubter retired from the field rather worse for 
wear. 

Dr. Le Prince's paper set forth that, mosquitoes not being able to travel 
against the wind, in a district where the winds blow steadily in one direction 
an infested community can concentrate its efforts on the marshes which lie to 
the windward. 

Euge put a good deal of stress on fighting mosquitoes out of season. The 
race is kept alive by adults that get into warm places and live through the 
winter. He advocated fumigating all houses at least once during the winter by 
burning pyrethrum powder in them and sprinkling with Giems 7 solution. He 
advised that whenever it was necessary to keep water around the house in 
cisterns or like places minnows should be kept in the water. All unnecessary 
water catchers, such as bottles, tin cans, fountains, small ponds, should be 
done away with. Ditches and ponds that cannot be drained must be oiled. 

Sergeant said that in North Africa they required that irrigated districts 
be allowed to dry out at intervals less than the life cycle of the mosquito, the 
idea being that the eggs deposited and the larvae developed from them would 
be destroyed before maturing time. Several towns in Constantine, Sahara, 
have been moved bodily by the government from an unhealthy site to a new 
one provided and made healthy by the authorities. 

There seems a fair chance that the Mediterranean country will have elimi- 
nated its malaria by the time ours is gone. Perhaps by that time South 
America may be in a fair way to clean out its foci. 



MALAEIA 



275 



CURE YOUR MALARIA 

In the United States malaria is one of the fast disappearing diseases. In 
another generation it should be as rare in the gulf states as it is in Illinois 
today. Half a century ago the New Englander was afraid to emigrate to 
Illinois on account of the dreaded malaria. The more active the efforts made 
to control this disease in a malarial region, the more quickly the disease will 
disappear. 

Fall is the most important season from the malarial standpoint. The 
people who have been repeatedly bitten by infected mosquitoes are in greater 
danger of losing their lives now than earlier in the season. 

After each infection they have taken enough treatment to stop the chills, 
but not enough to kill all the parasites in the blood. In consequence many of 
them have a few ma- 
larial parasites of the 
tougher kind in their 
spleens and livers. 

In certain phases 
of the life of the ma- 
larial parasite quinin is 
a deadshot remedy. In 
other phases the para- 
site is not so easily 
killed by quinin. In 
the fall those who have 
been chilling from time 
to time are liable to 
have outbreaks of ma- 
lignant malaria. 

King, in writing 

of malaria in central Africa, says: "The cold weather brings out the fever 
in those natives who have suffered from it in previous months." 

Rosenau tells us that as the troops returned from Cuba after the Spanish 
war "many cases of malaria broke out among those previously in good health 
upon reaching the cold winds about Cape Hatteras." 

It is wise to cure one's malaria as completely as possible before going 
into the winter, to cure it up with plenty of quinin followed by an arsenic-iron 
tonic. This policy is wise from the standpoint of the individual. It is also 
wise from the standpoint of the community. 

The mosquitoes that are to carry over into next year are searching out 
sheltered places in which they will manage to keep alive through the winter. 
Those that come out next spring will be free from malaria infection. Mos- 
quitoes have such a hard time in living through the winter that it is certain 
the sick ones will die. 

// there is to be any malaria next spring the mosquitoes to spread it must 
get infected. They will get infected through biting the people who now have 
malaria in their blood and who will go through the winter only half cured* 
having chills once or twice but feeling fairly well most of the time. 

After the intelligent people have cured themselves completely it would be 




Fig. 121. — Usual Position of Larva in Obtaining Air 
(Howard) . 



276 CONTAGIOTTS DISEASES 

wisdom as well as charity to help the less fortunate people to get a complete 
cure. 

HALF CURED MALARIA 

Mosquitoes capable of spreading malaria are found all over the United 
States. They are a great annoyance, and as such they should be prevented, but 
when uninfected they cannot spread malaria. They must be sinned against 
before they can sin. As they are uninfected in the upper Mississippi Valley, 
there is no health reason for paying any attention to them. 

So much for the general run of towns. Any place which is a summer 
resort for half cured "malarias" had better take care of its mosquito problem 
to prevent breeding, or, failing in this, to prevent them from becoming in- 
fected. It has a health as well as a comfort reason. 

The visitor to Havana is impressed by the promptness with which the 
oiling squad turns out after a rain. Within a few hours the little puddles of 
water, the tin cans, every little accumulation, are oiled. These efforts are 
important, but they are no more important than seeing to it that no malarias 
are left half cured. 

During the days of chills and periodic fever — say, May, June, and July — 
most people know the need of keeping mosquitoes away from the sick. Some 
do not know or do not care. But the custom is to give quinin for three days 
only, and this is not long enough to sterilize the blood completely, particularly 
after August 1. Dr. Henson, in the Journal of Tropical Medicine for Feb- 
ruary, 1912, says twenty grains a day for three weeks will completely sterilize 
the blood when fever is intermittent in type, and thirty grains when the fever 
is of the type found in the autumn — the irregular type. 

Thirty grains of quinin make one feel far from comfortable. To ask a 
malarial subject to keep it up for two or three weeks is asking a good deal, but 
then to ask a "chiller," a big-spleened sufferer from latent malaria, to stay be- 
hind mosquito bars all of the time is asking a good deal. Asking people to get 
vaccinated, to keep diphtheria quarantine after they feel well, to burn the 
sputum in all coughs and colds — all of these things ask a good deal. 

A badly infected malarial section labors under a great handicap. The 
land sells below its value. There is some hazard to life. Malaria is a bar to 
prosperity. 

If a man is willing and anxious to be quininized for three days for his own 
good, he ought to be willing to make it three weeks even if the last two weeks 
is 75 per cent public good and only 25 personal good. Why not indulge in 
fewer windy words about dying for one's country and put in the time getting 
cured for one's country? Foreign enemies are bad, but men with half cured 
malaria are worse. 



THE COST OF MALARIA ON A PLANTATION 

A Department of Agriculture newsletter to crop correspondents tells of 
an effort made on a plantation in Louisiana to find out the cost of malaria to 
the planter and his hands. One thousand eight hundred acres of this planta- 
tion were farmed, mostly by tenants working on shares, though there were 
some day hands. One thousand seven hundred and forty acres were uncleared 



MALAEIA 



277 



swamp land. The department estimates that the conditions were the same as 
on 200,000 acres of cultivated land in other parts of this country. 

The plantation physician treated members of forty-six out of sixty-four 
families during the year for malaria. The loss from loss of time to the owner 
was $3,835 and to the tenants $1,115. Had malaria been eliminated, the 
manager figured, the income of each family would have been increased $24. 
He thought forty families entirely free from malaria could do the work of the 
sixty-four families, sick as they were. 

The harvest seasons in that section come just as malaria is at its worst. 
In the sections where boll weevil now is, the people are suffering double loss 
from malaria. 

In the old days, when the crops had been laid by there was not much 
to do until the gathering time 
commenced. If the hands were 
laid up with chills, not much 
money was lost. When boll wee- 
vil is around, the crops must be 
cultivated after the old "laying 
by" season in order to keep ahead 
of the weevil. 

The writer of this letter 
thinks the most effective method 
of prevention is complete cure of 
the sick. He does not think it 
possible properly to screen negro 
cabins or to keep mosquitoes 
away by bars over the beds. The 
drainage of the lands will require 
many years. But if the cases of 
malaria are completely cured, the 
mosquitoes cannot become infected. 

Concentrating on people sick with malaria, seeing that they get quinin 
free if not able to pay for it, and at a low price under other circumstances, 
is the method of control of malaria which is proving so effectual in Italy. The 
letter says that in the ultimate control drainage would probably play the 
greater part. 

To distinguish the malaria mosquito from the other varieties, the letter 
says, it is only necessary to notice its position as it bites. The biting malarial 
mosquito lifts the hind end of the body and hind legs from the skin. The 
ordinary mosquito stands on the skin with all its legs. 




Fig. 122. — Culex Pungens, or Common House 
Mosquito: Female (Howard). 



USE OF QUININ 

To spread malaria the anopheles mosquito must bite a person in whose 
blood the malarial organisms are ready for the mosquito stage. In the blood 
sucked up there must be malarial parasites, for not every blood cell, nor even 
every hundred cells, contains a parasite. The mosquito must live for ten days 
while the parasite is getting ready for man again, and then the mosquito must 
discharge the young parasite into the blood of a susceptible man. 




278 CONTAGIOUS DISEASES 

To render the blood of men unsusceptible to malaria small daily doses of 
quinin are used. In the Panama Canal Zone the three-grain chocolates of 
quinin are kept on the eating tables. Of the 40,000 people in the zone 20,000 
use this prophylactic quinin daily. The quantity taken is nine grains — three 
grains three times a day. 

The proper plan is to begin taking quinin this way when the mosquito 
season opens and to keep it up until the mosquito season closes. The tannate 
and other tasteless forms of quinin seem to work just as well as the bitter 
forms. 

Bartholow says that in the Civil War every soldier in the army of northern 
Virginia took a measure of quinin and a jigger of whisky every day and that it 

was good "neither mor- 
ally nor physically." 
The judgment of the 
men in charge of the 
malaria campaigns in 
fa Italy, Algeria, and in 

Fig. 123.— Manner in Which the Eggs of the Culex Pun- Paxiama IS that Bar- 
gens, or Common House Mosquito, are Deposited tholow was wrong, at 
(Howard). l eas t so far as the quinin 

was concerned. 

To the International Congress on Hygiene, Celli, speaking of Italy, said : 

"The prophylactic administration of quinin has reduced the malaria rate 
to the minimum." 

Sergent, from Algiers, said: "In Algeria the government distributes 
three-grain quinin tablets free of charge." 

Euge, from Kiel, advocated the preventive use of quinin. 

Gorgas, speaking of Panama, says : 

"Prophylactic quinin is furnished in three-grain doses either in a solution 
in the form of a tonic or in pills. It is placed on the table at all the messes, 
given to any employee who applies for it. Besides we have from one to three 
dispensers in each district, who go around to the various villages, offering 
quinin to all employees who will take it. We look upon prophylactic quinin as 
a most important measure." 

They use about 500 pounds of quinin a year in the Canal Zone. 

The question arises : By whom should prophylactic quinin be taken ? The 
answer is: Everybody living in a highly malarial district. If anyone stays 
behind screens every night during the malaria season he may omit quinin with 
safety, but others cannot. Negroes and poorer whites living in unscreened 
cabins should take it from spring until fall. The better-to-do can well afford 
to see that the poorer people get it without cost. 

Keep clear the distinction between the large doses needed to cure an in- 
fection and the small doses to prevent one. 

OUTLINE OF MOSQUITO WORK 

1. Find the breeding places. 

2. Destroy all bottles, cans, and buckets capable of catching water. They 
serve as breeding places. 



MALARIA 



279 



3. Fill up the cow tracks and ruts. 

4. Drain the small pools and puddles. 

5. Drain the marshes. 

6. Clean out and straighten *the ditches, 

7. Clean and slope the ditch banks. 

8. Tile ditches, whenever possible. 

9. Screen all tanks and water barrels with No. 18 mesh screening. 

10. Tag the breeding places which cannot be drained, emptied or destroyed. 

11. Oil the breeding 
places. 

12. Oil once every three 
weeks in cool weather. 

13. Oil once every two 
weeks in warm weather. 

14. Oil once every week 
in very hot weather. 

15. Oil after every hard 
rain. 

16. Oil after every very 
hard wind. 

17. Cover the entire 
surface of the pond with a 
thin film of oil. 

18. The oil mixture to 
be used is a combination of 
kerosene and crude oil. 

19. When a spray pump 
is not available a sprinkling 
can may be used. 

20. One ounce of oil properly used is enough to cover fifteen square feet 
of water with a thin film. 

21. In cooler weather the oil mixture used can consist of three parts 
kerosene and two parts crude oil. In very hot weather the mixture should 
contain twelve parts crude oil to ten of kerosene. 

22. Grassy marshes where an inch or more of water stands in the grass 
are especially in need of oiling. 

23. Special attention should be paid to small accumulations of water. 

24. Water liable to serve as a breeding place and which cannot be emptied 
should be treated with larvacide. 

25. A good larvacide made from tobacco can be had from tobacco 
firms. 

26. Bodies of water which can neither be oiled nor treated with larvacide 
can be kept free of mosquito larvae by stocking with fish. Native minnows are 
best. 

27. Mosquitoes rarely make their way across open ground for a distance of 
more than 100 yards. Therefore, if mosquitoes do not breed within 300 feet of 
a house they rarely cause great discomfort therein. 

28. Female mosquitoes, the biters, live for a month or two. They work 
their way through the woods and dense grass. They hide in heavy cover. 




Fig. 124. — Culex Solicitans, Salt Water Swamp or 
Striped-Legged Mosquito: Female (Howard). 



280 



CONTAGIOUS DISEASES 



29. Clean the vines and bushes away for a space of 100 feet from the 
house. Vines on the wall are excellent hiding places for mosquitoes. 

30. Screen porches with No. 18 gauze. 



A MOSQUITO CAMPAIGN 

New Jersey has a reputation for mosquitoes. In 1911 the legislature 

decided that the reputation was doing the state harm, and it therefore passed 

"an act for the establishment of county mosquito extermination commissions/' 

In April, 1912, Union County organized its commission. The budget for 

that year was $28,000. The budget for 1913 was $26,000. In the first annual 

report of the commission there 
is a statement of the reasons 
why that county was willing to 
spend that amount of money 
in anti-mosquito work. 

It is said that mosquitoes 
cause some, though not much, 
disease in New Jersey. They 
are unpleasant pests, and they 
cause the people great dis- 
comfort. But the reasons for 
the activity are largely eco- 
nomic. 

"Swamps that are useless 
now become fertile fields after 
drainage and a source of gain. 
Valuable building lots are 
made by filling in low lands, 
and once freed from the pests 
that have given New Jersey a 
bad name people will come to 
our county and establish their 
residence, and this means an increase in property values and prosperity." 
Union County embraces a good deal of sea marsh land. The 1913 
report shows that the better drainage of this land had materially increased 
the value of the hay crop, an economic benefit not included in the first 
prospectus. 

It is infinitely more difficult to rid a sea marsh of mosquitoes than it is 
to get rid of them in an upland district. The rise and fall of the tides and 
the great expanses of grass-covered marsh with its multitude of sluggish ditches 
create conditions without parallel in upland work. If they can control mos- 
quitoes the people of Chicago and vicinity would find their work of mosquito 
extermination child's play. 

The report from Union County is that the mosquito pest is ancient his- 
tory. More than a year ago all the district was practically free except a section 
of northeastern Elizabeth. In 1914 the city of Newark undertook to rid that 
district of mosquitoes since they came from a section of Newark meadow for 
which Newark, not Elizabeth, was responsible. 




Fig. 125. — Stegomyia, or Yellow Fever Mosquito: 
Female (Howard). 



MALARIA 281 

The Union County commission keeps three men at work cleaning out 
ditches and draining the salt marsh throughout the winter. Early in March 
it sets a gang at work cleaning out ditches on the salt marsh and another 
gang draining small pools in the upland. 

About May 1 the oiling begins. About 2,000 sewer catch basins, stagnant 
pools and ponds, gutters, open cellars, slow-running streams, open manure 
pits, drains, and other breeding places were oiled once every ten days from 
May 1 to October 1. The cleaning of the salt marsh ditches began March 16 
and was completed on May 20. 

"Now is the time to start anti-mosquito work." 

The statements quoted below are worth listening to because they are 
based on the experience of men who had a hard job and made good. The 
men referred to are the mosquito extermination commission of Union 
County. 

Note this money benefit: "The amount of salt water hay harvested is 
growing greater every year." And this comfort benefit: "Hardly a single 
specimen of the salt marsh mosquito was seen in places where in previous 
years it was a pest." 

The following statements would apply anywhere: 

"The importance of the small breeding place is being realized more 
and more when the enormous number of barrels, open cesspools, and cis- 
terns, tubs, pails, broken dishes, cans, etc., found each year is taken into 
consideration. Even in good neighborhoods dozens of these breeding places 
are found. In almost every factory yard from one to ten unused vats and 
barrels holding water can be found, serving no purpose except to breed mos- 
quitoes. 

"In the patches of gardens scattered throughout the cities, barrels and 
tubs to hold water are common. Around stables and in vacant lots miscel- 
laneous collections of old cans, pails, etc., the dumping of many years, are 
plentiful. Any such breeding places can produce enough mosquitoes to keep 
the neighborhood for two blocks awake." 

In the opinion of the writer of the report, most of the mosquitoes which 
infest residences are bred in water in small containers, and not in ponds and 
marshes. 

The commission has noted sewage-polluted road ditches black with wig- 
glers. Sewage pollution furnishes plenty of wiggler food. "One hundred 
times as much breeding will take place in polluted water as in clean." This 
may be true of ordinary mosquitoes. Yellow fever mosquitoes require clean 
water. Malaria mosquitoes prefer to breed in greenish water not very badly 
polluted. 

About 200 premises were inspected each day by each city inspector. 
The country inspector had forty to fifty inspections as his daily task. An 
inspector was expected to get around his district, inspect every premise, once 
in fourteen days. "Although they found a very large amount of breeding, 
but few mosquitoes got on the wing." 

"The kind of mosquitoes that infest your houses do not come from the 
salt marshes or large bodies of water, but in nearly every case they were 
hatched within 1,000 feet of your house, in some small pool or collection of 



282 



CONTAGIOUS DISEASES 



water. One rain barrel by actual count has been known to produce 16,800 
mosquitoes in a week." 



OILING TO PREVENT MALARIA 

The workmen on the Canal Zone suffer very little from malaria. Dr. 
Watson, who has charge of the malaria work in the Federated Malay States, 
visited the Zone to study the methods in use there. He reported to the Royal 

Colonial Institute : 

"I concluded the results 
were mainly from oiling, which 
was done for practically half 
a mile on each side of the 
canal. The great majority of 
the population do not live in 
screened houses and very few 
take quinin." 

Dr. Le Prince, who has 
had a broad experience in the 
Canal Zone, has devised a 
method for oiling running 
streams. He holds that, wher- 
ever draining is feasible, it will 
be found the cheaper as well as 
the more effective method for 
controlling mosquitoes. Where 
a film of oil can be made with 
a spray pump or a sprinkling 
can it should be done. 

However, the question of 
oiling flowing streams arose 
with them as it does with 
others. Dr. Le Prince uses a homemade device made with an ordinary five- 
gallon oil can, a three-inch round nail, and a little cotton. The nail is driven 
through the bottom of the can from the inside out. A wad of loose cotton 
is wrapped around the nail just below its head and within the can. 

The can is hung or otherwise held over the water. The drop should fall 
far enough before striking the water to cause it to break into a thin film on 
the surface of the water. By varying the pressure of the head of the nail on 
the cotton the flow of oil is regulated. The number of drops per minute should 
range between ten and twenty. 

For kerosene and light oils one can use an oil can with a small spigot 
located on the side of the can an inch above the bottom. The handle of the 
discharge tap, or spigot, can be manipulated to regulate the rate of dripping. 
In hot weather, when heavy oils are used, neither of these methods is 
very satisfactory. The grease clogs the opening after a little time. To obviate 
this the following plan was devised: 

An opening is made in the side of the can about two inches above the 
bottom. A flange of thin metal, similar to that used in a lamp burner, is 




126. — Anopheles, or Malarial Mosquito: 
Female (Howard). 



MALARIA 



283 



fastened to the outside of the flat opening in the side of the can. A flat wick 
is run through the opening. Two or three inches of the inner end of the 
wick rest on the bottom of the can, and about half an inch of the outer end 
projects beyond the flange. An inch or two of water is placed in the bottom, 
and then the can is filled with oil. By pressing the flanges against the wick 
or by opening them out the rate of dripping is lessened or increased. 

This method is especially adapted to small drainage ditches. It may be 
adapted to irrigation ditches. Several cans properly spaced may be placed in 
a row across a larger ditch. 

A marshy place supplied by an oozing spring Le Prince would handle as 

follows : 

A small bundle of oil-soaked cotton waste is placed on the wet ground at 
the point where the spring oozes out. It will give off a thin film of oil for 
a week. 

Weeds and Malaria. — Mrs. F. A. T. lives in a southern town within the 
malarial belt. The town has 2,500 inhabitants and is scattered over a 
large area. She asks the follow- 
ing questions: Do rank weeds 
growing on vacant lots where 
surface water is liable to stand 
cause malaria? There are many 
people ill with malaria, chills and 
fever both in town and in the 
surrounding country. How is 
malaria akin to typhoid fever? 
If a sewer system is installed it 
will cost about $18 per inhabitant 
and the sewage would have to be 
emptied into a sluggish river. Is 
there a substitute? Is the odor 
from stables injurious? How did 
the belief originate that "horses 
and hogs are healthy"? 

Eeply. — 1. Tall weeds con- 
tribute to the breeding' of mos- 
quitoes. They keep the ground 
from drying out and are respon- 
sible for small puddles of water 
in which mosquitoes can breed. 
A can of water will sometimes 
breed enough mosquitoes to spoil 
a neighborhood. There being 
cases of malaria in the neighbor- 
hood, these mosquitoes become 
infected and then spread the in- 
fection to other people. 

Malaria reduces the price of 



H 


^J 


\ 


j$&-^- 


3^_ 


3?C 


ytSL. 


y^ 




At 


J^f 


/v 



Fig. 127. — Resting Attitudes or the Cu- 
lex (left) and Anopheles (right). 



every acre of ground in the district; it lowers the working efficiency of 
the people from 10 to 25 per cent. ; it causes a good deal of sickness and 
some deaths; it prevents immigration. Therefore a malarial section is 
warranted in going to a good deal of trouble to get rid of mosquitoes. 



284 CONTAGIONS DISEASES 

The following plan should be followed: First, require that malaria 
be a reportable disease just like diphtheria ; second, require that all people 
having malaria shall be screened from mosquitoes; third, insist that all 
those suffering with malaria shall be forced to continue taking quinin until 
fully cured, since half cured malaria is largely responsible in spreading the 
disease; fourth, screen dwellings against mosquitoes; fifth, cut weeds so 
that puddles of water may dry out; sixth, drain stagnant water; seventh, 
kerosene bodies of water which cannot be drained and which are mosquito 
breeders. 

2. Malaria is not akin to typhoid. As malaria disappears from a sec- 
tion typhoid comes more to the front, but it is our opinion that typhoid was 
always present but was overshadowed by malaria during the years when 
malaria was rife. 

3. If sewers are expensive for your town we suggest that ordinances 
relating to outhouses should be passed. These ordinances should require 
a permit for every yard closet and should specify the location with relation 
to dwellings and wells, also the style and type of building. A letter sent 
to the Public Marine and Hospital Service, Washington, D. C, asking for 
plans of the Stiles closet will bring a pamphlet telling all about it. It can 
be built for less than $10. 

4. The odor from a stable is not injurious under ordinary circum- 
stances, but there are places around stables in which flies breed, and this 
is a source of bad health. City ordinances should always specify that the 
manure should be kept in boxes which are fly proof and that the manure 
boxes should be emptied at weekly intervals. There is no basis for the 
legend that the odor of horses and hogs is healthy. Another and similar 
legend is that the odor of goats is healthy. There is no truth in any of 
these. 

Malaria Easy to Cure. — Mrs. B. P. writes: "We now know, I believe, 
where malarial fever comes from, but I wish to ask if there is any cure 
for it. Can the fever ever be entirely eradicated and if so by what means? 
Will medicine, antitoxin injection, diet or climate affect the disease when 
it has a hold? Will life out of doors help it?" 

Reply. — Generally speaking, malaria is the most curable of all diseases. 
Unless the patient is being reinfected by mosquitoes, the disease clears up 
spontaneously. A few doses of quinin given while the parasite is in the 
growing stage and repeated for three days are generally all that is neces- 
sary, if mosquitoes are barred out. 

Occasionally, as Craig of the army has shown, malarial organisms get 
in the spleen and bone marrow and lie latent for some time. Iron, arsenic, 
and quinin nearly always suffice for these. 

Ninety-nine per cent of the people who think they have intractable, 
recurring malaria have no malaria at all; they have something else. 

Daily Allowance of Quinin. — D. B. B. writes: "In taking quinin to 
cure malaria, how large a dose should be taken at a time and at what 
intervals? From what part of the body is it best to take a sample of blood 
for a microscopic examination for malarial germs? When a chill is not 
evident, what are the symptoms of malaria? Would a severe headache 
about the same time each week indicate malaria in one who has been in- 
fected for about three years but had no chill in the last year? Is the tak- 
ing of large quantities of quinin injurious to any organ of the body? 
How would it affect a leaky heart?" 



MALARIA 285 

Reply. — 1. Thirty grains a day. If the condition is urgent it can be 
given in one dose. The usual plan is to give it in five-grain doses. Some 
give the thirty grains in eight hours, some distribute it over the twenty- 
four hours. 

2. It makes no difference in an ordinary case. The finger is frequently 
used. The lobe of the ear is preferred by many. 

3. In a marked infection, fever and aching, followed by a sweat. But 
the variations from this type are many. The microscopic test is practically 
always available. 

4. It would be ground enough to warrant repeated blood examinations 
and the therapeutic test — trial of quinin. 

5. No. 

6. Not at all. 

Effect of Quinin. — J. 0. T. writes: "Is quinin a mineral or a vegetable? 
A party claims that quinin is bad for the health, as it is a mineral. I have 
always been under the impression that it came from Peruvian bark." 

Reply. — You are right. Quinin is derived from Peruvian bark and it 
is, therefore, a vegetable substance. Quinin is a poison. If you are in- 
fested with malarial organisms, take quinin. It will poison you some- 
what, but it will kill the malarial organisms. If you have not malaria, 
do not poison yourself with quinin. 

Mosquitoes. — H. J. H. writes: "In your article on malaria you quote 
Ruge, who says the race of mosquitoes is kept alive by adults that get into 
warm places and live through the winter. If this is true where do the 
countless millions of them come from in the arctic regions? They swarm 
in clouds over every northern swamp, where the temperature is 50 to 75 
below zero and no warm places for them to live" 

Reply. — There are warm places even in the arctics. Within a short 
while after the warm weather of the spring comes on the surviving females 
begin laying. Multiplication is very rapid. The marsh mosquito eggs can 
live through the winter in mud and hatch in the spring. Whether the eggs 
of other species can or not is unknown. A few larvae survive. The impor- 
tant method of winter survival is by hibernation in warm places. 

Mosquitoes from Cisterns. — J. H. F. writes from Joliet: "In your 
catalog of breeding places for the mosquito you overlooked the cistern. So 
far as cities and villages go cisterns are the breeding ground of mosquitoes. 
Where cisterns are in basements it is difficult to shut the mosquito out, 
unless it is done at the time of construction" 

Reply. — There are anopheles mosquitoes in Joliet, but they are not 
infected with malaria. 

Malaria in Lexington. — Anxious Mother asks: "Is there much malaria 
around Lexington? We drink water from a well; is it safe?" 

Reply. — The malaria rate in the district you mention is not high, and 
it is getting less year by year. Where water is from wells, the question as 
to safety must be answered for each well. Probably the Kentucky Board 
of Health can advise you as to the safety of the well to be used. 



Where Mojxjuitoej* Breed— 




Jn "Ponds and Riddles 




\n Tloo&fyMezr end Rain- 
water BorreLr 




»«&" 



JnEmptq Canr eu^d 
Bottler eic. 



LUi- 



jhe Pitcher in the Sp 



ore 



- Room Maij Breed Enough 

Noscmiiozs to Infect the 
% Whole Nei/ihhorhood. 




Jn Neglected Street Cuttfe 



4/ C** «*<»/>£* ■ ■flf- 



Florida Health Notes. 



Fig. 128. 
286 



— and How {o Preveni Them. 



~ ^_JHT o^s. V S^ 



\~ 




Stock Ikmancni Ponds J)rbin or Fill All Low Spotr 

With Firh. mere Stagnant Water May 

S~ ^ ^v Collect. 

h fire- 




"Wtcnl&u CantPrain,Oil 




JJo Noi Allow Stagnant "WS^rl^ 
Collect -Anywhere onl&ur Ptemirej: 



Florida Health Notes, 



Fig. 129. 

287 



288 CONTAGIOUS DISEASES 

To be protected against malaria, be careful of mosquitoes, particularly 
of mosquitoes that breed and live around the house. Keep away from 
people who have malaria, or who have had it within a year. 

The disease cannot pass directly from such a person to you, but the 
mosquitoes around such a person will be a menace to you. 



ANTHRAX 

One of the first bacteria discovered was that of anthrax. The reason 
is that it is so large that it can be readily seen with low power imperfect 
microscopes — the only kind the pioneers in bacteriology possessed. 

The disease is frequent in cows and horses. It is infrequent in man. 

Human anthrax is of several varieties. In most cases the bacillus gets 
into the tissues through some wound in the skin. For some reason, prob- 
ably because of its large size, it is held near the point where it got in. 

In over half of all the cases the anthrax carbuncle is on the face. In 
38 per cent, of the cases the infection is on the hands or arms. About 
two days after the exposure the carbuncle starts as a small red itching 
point which feels and appears like an insect bite. In less than a day the 
small pimple is a small blister and within another day it is a fiery carbuncle. 

There is no way to tell this carbuncle from an ordinary carbuncle 
except to examine for anthrax bacilli under the microscope. This form of 
anthrax is not a very violent disease. Two-thirds of the cases get well. 

Perhaps some cases of anthrax carbuncle are diagnosed as ordinary car- 
buncle. Unless the sick man happened to be a dairyman or hostler, 
shepherd, butcher, tanner, wool sorter, or rag picker it would not occur 
to the physician in most cases to examine the secretion of the carbuncle 
under the microscope. 

In Europe the peasants have internal anthrax. Perhaps it comes from 
eating pickled meat from animals that have died of anthrax. Edwards says 
that in Saxony in one year there were 206 cases t)f internal anthrax. 

The disease starts with a sharp rise in temperature. The fever is high. 
There is vomiting of blood. Blood is passed in the stools. Carbuncles of the 
skin may appear. If the physician gets suspicious and examines the stools for 
bacilli he discovers the disease, otherwise not. 

ANTHRAX OF THE LUNGS 

Wool sorters and rag pickers sometimes inhale dust containing anthrax 
bacilli. As the bacillus is large it is caught in the small blood vessels of 
the lungs. The patient has a high fever and cough. His sputum contains 
blood. He is liable to die on the second or third day. About the only way 
to diagnose the disease is to find anthrax bacilli in the sputum. 

ANTHRAX IN THE BLOOD 

Sometimes the bacillus, in spite of its size, gets into the blood stream. 
When it does it finds itself at home. It multiplies rapidly. Many of them 



ANTHRAX 289 

lodge in the tissues but in spite of this they can be found in numbers in the 
blood stream. The disease is rapidly fatal. 

The patient has a chill, followed by high fever and great exhaustion. 
The spleen may be large, especially if the patient lives a few days. The 
urine contains blood, albumin and anthrax bacilli. This is the form in 
which anthrax usually appears in the lower animals. 

Since the disease is not natural in man it takes on the atypical form — 
the carbuncle rather than the typical form — of blood infection when it ap- 
pears in the human subject. 

Anthrax as a disease of human beings has never been, is not, and prob- 
ably will never be a disease of first importance. The ordinary man engaged 
in the ordinary work of society is in practically no danger from it. Men 
who work in hides, hair, and wool need to be protected against it. In some 
instances that which they work in can be sterilized. To protect against 
dust the hides, wool, or rags should be sprinkled. Some wool sorters 
and rag pickers can be persuaded to wear respirators when at work. 

ANTHRAX AND FURS 

A short time ago a girl in New York died from anthrax. The carbuncles 
in this case were on the neck and the girl had recently worn a new fur 
collar. Since it was not possible to find any other way in which the girl could 
have contracted the disease the suggestion was made that the fur collar 
carried anthrax to the girl. The health authorities investigated the case 
as well as they could. They came to the conclusion that the fur collar was 
not responsible. They found that furs are so carefully cleaned that any 
anthrax bacilli there would be cleaned out. Furthermore, they found that 
there was no record in medical literature of a case of anthrax in workers 
in fur. 

Anthrax is due to a very large spore-bearing bacillus. The spore-bear- 
ing bacilli are hard to kill. When anthrax once infects a pasture or a barn 
it is exceedingly hard to get rid of it. 

A certain dairy district in northern Illinois had a small amount of 
anthrax infection which hung on for nearly ten years. About once in two 
years a few cows would be found infected. The cows would be killed and 
their bodies burned, whereupon the disease would disappear and no evi- 
dence of it could be found for a year or two. The bacilli either lay dormant 
as nonactive spores, probably in the soil of the pastures, or else they lived 
an active life in some unknown host. 

Anthrax bacilli have been known to keep alive in hides which have 
been thrown about, beaten, shipped long distances over land and sea and 
subjected to all sorts of climatic influences. 

The authorities found no account of fur-borne anthrax in medical 
literature. How much is that point worth? Anthrax in the human sub- 
ject is a rare disease. The number of cases on record is small. When a 
case was recorded in the health department recently the newspapers said it 
was the first case on record in Chicago. While this statement was in- 
correct it indicates that the disease is very rare. Few physicians know 
anthrax. If the average physician were to see a case the probability is that 
he would fail to diagnose it. 



290 CONTAGIOUS DISEASES 

Anthrax carbuncle looks like ordinary carbuncle. A suspicions carbuncle 
in a tanner or wool sorter might cause a bacteriologic examination for an- 
thrax. A carbuncle in a person who wore furs would not occasion suspicion. 
All in all, the fact that there are no cases of anthrax in fur workers on 
record does not prove that there were no cases. 

Considering these several points, the negative finding of the authorities 
does not convince us that fur might not have been the means of infection. 
But there is no reason for women to discontinue wearing furs. Even if this 
case was so infected the fact is that the danger is so slight as to be 
negligible. 

PLAGUE 

"THE PRESENT PANDEMIC OF PLAGUE" 

Such is the title of a report written by Dr. J. M. Eager in 1908 and 
issued by the Public Health and Marine Hospital Service at a time when the 
disease threatened to spread from California to the remainder of the United 
States. 

There are two perennial foci of plague — places where the plague seed 
stays and from which, from time to time, epidemics travel out over the world. 
One of these is in western Asia. This is the more violent strain, but it has 
less tendency to break out over the world than its kinsman. It is from the 
other strain — that whose home is Yunan, China — that the present epidemic 
began to spread in lS9Jf. 

In 1894 plague got out of its home ground and traveled from Canton 
to Hongkong. By 1896 it had reached Bombay and there it found two 
conditions making for its growth and spread. The caste and religious preju- 
dices of the people prevented proper sanitary measures of control and thus 
the plague got a good foothold. The steamship connections at Bombay then 
opened up new possibilities for spreading it over the world. 

Eager says that by 1900 plague was present in every quarter of the 
world — Europe, Asia, Africa, Oceania, North and South America — a pan- 
demic, or, in other words, a world wide epidemic. Since that time it has 
been beaten back in this place and that while hither and yonder it has pushed 
forward. 

The more civilized countries into which it has been imported have driven 
it out only to find that in some careless land it has been gaining headway, 
and is ever ready to push back into the forbidden country. 

For instance, it reached California in 1900 and flourished for three 
years; then it became invisible and so stayed for four years; then it flared 
up for two years, spread up and down the coast from Los Angeles to Seattle, 
then vanished and seemed willing to give the San Francisco exposition a fair 
chance. It quit the attack on the Pacific seaboard and swung around into the 
Gulf of Mexico and having got a foothold in Cuba and Porto Eico it has 
again threatened us this time from the East. 

While it seems to yearn for a chance to get at white people it does not 
make any headway when it gets among them, and is rather easily dislodged. 
It is most destructive among the yellow people, the Chinese, and brown 



PLAGUE 291 

people, the East Indians. In the last sixteen years 7,500,000 East Indians 
have lost their lives from it. In one province 1 per cent of the total popula- 
tion died from it in ten years. In Canton between March and August, 1894, 
it killed 120,000 people. 

Its history on the California coast is most interesting. In January, 
1900, plague was discovered in San Francisco by Surgeon J. J. Kinyoun of 
the Public Health and Marine Hospital Service. The existence of the disease 
was denied by certain business interests. Pressure was brought to bear on 
the governor who, in turn, proclaimed that there was no plague in San 
Francisco. 

The national authorities stood their ground. As the plague was wholly 
among the Chinese and this race habitually herds to itself the bureau's 
orders governing interstate quarantine and supervision were made to apply 
only to Chinese. 

There seemed to be no use in supervising the coming and going of white 
people as none of them had been found sick with the disease. The chance to 
draw an easy line between the safe and the unsafe appealed to the common 
sense of the men in the service. 

However, somebody saw a chance to take advantage of a technicality and 
the Chinese Six Companies were persuaded to ask for an injunction from 
Judge Morrow. 

The judge heard no testimony as to whether plague was present or not. 
He granted the injunction on two grounds : First, the regulations discrimi- 
nated against the Chinese; second, there was no plague in San Francisco. 

Twenty-eight Chinese died of plague in San Francisco in 1900. 

By June the powerful politico-business combination had reached the 
national government, and the Public Health and Marine Hospital Service 
was ordered to stop its activities. Officially there was no plague. 

The people of the United States, however, and particularly of Idaho. 
Washington, Oregon, Nevada, and southern California, would not be fooled. 
They refused to trade with San Francisco. They did not care to buy carpets 
there and have plague thrown in for good measure — what they call lag- 
niappe in New Orleans. 

By 1901 the politico-business combination had begun to yell like a 
whipped cur. In that year twenty-five Chinese died of plague in San 
Francisco. In January, 1901, Secretary Gage of the treasury appointed 
a commission to investigate the plague in San Francisco. The three com- 
missioners were from the universities of Pennsylvania, Michigan, and 
Chicago. The railroads and the Chinese Six Companies, forgetting the in- 
junction granted them by Judge Morrow, cooperated with the commission. 

The commission carefully investigated six dead Chinamen and found 
plague beyond question. Among other conclusions was one that Wing Chut 
King had died at 1001 Dupont Street on March 6, 1900, of plague and, 
inferentially, the learned judge was wrong. Dupont Street at this number 
is on what is called the Barbary coast. 

Is it any wonder that a political revolution came about in California, 
that the politico-business combination was thrown in the discard, that the re- 
call was passed, that women were given the ballot and that the people de- 
manded the recall of decisions? 



292 CONTAGIOUS DISEASES 

The California legislature in 1900 appropriated and the state board of 
health spent unavailingly $50,000 in trying to control plague. In 1902 
there were 41 fatal cases in San Francisco's Chinatown. In February, 1903, 
the national, state, and municipal governments began a joint campaign against 
plague in Chinatown. For eighteen months they spent monthly sums as 
follows : United States, $1,600 ; state, $1,500 ; city, $2,500. There is no way 
of knowing what was spent by property owners. 

By July, 1904, the disease was cleared out of Chinatown. There were 
17 deaths in 1903 and 8 in 1904. For three years there was no case of human 
plague but it is quite certain that the disease was kept alive among rats. In 
June, 1907, a sailor on a harbor tug plying San Francisco bay was found to 
have plague. 

It has been suggested that the earthquake and fire in 1906 had driven 
infected rats into closer association with men and thus the disease was 
brought back to the human family. In 1907 and 1908 there were 159 cases 
and 77 deaths, all among white people. The Chinaman had learned his 
lesson. Chinatown had been rebuilt. 

Since 1900 United States supervision and cooperation have been wel- 
comed. Between 1907 and 1911 the national government spent $900,000 in 
plague work in California, and the state and municipal governments an aggre- 
gate of many hundreds of thousands in addition. 

Surgeon General Blue writes me that in the four years, 1907 to 1911, the 
people spent $2,000,000 in rat-proofing. All these millions to do what a 
few thousand dollars would have done had the people stood behind Kinyoun 
in 1900. 

Let me wander enough to emphasize the following: Because he did 
his duty and tried to protect them, the business-political combination in 
California drove Kinyoun, a brave, heroic public servant, not only out of 
California but out of the Public Health and Marine Hospital Service. When 
Carnegie medals for heroism are being distributed, one should go to Joe 
Kinyoun. It should go to him on the motion of Lyman J. Gage, because 
he knows where the pressure came from, and be seconded by ex-Governor Gage 
of California, who exerted a part of it. 

For several years neither infected people nor infected rats have been 
found in San Francisco or on its peninsula. But in August, 1903, a black- 
smith from across the bay spent a day shooting ground squirrels near his 
home. Two weeks later he had the plague. 

During the next five years case after case developed amongst people who 
had been shooting ground squirrels; so that although no plague now exists 
on the Pacific slope among the people or the rats it is more than possible 
that here and there it is being kept alive by the small animals of the fields. 

It is recognized now that plague is a disease of rats as well as of human 
beings. Therefore, when a people is threatened with plague it must take 
thought of its rats. Sick rats are harder to watch than sick people. There- 
fore, when plague threatens rats are nearly as important as people. 

However, rats are never unimportant. They are enormously destructive. 
They cost enough to make them burdensome without regard to the danger 
from them. They spread some disease other than plague. They are nasty 
as well as destructive. They haul garbage and meat into out of the way 



PLAGUE 293 

places there to rot, offend, and become a source of nuisance. There is no 
redeeming word to be said for a rat. Human affections have been bestowed. 
and often wasted, on everything from trained fleas to elephants, but who ever 
loved a rat? 

The common rat of this country is the brown rat, the roof rat not being 
of much consequence. These, our usual rats, can harbor plague but if the 
disease comes to us, it will probably be brought into the country by the black 
rat — the usual ship and harbor rat. 

The black rat, as compared with the brown rat, is smaller, more lithe, and 
more active, It has longer legs, longer ears, a longer, more pointed nose, 
and is darker in color. 

A female rat has about ten to a litter and bears four litters a year. 
No rat census of the United States, or any part thereof, has ever been taken, 
but we can get some idea of their abundance from a report that on a 2,000 
acre estate in England they caught 37,000 rats and Lantz says: "Even 
then the property was by no means free from rats." 

Once, in time of famine in India, when food counted, rewards were 
offered for rats, and 12,000,000 were brought in. The rat population of 
any city is probably greater than the human population. 

Lantz, in an interesting bulletin, "The Eat in Its Eelation to the 
Public Health" (Public Health and Marine Hospital Service, 1910), tells 
of some interesting rat migrations. 

In 1903 there was a rat migration in Eock Island and Mercer counties, 
Illinois. The Moline Evening Mail said that F. W. Montgomery of Pre- 
emption killed 3,435 rats on his farm between March 20 and April 20, 1894. 
In 1877 there was a similar migration in Saline and Lafayette counties in 
Missouri and in 1904, another in the Kansas Eiver Valley. 

Eats do not migrate unless there is a reason and not infrequently the 
reason is the existence among them of an epidemic disease. Therefore, 
whenever rats are to be seen in the daytime, whenever they get out on the 
street or on the road, whenever they appear in large numbers or in unwonted 
places, whenever dead rats are found in unusual abundance, whenever the 
newspapers or the neighbors note a plague of rats, it is wise to take notice 
and to inaugurate an investigation. 

California has proved that the ostrich policy does not pay. A rat migra- 
tion may have health significance. 

Lantz says: "The ferocity of rats has been grossly exaggerated. The 
stories of their attacks upon human beings, sleeping infants especially, have 
but slight foundation. Ordinarily, the probability of being bitten by rats is 
remote, and the bite is not poisonous," which is true. 

I have been in the stockyards and around slaughtering houses after 
.midnight and have seen hordes of enormous rats, but I have never seen 
them disposed to fight. I have known children to be bitten by sick rats, not 
plague-infected rats, but rats otherwise sick. I think when a rat viciously at- 
tacks a man there is a fairly good chance that the rat is sick, at least it is 
suggestive enough to demand investigation. Viciousness in rats may have 
an epidemiological significance. 

In an epidemic of plague in people it is the rule that rats, dead or sick 
of the plague, are frequently found. Sometimes the finding of a plague- 



294 



CONTAGIOUS DISEASES 



stricken rat is the means of establishing a diagnosis of the disease in the 
human subject since often those who have it cover it up and sometimes the 
attending physician does not recognize this, to him, strange condition of 
his patient. 

Sometimes a first case having been found in a human being and a crusade 
against rats having been started, the disease has been found widely spread 
among rats. Eats seldom bite people or any article that any person is sub- 
sequently to eat. The chances of sick people directly infecting rats is slight. 
All of which suggests that there is needed some agent to bridge over the 
space between rats and people. 




CLDSED 




□PEN 



Fig. 130. — Rat Guard for a Ship's Cables. 



The flea is the agent that binds them together. Bat fleas carry the bacillus 
of plague back and forth between rats and men by sucking the bacteria into 
their stomachs along with the blood. The India Plague Commission found 
that plague bacilli remained alive in fleas for fifteen days. 



DISEASES OF RATS 



As Rucker says: "Plague is primarily a disease of rodents and, sec- 
ondarily and accidentally, a disease of man." He puts it in doggerel as 
follows : 



PLAGUE 295 

"First plague in rats, and then in fleas, 
Then plague in man and quick disease. 
No rats, no fleas, no plague disease/' 

Our present day interest in rats is because plague is epidemic in Porto 
Eico and Cuba, and from those footholds is menacing us. 

Through the Panama Canal the pest holes on the north part of the 
west coast and some of the north coast of South America are within menacing 
distance of our gulf and Atlantic ports, and plague can jump as far as a 
freight car or ship can haul a rat in two weeks. 

But we must not lose sight of the fact that rats have other diseases some 
of which human beings also have. 

Probably the first nation to take an interest in rats was Denmark and 
the larger part of their interest was due to the rat as a spreader of trichina. 
Trichinosis is abundant among rats. Stiles says: "Trichinosis will probably 
never be eradicated from man until rats and mice are practically eradicated, 
and any public health campaign against trichinosis must take the rat into 
serious consideration." 

Eats have eleven kinds of internal parasites which also infect men. 
Among these are tapeworms. The dwarf tapeworm of man is similar to a 
dwarf tapeworm found in rats. 

They also have fleas, lice, and mites. The flea carries the plague from 
rats to men and from men to rats. Plague bacilli have also been found 
in rat lice. 

Eats have pneumonia, Bright's disease, drunkard's liver, stone in the 
bladder and many other diseases that man arrogates to himself. 

They have many different kinds of tumors, including every sort of 
cancer. In fact, the most promising experimental work now being done look- 
ing toward a cure for cancer is that on cancer in rats and mice. Cancer 
in rats and mice sometimes runs in epidemics. With it they can be inoculated ; 
they can be cured; the sera from cured cases will cure the disease in other 
animals. And now experimenters are trying to find a way to apply this 
information, and possibly even these sera, to the cure of cancer in the 
human subject. 

Eats have leprosy, and it is hoped studies of rat leprosy may help in 
working out better cures for human leprosy. 

Eats also have a rather queer disease known as rat-bite disease. Most 
of the reported cases of this disease have come from Japan. Most of the 
cases reported from this country have come from the Mississippi Valley. 
Stiles suggests that rats may be a factor in the spread of sleeping sick- 
ness — a disease due to a wavy blood parasite known as trypanosoma. These 
cases were observed before a certain kind of blood parasite had been dis- 
covered. Probably a parasite of this type is responsible for rat-bite disease. 

PLAGUE AND THE CANAL 

Eecently Dr. Howard King of the Tulane University School of Trop- 
ical Medicine, taking as his text an old Spanish proverb, "He is in safe 
quarters who sounds the alarm," told the people of New Orleans and the 



296 



CONTAGIOUS DISEASES 




Fig. 131.— The Human Flea. 



Mississippi Valley generally of some of the disadvantages of the Panama 
Canal. 

Within a few years traffic will be pouring through the canal — many 
of the ships manned by celestials. Much of the traffic will come into 
New Orleans. The most efficient health organization in the world — that of 
the Canal Zone — will have been dissipated. Places now weeks removed 
from the United States will be close at hand, right on the arteries of com- 
merce. 

This axiom is everywhere accepted — "Disease follows trade." Certain 
diseases are best carried by passengers, others by freight; some by railroads, 
others by steamships. 

Sailors are proverbially indifferent to rats. Some are superstitious 

about sailing on a rat- free ship. 
Therefore, plague is frequently 
a ship-borne disease. 

Dr. King's alarm is based 
upon the fact that the canal is 
going to put us in close touch 
with some careless people. In 
neither Colombia, Ecuador, 
Peru, nor Chile does there 
exist a properly constituted 
board of health. There is no 
trustworthy recording of deaths. 
The authorities have neither the power nor the knowledge to prevent the 
spread of disease among themselves or those who trade with them. The people 
are both ignorant and indifferent. For example, he says, in Guayaquil the 
inhabitants are inclined to rejoice in yellow fever because it scares foreigners 
away. 

President Castro of Venezuela once declared La Guayra a healthy port 
open to commerce while plague was raging citywide. The order was an- 
nulled because of the trouble the German minister made about it. La Guayra 
and Guayaquil are within three days' sail of the canal — and plague is not easily 
recognized nor easily controlled. Let us not forget that a man died a 
while ago in the government hospital in Colon from unrecognized plague. If 
that medical corps fell down anybody will and you and I should base our 
positions on things as they are. 

Dr. King made two specific recommendations — that the United States 
Public Health and Marine Hospital Service organize the health forces of the 
west and northwest coasts of South America and that New Orleans be cleaned 
up. 

The newspapers recently contained telegrams saying Ecuador had asked 
Gorgas to clean up Guayaquil. 

From a New Orleans newspaper recently I learn that Dr. Dowling is 
winning his fight in New Orleans — the French market is to be screened and 
made more sanitary. 

The leaven is working. 

The changed conditions in California will make San Francisco the 
safest place, as regards plagues, in the United States. 



PLAGUE 



297 



SPREAD OF PLAGUE 



It is rather easy to watch and to isolate plague-afflicted people, but 
plague in rats is a difficult proposition. Therefore plague is a jumping 
disease. It jumps from town to town, over others to another. 

A small boy playing near the Southern Pacific freight yards in Los 
Angeles was bitten by a ground squirrel. He became sick, had buboes, was 
feverish. His physician called for several days but was still puzzled over a 
diagnosis, when he asked Dr. Powers to help. Dr. Powers, who had seen 
plague, inquired if the boy had been around rats. No, but he had caught 
a sick squirrel. Presto ! the boy had 
plague. Los Angeles was infected. 
A freight car had brought an in- 
fected rodent from San Francisco — 
a long jump, but one easily under- 
stood in the light of the yard full 
of empty grain cars near by. 

The moral is — to prevent plague 
from getting a foothold in a com- 
munity two things are necessary: 
rats must be watched, and the 
people, especially the doctors, must 
know the disease when they see it. 

The three kinds of plague are 
bubonic, septicemic, and pneu- 
monic. In the bubonic type the 
lymph glands, and particularly 
those in the groin, filter the bac- 
teria out of the lymph, keeping most of them from getting into the blood. 

In the septicemic form the bacteria get right into the blood stream 
and the groin glands, not being choked with them, do not swell up; in 
other words, do not make buboes. 

In the pneumonic form the bacteria are carried into the lungs by the 
air and cause pneumonia. 

In a given epidemic the type of the disease is either pneumonic or 
bubonic, the septicemic cases being modifications of the bubonic type. 

The bubonic form starts with a chill, followed by a fever, which 
may go as high as 108°. About this time the glands begin to swell. Generally 
the swelling is limited to one group of glands. This group is the one which 
serves as a filter for that part of the body through which the infection entered. 
There is nausea, vomiting, aching, and profound prostration. Later there is 
stupor, delirium, and unconsciousness. The glands may break down, may 
suppurate. There may be hemorrhage from the nose or from any mucous 
membrane. There may be small hemorrhages under the skin. 

Any physician who reads this description will recall cases of infection — 
so called blood poisoning — in which there was just this train of symptoms. If 
the pared corn or the needle prick had been overlooked the case might have 
easily been called plague. 




Fig. 132.— Dog Flea. 



298 CONTAGIOUS DISEASES 

It takes a good deal of mental alertness and usually a bacterial examina- 
tion to decide whether a bubonic fever is due to pus germs or plague bacillus. 
There are cases of blood poisoning where the cocci get past the glands and into 
the blood stream. If in these cases the cut toe or finger is overlooked alert- 
ness and judgment are required to decide whether the germ in the blood 
is a streptococcus or a plague bacterium. 

The first requirement of plague prevention is that physicians be able to 
know the disease when they see it. 

THE COST OF RATS 

Lantz of the national agricultural department wrote one of the articles 
in the government bulletin on "Rats." His article is on "The Eat as an 
Economic Factor," and he ends it with the statement, "The keeping of rats 
is exceedingly expensive." 

Did you ever think of yourself as a ratkeeper ? 

Lantz estimates that it costs $1 a year to keep a rat in a city. A farmer 
can keep one for about 60 cents. The farmers within 500 miles of Chicago 
keep about one rat to each acre. These figures give the cost for plain feed- 
ing. Fancy-fed rats are more expensive. A silk-eating, or a picture-chewing, 
or a shoe-cutting rat costs more to maintain. 

An Iowa farmer wrote the Missouri Valley Farmer that the rats in his 
three bins destroyed more than enough corn to pay taxes on 400 acres of land. 

Lantz quotes a newspaper correspondent as writing: "Eats destroyed 
enough grain and poultry on this place this season to pay our taxes for three 
years." 

A Washington commission merchant stored one hundred dozen eggs in 
a tub. When he went for them he found the rats had gnawed through 
the bottom and made a clean getaway with over seventy-one dozen. 

Lantz thinks rats are worse chicken catchers than skunks or minks. 

To the cost of feeding the rats are added fire loss, damage to property 
from gnawing and breaking and the indirect loss due to the expense of rat 
catchers and rat-proofing. 

The total cost per inhabitant for city people is $1.27 per year per rat. 
In other ivords, Chicago's rat bill is something over $3,000,000 a year; that 
of the United States, $35,000,000. 

In rat killing the author places traps first, poisons second, dogs third, 
skunks fourth and cats a bad fifth. An alley cat in a city is worth while, 
but a kitchen fed cat is useless. While rat-catching dogs, rat traps, rat poisons, 
covered garbage cans, and other anti-rat procedures help a little, no plan of 
rat eradication makes much headway except rat-proofing or a part of it. Eat- 
proofing means cement construction. A man who will rat-proof his buildings 
and then keep a few rat dogs around will not be greatly annoyed by rats. Any 
man in a city can keep the rat population off his premises in this way. 

But eradicating rats from a city is a different matter. In San Francisco 
the United States has spent several hundred thousand dollars for rat 
catching since 1907 and the citizens have spent more than $2,000,000 in rat- 
proofing. A good day's rat catch is not a fifth of the 1907 figures; still 
San Francisco is not rat-proof nor rat-free. 



LEPROSY 299 

Dr. Heiser says Manila, in 1900 to 1905, paid $15,000 in rat bounties and 
$325,000 in other rat-catching expense without decreasing the number of rats. 

The way they succeeded in getting rid of bubonic plague was to catch 
a few rats in each part of town, examine them for bubonic plague — a rat- 
sampling process, if you please — and then draw circles around the places 
where plague-infected rats were found. They then began rat extermination 
and rat-proofing at the periphery and worked toward the middle. 

Symptoms of Bubonic Plague. — G. V. H. writes: "Kindly tell me the 
symptoms of bubonic plague." 

Reply. — The symptoms of bubonic plague usually follow one or two 
types, the bubonic or the septicemic. In the first, the attack starts with 
a chill and the fever rapidly rises to somewhere between 104° and 108°. 
Prostration is extreme — the lymph glands swell, usually beginning with a 
swelling of the groin glands. Sometimes the buboes form abscesses ; usually 
they do not. In the septicemic form there are chills, fever, prostration, 
unconsciousness, but no glandular enlargement. The most violent of all 
the forms is the pneumonic, where the disease manifests itself as a rapidly 
fatal pneumonia. This was the variety they had in Manchuria two years 
ago. It is, however, not often found in the strain that is threatening us 
now through Cuba and Porto Rico. That strain usually furnishes the 
bubonic type and often the septicemic, but not the pneumonic. 



LEPROSY 

DANGER OF LEPROSY 

Dr. E. L. McEwen analyzed the references to leprosy in the Bible and 
profane literature on the subject of leprosy in biblical times. The con- 
clusion to which he came was that the term leprosy in biblical times stood for 
many different skin diseases. Some of them were highly contagious. It may 
have been that leprosy proper in that day was extremely catching and also 
deadfy, but Dr. McEwen could not find evidence of it. 

However, if leprosy was highly contagious two thousand years ago it is not 
so now. Dr. McCoy, director of the leprosy investigation station in Hawaii, 
got the history of everybody connected with the leper colony or who had been 
connected with it for many years back. 

The Hawaiian law permits well people to accompany lepers when they go 
to the colony and to remain with them as long as they wish and then return 
to society, provided a careful examination shows no leprosy. 

Several hundred people whose histories were carefully investigated lived 
in the colony for months and some of them for years and then went back to 
society. Some are living with lepers as husband or wife; others live in the 
same rooms with lepers; others eat at the table with them. The contact is 
of the closest character and this intimate contact is kept up for years. 

The results? One person in twenty-five developed the disease. Then 
the chance that a person living in a leper colony will escape infection is about 
twenty-four to one. 



300 CONTAGIOUS DISEASES 

There are a moderate number of lepers in the United States. I pre- 
sume there are one or two in Chicago always. 

There is practically no danger that the people who incidentally meet 
lepers on the street, in the stores, in restaurants, or on the cars will contract 
the disease. 

There is about one chance in twenty-five for the people living in the same 
house with a leper to contract the disease. 

This degree of danger is great enough to make it advisable to care for 
lepers in leper colonies, but it is not great enough to warrant the average man 
on the street to have any fear of lepers or leprosy confined or at large. 

Leprosy is a disappearing disease. That which has made it a disappearing 
disease is the policy of caring for lepers in colonies. 

Causes of Leprosy. — J. F. B. R. asks: "1. Can you tell me if there is 
any way to prevent leprosy? 

"2. Has the germ that causes leprosy been discovered? 

"3. Is there any way, as, for instance, by the injection of a serum into 
the human body, to make it immune from leprosy? I have been thinking 
that as there is an antitoxin for diphtheria there might possibly be some 
preventive for leprosy. 

'%. Can you tell me, is there now being made, or has there ever been a 
systematic study made, of leprosy? 

"5. What has been done, and what is now being done to fight it?" 

Reply. — 1. Yes, by keeping away from those having the disease. The 
disease is very mild. It is not easily transmitted. It is not contagious. 
There is very little danger of contracting it except by prolonged contact 
with a leper. 

2. Yes. 

3. No. 

4. The disease is being thoroughly studied in Europe, in the Philip- 
pines, in Havana, and in a few places in this country. The investigators 
are about convinced that they have worked out a solution. It is too early 
to talk much about it. 

5. Several states have isolated their cases of leprosy. A few cities 
have done likewise. The national government is in control of several 
colonies. It is the general belief that the disease is losing ground. 

HYDROPHOBIA 

DOG DAYS 

Summer is the season of the year when the mosquitoes are trying, 
the flies are annoying, the snakes are most menacing, and our fear of dogs is 
the greatest. The season is known as "dog days," and the reason for the 
name is that for some strange reason dogs are supposed to be in especial 
danger of going mad. If mad dogs were found to be especially abundant in 
July and August it would be a good reason to call March and April the dog 
days, since about that much time is needed for hydrophobia to develop. 

But there are no dog days. The sun, the summer solstice, the July 
moon, the torrid heat, the high humidity — none of these has anything 
to do with hydrophobia. January is just as much dog days as July, 



HYDROPHOBIA 301 

Hydrophobia is a disease of dogs. It can be spread to men, cats, skunks, 
cows, mules — in fact, almost all animals. But it is not of importance except 
in two of them — men and dogs. A campaign against hydrophobia need not 
take in anything except man and dogs; men because their protection is our 
problem and dogs because they create the hydrophobia problem. 

The disease is due to an infection. The infection locates in the brain. 
The infecting virus is excreted by the saliva. The virus travels slowly from 
the bite up the nerves to the brain. The journey takes time, more than is 
required for any other germ. It may take three weeks, it may take three 
months, and it may take several times three months. 

We have no laboratory test for hydrophobia that can be applied in a 
living animal, be it man or dog. The veterinarian or the doctor can watch the 
symptom and conclude usually whether the disease is hydrophobia or not 
but he cannot get any help from the laboratory until after the sick one has 
died. The laboratory worker can then take the brain and if he finds negri 
bodies in it can say positively that hydrophobia was present. 

This is not so important as it seems on first blush. It is nearly always 
possible to tell from the symptoms. It is easy so to keep a dog and very easy 
so to keep a man that he is not dangerous to the attendants and if the head 
is sent to the laboratory in every case they will clear up the few doubtful cases 
in ample time to protect all of those who were bitten. From the standpoint 
of treatment it makes no difference. There is no treatment for hydrophobia 
after the disease has developed. After the symptoms have started and the 
disease is clearly developed, there is nothing to do with an affected man 
except to take him to a hospital and then have him cared for — have his symp- 
toms treated as they arise. In that event the disease is not being treated. 
The treatment is of the symptoms. 

HYDROPHOBIA PREVENTION 

The Conference of State Health Officers has adopted the following as a 
standard plan to prevent hydrophobia : 

1. Destruction of ownerless dogs. Dr. Stimson of the Public Health 
Service thinks this the most effectual single measure. By an ownerless dog is 
meant a dog without a collar and license tag for the current year. This 
necessitates a dog-catching department and a pound. Dogs should not be sold 
from the pound. 

2. A license fee for dogs. In cities the tag should be attached by the 
license officer who files a report describing the dog and its appearance as 
to health. The license system (a) makes it easy to locate ownerless and 
straying dogs, (b) reduces the number of dogs kept, and restricts the owner- 
ship of dogs to those who will give them care. Unspayed females should be 
licensed at a higher rate than other dogs. 

3. Legal responsibility. Owners should be made legally responsible for 
damage done by their dogs. 

4. Public education. The care of dogs as well as the harm done people 
by infected dogs should be taught. 

5. Muzzling. All dogs should be muzzled for six months after each 
case of hydrophobia in a dog in the district under control. This means that 



302 CONTAGIOUS DISEASES 

in country townships in the Mississippi Valley the dogs need not be muzzled 
all the time. In cities, as six months practically never lapses between cases, 
the dogs must be muzzled all the time. In either case the season has nothing 
to do with the case. It is not the history of the weather but the history of 
the mad dogs around about that determines whether dogs are to be muzzled 
or not. 

6. Restraint of dogs. If there is much of the disease around the 
country dogs must be kept at home for at least three months after the time 
of great danger. 

7. Leading in leash. Not advised unless the dogs are also muzzled. 

8. Compulsory notification. Rabies in lower animals as well as in man 
should be reported. In the lower animals, in case the diagnosis is certain, the 
animal should be killed, the head sent to the proper laboratory and the case 
reported. If the case is suspicious the animal should be safely confined and 
developments awaited. Animals bitten by rabid animals should be reported. 
Those of little value should be destroyed. Those of greater value should be 
held under supervised quarantine for six months. No part of the carcass or 
hide of a "mad" animal should be used. Kennels and stalls should be disin- 
fected by the authorities. 

9. Imported dogs should be held in quarantine until the danger is past. 
A person bitten by a mad dog should have the wound cleaned, made to ooze 
and bleed and then cauterized. As soon as possible thereafter the Pasteur 
vaccine should be given. Mad stones are worse than useless. 

Hydrophobia and Milk. — H. E. V. writes: "Is there any danger in 
using the milk from a cow that has been bitten by a horse that had hydro- 
phobia? Today is the tenth day. How long before it would be safe to use 
her milk?" 

Reply. — No. If the cow should get sick, stop using the milk — not be- 
cause the milk will convey hydrophobia but because it is the milk of a 
sick cow. 

Dog Bites. — G. H. writes: "If a person is bitten by a family dog, 
treated by a physician who says the dog is not mad, ought the person to be 
treated by the Pasteur method? Ought the dog to be hilled? What are 
the kinds of treatment, where given, and by whom, and how long after a 
bite does rabies show in the person? Does the law require the person to be 
treated if all the evidence goes to show the dog is not mad? What shall 
be done with the dog?" 

Reply. — The dog should not be killed. He should be taken to a vet- 
erinarian for observation. If it turns out that the dog is not mad, nothing 
need be done. If the dog is dead the body should be taken to a laboratory 
for microscopic examination and biologic testing — that is, inoculation of a 
guinea pig. If these show the dog was not mad and the history of the 
sickness in the dog bears this out, nothing should be done. If the dog was 
mad, Pasteur treatment should be taken at once — the quicker the better. 
The disease usually develops within six weeks after the bite. Occa- 
sionally it is delayed. 



LOCKJAW 303 



LOCKJAW 



The physicians' name for lockjaw (tetanus) has the advantage of not 
putting too much emphasis on one symptom. As a matter of fact, tetanus 
runs a day or two before the jaws lock, and in time spasm of other muscles 
becomes much more prominent than spasm of the muscles of the jaw. 

A case of lockjaw starts in with difficulty in swallowing, profuse sweat- 
ing, and starting at noises, at bright lights, or when struck by the air from a 
fan. Perhaps before these symptoms came there was a period of head- 
ache and general sick feeling, not in any way different from an ordinary head- 
ache or the beginning of any one of a score of diseases. 

When the disease is fully developed all of the muscles of the body are 
rigid all of the time. The rigidity gets worse and better, alternatingly, but 
relaxation is never complete. Convulsions come on, last a few minutes, 
and pass away, but even when the period of quiet has come the pressure 
with the hand will show that certain muscles are hard and firm. 

The set contraction of the muscles around the mouth give to the face a 
grin that is characteristic. The muscles of the trunk bow the back. There 
is some fever. 

The tetanus bacillus lives in the intestines of animals, causing them 



Fig. 133. — Clinical Thermometer. 

no harm. It has been proved that certain horses are tetanus carriers, just 
as certain men are typhoid carriers. These horses pollute the soil with 
tetanus bacilli. The bacilli cannot increase in the presence of oxygen, 
which means that they cannot increase and secrete in any place which 
the air can reach. 

The wounds most liable to infection with lockjaw are the deep narrow 
wounds into which manure, or dirt, or powder has been carried. The ideal 
wound combination for lockjaw is a nail puncture which is made in a horse 
barn. 

The bacillus secretes a poison. Probably there are two drugs in this 
poison. The poison is absorbed by the nerves, not by the blood or lymph, 
as is the case with ordinary poisons. It is carried by the nerves to the brain 
and spinal cord. The symptoms are due to the action of the poison on the 
cells of the brain and, perhaps, the spinal cord. 

If tetanus starts within less than ten days of the wounding the outlook 
is bad. If it takes more than ten days for the poison to reach the nerve 
cells and affect them the outlook is good. 

The reports that come from the armies of Europe show that about 
one-half the cases of lockjaw are being cured. One authority reports that in a 
certain hospital six out of ten cases are being cured. . Anders tells us that 
eleven out of twelve of the slowly developing, mild cases get well. 

It is well to bear this in mind, because in lockjaw, cancer, consumption, 
and other dreaded diseases well meaning people jump to the conclusion that 



304 CONTAGIOUS DISEASES 

some remedy used in one case which recovered is therefore a newly discovered 
panacea capable of curing all cases. 

The treatment used in these hospitals is antitoxin into the tissues 
around the wound; oxygen, peroxid of hydrogen, and air into the wound; 
antitoxin into the vein; iodized serum and a solution of Epsom salts into 
the tissues; good nursing and the control of symptoms according to the 
judgment of the attending physician. 

The experiences of this war have taught us several things about wounds. 
They are : 

1. Dirty wounds must be so dressed that they can get air. 

2. Every man who has received a dirty wound should have a small 
dose of antitoxin ; twenty to fifty units are enough. 

3. Certain horses are tetanus carriers. Attention should be concen- 
trated on these carriers. 

4. Tetanus is fairly curable. But before this information will be 
very helpful it is necessary that the people know the warnings of the 
disease. 

TYPHOID FEVER 

Typhoid fever is a preventable disease. This means it can be prevented, 
not that it is being prevented. The armies have prevented it. The United 
States Army has had no typhoid for four years. The soldiers are vaccinated 
against it. 

Typhoid fever is due to the typhoid bacillus. The typhoid bacillus is 
closely allied to the colon bacillus, but there is this important difference be- 
tween them — the colon bacillus lives in the intestines of many species of ani- 
mals; the typhoid bacillus lives in the intestines of man only. Nor can it 
live in the human intestine indefinitely. It abounds there during an attack 
of typhoid fever. In some cases, during the attack of fever it gets into the 
gall-bladder and, having secured a hold, remains there almost indefinitely. 
Such an individual is known as a typhoid carrier. 

No animal except man is subject to typhoid fever. The excretions of no 
animal except man contain typhoid bacilli. Therefore no animal except man 
pollutes the water and soil with typhoid bacilli. 

Furthermore, typhoid bacilli do not live long outside the human body. 
Polluted water, polluted soil, or polluted milk will be free of typhoid bacilli 
after about one month. One of the great laws of nature is that forms of 
life which are capable of rapid multiplication are easily destroyed. 

Not all men are subject to typhoid fever. Some have the power to 
throw off the bacteria without contracting the disease. A small dose of 
typhoid bacilli will not cause typhoid fever. The laboratory men have 
worked out just the number of bacilli to an ounce of water required to cause 
infection with typhoid bacilli. It is easy to see that in man's combat with 
typhoid fever the bacillus is at a disadvantage. It should be easy for man 
to win. Then, is there wonder that typhoid is disappearing? 

Any man can avoid the disease. He can be vaccinated. That is certain 
to make him safe. He can take no raw water or raw food. He can refuse to 
eat with unwashed hands. If he does not care for water that has been heated 



TYPHOID FEVER 305 

he can refuse to drink any polluted water. If he does not care to boil his 
milk he can drink pasteurized milk. Properly inspected milk is fairly safe. 

A community can avoid the disease. It must have its typhoid citizens, 
carriers as well as sick, properly nursed and cared for. It must have- its 
water supply, milk supply, and food supply protected. It must abolish its fly 
nuisance. It must vaccinate. 

After the bacilli get into the intestines there follows a period of ten days, 
called the incubation period. What is happening during that time nobody 
knows. It is something of importance in the course of the disease. The 
sickness starts gradually and slowly at the end of the incubation period. There 
is a tired feeling and some aching. The bowels are usually constipated. After 
about a day of this the patient feels feverish, and if he takes his temperature 
he finds that he has an elevation of a degree or two — say 100.5. By the next 
day he is feeling generally more achy, with a higher fever. He sends for the 
doctor. The doctor takes a half-teaspoonful of blood from the patient's elbow. 
This is examined in the laboratory. Two days later it is found that typhoid 
bacilli are growing in the laboratory test tubes. If a blood culture was not 
made toward the end of the first week, the doctor will take a drop of blood 
from the finger or ear and send it to the laboratory for a Widal test. A blood 
culture will usually show the presence of typhoid fever within the first few 
days of the start. The Widal test will not show it before the end of the first 
week or ten days. 

A positive blood culture means that the patient has typhoid bacilli float- 
ing around in his blood. A positive Widal means that the patient has bacilli 
in him and that he is beginning to make substances and pass them into his 
blood, substances which knock out typhoid bacilli in several ways. In the 
meanwhile, the fever is getting higher and the symptoms more characteristic. 

It generally takes a week from the time that the fever starts for the diag- 
nosis to be fairly certain. Therefore, in figuring out the source of contagion 
you must figure back seventeen days — ten days for the incubation period and 
seven days for the diagnosis period. If the milk is being investigated two 
more days should be added — the time from the cow to the consumption by 
the consumer. 

During the second week the .fever is getting higher day by day. The 
patient is getting thinner and weaker. He is, however, more comfortable 
than during the first week. During the third week the fever remains at 
about the height reached during the second week. The patient is getting 
progressively weaker and thinner. 

If the patient was freely purged during several days at the beginning of 
his fever and his bowels have been well attended to since, there will be no 
diarrhea in the average case. If these things have not been properly attended 
to diarrhea usually gets troublesome in the third week. Early in the disease 
the lower end of the small intestine becomes swollen in patches. In the 
second week these patches break down and form ulcers. These ulcers vary in 
size from that of a pea to more than an inch in diameter. Sometimes these 
ulcers cause troublesome diarrhea in spite of everything which can be done. 
But when proper care is used the danger of this is slight. The ulcers some- 
times spread from the large intestines and thus increase greatly the chance of 
diarrhea developing. 



306 



CONTAGIOUS DISEASES 



During the fourth week the fever gets less day by day. By the end of 
the fourth week the temperature will be normal for several hours during the 
day. It is during this week that complications are most liable to occur. 
Complications hill more people than typhoid of itself. 

The complications usually met with are : 

Secondary infections, particularly pneumonia. 

Inflammation of veins, inflammation of glands. 

Perforations and secondary peritonitis. 

Hemorrhages. 



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Zowa Bulletin. 
Fig. 134. — Typhoid Fever Death-Rates in German Cities, Showing Decrease in the Last 
Three Decades, Due Largely to Improved Water Supplies. 

The old-fashioned typhoid with low muttering delirium, great exhaustion, 
dirty mouth, and flies crawling over the eyes we seldom see at the present 
time. When the case has been properly cared for by nursing and properly con- 
trolled by medical supervision this old-style typhoid state does not develop. 
This is a partial statement of the nature of a more typical run of typhoid at 
the present day. It is not so long drawn out nor so exhausting as the typhoid 
of twenty years ago. The number of cases which cleaning out of the bowels 
and other good care cut under four or five weeks is getting larger all of the 
time. 



TYPHOID FEVER 



307 



It is a disease in which the patient is influenced by good medical care 
and good nursing to an unusual degree. The patient sails a sea in which there 
are many covered rocks and good piloting is essential. During the first week 
it is easy to get the bacteria from the blood. After that it is increasingly 
























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Kansas State Board of Health. 

Fig. 135. The Fly as Carrier or Typhoid. Numbers indicate order of cases by date of 
onset. Cases •. Deaths ©. Wells °. 

difficult. During the first week a Widal reaction is not given. After that 
and for weeks after recovery the blood will give the Widal test. 

What is the meaning of these two facts? The bacteria run unhindered 
during the first week. By the end of that time the body has developed a 
pretty good power of hindering the bacilli. This power increases in strength 
until the body can destroy typhoid germs whenever they get into the blood. 
This is called immunity. The man is immune to typhoid. Soon after the 
disease began the sick man started throwing off typhoid bacilli. This is done 
principally by the kidneys and liver. The excretions from the bowels and 



308 CONTAGIOUS DISEASES 

kidneys contain live, active, virulent typhoid germs. It is in this way that the 
disease is spread. 

When the man has got well from the disease he still excretes typhoid 
bacilli from his kidneys and bowels. Sometimes this keeps up for months. 
Occasionally it persists for years, and semi-occasionally for a lifetime. People 
who continue to excrete typhoid are called typhoid carriers. The reason is 
this: 

A mother colony of bacilli will locate in the gall-bladder or in the urinary 
passages. The young are thrown out each day just as a hive of bees sends 
out swarms periodically. 

The bacilli in the gall-bladder do not infect the man, because he is im- 
mune. But should they pass out and eventually get on the raw food eaten 
by a susceptible man they are fully capable of infecting him. 

Then what is a man to do if he has the disease? 

Get the best medical and nursing service possible and obey orders abso- 
lutely. Equanimity is necessary when one has typhoid fever — no worrying, 
no fretting — just quietly accepting and trusting. Therefore, take aboard 
pilots at once and let them walk the deck. 

// proper freedom from worry, proper security for the family, and 
proper 7iursing cannot be had at home, then go to the hospital by all means. 

What is the man to do who has not had the disease? 

In ordinary times be careful of the water. Drink no suspicious water 
which you do not know to be right. 

Of the milk — drink no raw milk unless you are positive that its source 
is safe. 

Of raw fruits and vegetables — if they can be peeled, peel them yourself. 
If you are not certain of the raw vegetables eat cooked vegetables. 

Of raw oysters and clams — unless you are certain of them, have them 
cooked. 

Of flies — do not eat food in places where flies abound. 

Of hands — see that your own hands are washed before eating. Insist 
that all who handle your food shall have clean hands. 

Of cooks — at least in your own house see that no cook is employed who 
has recently (within six months) had typhoid or who has been in places where 
there was typhoid. 

Following these directions, no man under ordinary circumstances should 
have typhoid fever.' 

The United States soldiers sent to the Mexican frontier in the spring of 
1911 were vaccinated against typhoid. Those soldiers have been returned to 
their posts and Colonel J. E. Kean has reported to the surgeon general the 
lessons taught by that campaign. He compares the 12,000 troops stationed at 
San Antonio with 10,000 stationed at Jacksonville, Florida, during the Cuban 
War in 1898. In the Jacksonville troops there were 2,693 cases of typhoid 
fever, with 248 deaths. In the San Antonio troops there was one case of 
typhoid and no deaths. That some of this improvement was due to better 
general sanitation and better medical attendance is shown by the decrease in 
the number of deaths due to other causes from thirty-three at Jacksonville to 
eleven at San Antonio. 

The decrease in typhoid was out of all proportion to the decrease in other 



t10WTOGO"fTPflOID 




OPEN PRIVIES SPREAD TYPHOB) 




PLIES CAREY TYPHOID 




OPETf WELLS ARE: CAmEROUS 




DIRTY MILK CARRIES DISEASE 



Eft 




ABOUT one: person out op three 

C0MTRACT3 TYPHOID 



TYPHOID FEVER 



HOW TO GET IT AND HOW TO PREVENT IT 

More than one person out of three in North Carolina has 
had typhoid. If you haven't had it yet you are fortunate. 

ABOLISH OPEN -BACK PRIVIES 

Old open-back privies spread much typhoid. AD privies 
should be fly-tight. In general, they should be placed over 
pits or holes in the ground about three feet square by four 
or five feet deep. In two or three years, if the pit becomes 
filled, dig a new one nearby and cover up the old one.' 

FLIES SPREAD TYPHOID 

Flies carry typhoid and other diseases on their feet and 
bodies, and, worst of all, in their own excreta. Screen them 
out and aboVfh their breeding places. 

USE PUMPS INSTEAD OF OPEN WELLS 

Open wells are much more likely to be polluted than 
closed wells. Cover your well tight and use a pump. 



BEWARE OF DIRTY MILK 



Dirty milk is i 
germs. Never di 



breeding place for typhoid and other 
nk milk unless you know it is dean. 



DIRTY HANDS SPREAD DISEASE 



Much typhoid is caused by handling food with unwashed 
hands after attending the sick, especially in the case oj 
typhoid. Be clean. 

FREE ANTI-TYPHOID TREATMENT 

Why take further chances with typhoid? The anti- 
typhoid treatment win protect you absolutely. It is safe, 
practically painless and furnished free by the State. It is 
administered by a health officer or physician in three doses 
as shown below. Health officers administer it free. If 
your county has no health officer ask your family physician 
to secure it for you and have 1 



STATE BOARD OF HEALTH 

RALEIGH. N. C 

null PUT THM PIACAKD I 



OW TO PRtVtMT TYPTIOID 




CLOSED PRIVIES PPEVE/YT TYPHOID 




SCREEN THE rUES OUT 




CLQ5ED WELLS 4RESAEEE 




CLEAM MILK 15 HEALTHFUL 






DKIT HANDS SPREAD TYPHOID 



FREE ANTI-TYPHOID TREATMENT 



CLfA!iUME55 PPEVEAi75 TYPHOID 



Fig. 136. 
309 



Chicago Health Department, 



310 CONTAGIOUS DISEASES 

causes. As the result of this experience the surgeon general has ordered that 
all soldiers shall be periodically vaccinated against typhoid fever. 

In certain localities in this country it is becoming the custom for men 
going off for vacations to have themselves vaccinated. 

People who live in other localities had better pursue the same 
policy if their community has a high typhoid rate or if they are going to 
travel in a country having a high rate or be in hotels or other stopping places 
where they are not certain of the care of the food. 

Travelers in central Europe, including England, are safer than when at 
home. Travelers in Asia and Africa, Central and South America, and the 
islands generally had better be vaccinated before leaving. 

WALKING TYPHOID 

There are people who take life seriously. There are others to whom 
everything is a joke. There are people who take disease seriously. There are 
others who have their diseases in milder form. One man may have one 
disease seriously and another one mildly, while his neighbor may reverse the 
degree of response to the invading cause. People differ in their way of doing 
things and disease is no exception to the above general rule. 

While the typhoid bacillus in two people may be the same in virulence, 
just as poisonous, just as active in growth, just as prompt in getting into 
the blood stream, the disease in the two individuals may be widely different. 
It is the man who makes his disease. 

The virulence of the bacilli of typhoid is not to be judged by the virulence 
of the disease. It is just as dangerous to have a case of walking typhoid 
around the milkhouse as it would be if he were violently ill, even more so, 
for in that event he would be in bed away from the milkhouse, and there is 
a pretty good chance that the nurse would wash her hands before leaving the 
presence of the sick man. 

Perhaps the reader wonders how anyone is to tell when typhoid is typhoid 
if every man makes his own typhoid. Just there is where diagnostic skill 
comes in. Ability in guessing the typical and early cases rightly makes the 
difference between good and poor medical service. 

But fortunately, in recent years, some tests have been discovered that 
help out. Such are the blood tests for typhoid fever, and especially the 
Widal tests and the bacteriologic blood examination. Every state and most 
cities now have laboratories where these tests are made free of charge. A 
drop of dried blood on a clean piece of glass is all that is required. 

In the winter time the typhoid fever in a city is something the govern- 
ment can properly be blamed for. In the fall a good part of the blame falls 
on the shoulders of the people themselves. The fall rise in typhoid fever 
means infection by careless people, walking typhoid carriers, typhoid milk, 
and by flies. 

I notice that Dr. Hurty of the Indiana State Board of Health chided 
the rural citizens of his state with being less clean than they ought to be, 
whereupon a local granger rose up and called him names. 

Typhoid is more nearly a filth disease than is smallpox or most any other 
disease. 



TYPHOID FEVER 311 

Chicago's typhoid rate for 1912 should be under 8. Indiana's is over 34. 
Chicago is far from clean. Under this test, how about Indiana? Would it 
not be well for the granger to make a survey of local conditions similar to 
the one made by Professor Condra of Nebraska, and then decide on the facts 
as the survey shows them? 

FOODS THAT CAUSE TYPHOID 

Milk and water are foods, but they are so important as spreaders of 
typhoid that I have treated them separately. The other foods are not of much 
importance as compared with milk and water. 

In considering foods three questions should be in mind: 

1. Is the food to be eaten raw ? 

2. If it is cooked, is it handled after cooking by anyone who has recently 
had typhoid or been around typhoid? 

3. Have flies got on it after cooking? 

Articles to be watched are fruits, cabbage, lettuce, tomatoes, celery, 
radishes, onions, watercress, cucumbers, raw oysters and clams. 

To begin with, no one should buy vegetables or fruit from a store, stand, 
or wagon where things are not clean. Articles of food exposed where dust, 
flies, dogs, and cats can get at them should cause customers to buy elsewhere. 

However clean fruits and vegetables may look, before they are eaten raw 
they should always be ivashed in clean water. Celery should be split up so 
that each leaf can be washed. 

It is inadvisable to eat raw oysters. Methods of oyster shipping have 
improved greatly in the last two years. More than half the oysters are now 
shipped in excellent fashion. There is still some sloppy, open icing and dip- 
ping in stores, but the customers can control that end of it by refusing to buy 
oysters out of an open bucket in which there is a chunk of ice and a dipper 
not so clean as it ought to be. 

The principal reason for warning against raw oysters and clams is that 
so many of the beds are not properly supervised and so many of the oysters 
are being floated or fattened in foul water. Until oyster beds are better 
supervised and more information is available as to which are right and which 
are not, oysters and clams should be cooked before being eaten. 

No person should handle food who has recently had typhoid fever or who 
is a typhoid carrier. Washing the hands before handling food and before 
eating is not a fad. It is the best of common sense and prudence. No- 
body should ever eat without washing the hands. 

Flies can carry typhoid bacilli to the sugar, the bread, the butter, or any 
other article of food. The flies in a house may not have typhoid on them, but 
the person eating has no way of knowing, therefore the only safe policy is 
to keep flies away from the food. 

CONTACT OR FINGER TYPHOID FEVER 

Two years ago in a household on the west side of Chicago every member 
of the family had typhoid fever within three months. Two members of the 
family died of it. First one got sick and later another, and so on until it 



^snxmmMm, 





Illinois State Board of Health. Cartoon No. J+. 

Fig. 137. — Deadly Parallels. Perhaps this explains the "fine mineral flavor" you notice 

in well water. 



312 



TYPHOID FEVER 315 

went through the family. Had all of them got sick at the same time we 
would have thought of milk or water as the cause. They lived in an insanitary 
basement, but a study of the epidemic led us to think the cause was in the 
household. That was the cause of all of the cases after the first. 

A few years ago there was a milk epidemic in West Pullman. Ten days 
after the use of the typhoid-infected milk was stopped the cases of typhoid 
fever quit developing. In one household there were cases during the period 
of milk contamination and one developed some weeks after the use of the 
infected milk was stopped. This was a case of contact typhoid. 

Typhoid is "catching." It is not so catching as smallpox or measles. If 
100 persons who have never had smallpox diseases or have never been vacci- 
nated are brought into close contact in a room with a case of smallpox more 
than 90 of them will contract the disease. Measles is about as "catching" 
as smallpox. 

If 100 people who never had typhoid or who had not been vaccinated 
against it were brought in close contact with a case in a room, all of them 
might escape having the disease. Everything would depend on whether they 
swallowed any typhoid bacilli or not. Typhoid bacilli are liable to get on the 
hands, the bedclothes, and on articles around the room. The excretions of the 
patient are certain to contain them. Bits or droplets of excretion too small to 
see with the naked eye can get on the hands or on articles around the room. 
The nurse's hands are certain to get infected. The patient cannot be cared 
for without infecting the hands of those who care for him. "Whenever the 
hands remain infected for any length of time the infection is pretty certain 
to reach the mouth. The hands are traveling to the mouth frequently. In- 
fected hands are liable to infect food. 

Flies carry infection from the excretions of the patient to the food. 

It is in these ways that contact infection occurs. There is no air infec- 
tion. To visit in the room, if nothing is eaten and the hands are washed 
after the visit, is absolutely safe. Then in order that a patient may not cause 
contact infection it is necessary: (1) to have everybody's hands washed fre- 
quently — especially those of the patient and nurse; (2) to have the excretions 
and all vessels used therefor sterilized with carbolic acid,- bleaching powder, 
or some other strong antiseptic; (3) to have the bedclothes kept clean; (4) to 
have the patient and his excretions protected against flies; (5) to have the 
food kept clean and especially to have it protected against flies and against 
handling. 

If these things cannot be successfully accomplished in the house the 
patient should be taken to a hospital. No other course is fair to the other 
members of the family. 

Good nursing and good medical care are about as necessary for the pro- 
tection of the other members of the family as for the welfare of the patient. 
If such nursing and medical care cannot be had in the home the hospital is 
at hand. 

If the family, or any member thereof, is engaged in handling food for 
sale, then the patient should go to the hospital, or a high grade nurse should 
take entire charge of the patient and the family should do nothing more than 
visit. I have known of several local epidemics of typhoid fever due to some 
wife or mother trying to nurse the patient and at the same time attend to 



314 



CONTAGIOUS DISEASES 




MICHIGAN STATE BOARD OF Jjf ALTH 



Fig. 138. 



the milk or wait on customers in the store. No one should patronize a milk 
producer or milk dealer or buy goods in a grocery store, delicatessen, or bakery 
where a case of typhoid fever is being cared for on the premises. 
Typhoid will not spread in a family where cleanliness prevails, 



TYPHOID FEVER 31i 



ACTIVITY OF TYPHOID 



Drs. Sedgwick, Taylor, and McNutt of the Massachusetts Institute of 
Technology have attempted to find the answer to the question : Is there more 
typhoid fever in the city or in the country? It ought to be a disease of the 
city, because it is a disease of crowding, one party says. It ought to be a 
disease of the country because it is the result of pollution of food and water 
supply, and, whereas the cities try to protect their food and water, the village, 
township, and county authorities make no effort, says the other. 

Statistics show that where a city is grossly careless about its water and 
food it has a typhoid rate much higher than that in the country. They also 
show that when a city is exceedingly caref ul it has a typhoid rate that is lower 
than that of the country. 

This study was made in New England, and the conditions there do not 
exactly parallel those in the other parts of the country. The investigators 
conclude that in New England there is less typhoid in the country than in the 
cities and towns. 

Benjamin Franklin said that war was always paid for, but the plan was 
deferred payments. According to these scientists the soldiers returning from 
the Civil War infected rural New England. For twenty-five years some of the 
deferred payments for the war took the form of rural typhoid. Hence, for 
a quarter of a century there was more typhoid in the country than in the 
city. Since that time the pendulum has swung, and the cities are feeding 
typhoid into the country. Typhoid feeds into its surroundings, whether it 
be city or country typhoid. 

The city health authorities run down epidemics of typhoid to their origin 
in some milk farm in the country and then roundly abuse their country cousins. 
Or some cases of typhoid start in a hotel at some springs in the country and 
find their way into city homes. When the city authorities get the facts they 
publish them. 

The Institute of Technology scientists say the shoe is often on the other 
foot. The country people have not the same agents of publicity. Therefore, 
nobody hears of the case of typhoid carried from the city to the country. 

They quote Professor Bass' investigation of the Mankato, Minnesota, 
epidemic, wherein seventy-two cases of and five deaths from typhoid occurring 
in the country around Mankato were traceable to the epidemics in Mankato. 
Some of these radiated cases went to the country around Seattle, Washing- 
ton ; Cedilla, Michigan ; ToWner, North Dakota ; and White, South Dakota. 

HOW WINTER TYPHOID IS SPREAD 

The typhoid rate should be divided in two parts — the winter rate, com- 
prising the rates for December to May, inclusive, and the summer rate, that 
of the remainder of the twelve months. The winter rate indicates how much 
filth gets into the water supply. The summer rate indicates how much filth 
gets into the entire food supply, including the water. 

Freeman says: "We have learned by sad experience the measure of 
typhoid fever in any community is the measure of the distribution of human 



316 



CONTAGIOUS DISEASES 




i r if %$$^f-==. 



filth in that community, and that the dissemination of human excrement will 
inevitably result in the spread of typhoid fever." 

In the winter the conditions for the spread of filth to other foods than 
water are not good. The few typhoid bacilli that get into milk are killed 
off before they come to the consumer. The few flies stay so close to the 
warm places that they do not carry infection, at least in cold climates. 

But the sewers empty their contents into the water supplies during the 
winter as well as during the summer. 

The consensus of opinion is that water is about as dangerous in cold 
weather as in warm. There may be local conditions that modify this rule in 

certain cities, but it is true as a rule. 
Therefore the amount of winter typhoid 
is pretty nearly a measure of the 
habitual and customary water pollution 
of a given community. 

The existence of a typical winter 
typhoid is better known than the same 
condition as a summer complaint. 
Winter cholera and winter diarrhea are 
names by which it is known. When 
Yaughan was investigating typhoid at 
Chickamauga he found proof that much 
of the typhoid had been called diar- 
rhea, summer complaint, and similar 
names by the physicians in attendance. 
It is rather natural to ascribe diarrhea 
in summer to fruit, vegetables, and 
other foods. In winter it is more apt 
to be recognized as a typical typhoid. 
Winter typhoid is spread through 
infection of the water. The method of 
prevention is either to prevent infection 
of the water or to stop the use of in- 
fected water. Municipal filtration will do this; so will treatment with hypo- 
chlorite. A proper household filtration will do it. However, individual house- 
hold filtration has generally been of little service in lowering the typhoid rates. 
Boiling the water will do it. Here, also, individual action has never been of 
much service. Winter typhoid is a community disease which must be met by 
community measures. 

If we could manage to stamp out winter typhoid the control of summer ty- 
phoid would come within reach. It should get on the same plane as smallpox. 
The only agencies left to carry it over from season to season would be carriers, 
and the number of effective typhoid distributers is not large. The problem 
would then be about as difficult as the smallpox problem and no more so. 
Suppose a man lives in a town with an infected water supply, as shown 
by a high winter typhoid rate. What can he do? Get vaccinated and then 
agitate all the harder for better water. As Freeman says, "The problem 
remaining for solution is how to convince the American people that protection 
from typhoid is something worth spending money for." 



'""• ■ '••'■ •••••■ "•*■ •■ - ■ • ■' ■■'■ •■•■■' ■ • • ••••- ■•■ ' ■•■■■ ■'■•■ 



Virginia Health Department. 

Fig. 139.— Safe Well. 



TYPHOID FEVER 317 

Preventing Typhoid. — J. II. writes: 

"1. Would you advise vaccination as a preventive of typhoid fever? 
"2. Is such vaccination safe? 

"3. If cows drink water in which typhoid germs are present do these 
germs appear in the milk? 

"If. Should such milk be boiled? 

"5. How long should water be boiled?" 

Reply. — When an epidemic of typhoid fever is on: 

1. Nothing should be eaten raw. 
No raw water. 

No raw milk. 
No raw vegetables. 
No raw fruit. 
No raw oysters. 
Nothing raw. 

2. All typhoid should be promptly reported to the health department. 

3. A modified quarantine (typhoid quarantine) should be established. 

4. All nurses, or all doing nursing duty, should be instructed in detail 
how to take care of their patients. 

5. All the people should be vaccinated against typhoid. 

Such a policy will stop the outbreak of new cases in two weeks. It 
takes ten days for typhoid to develop after infection. 
Now, answering your questions in detail: 
1 and 2. Yes. 

3. No. 

4. Yes, for one minute after it starts to boil. Then keep it warm for 
fifteen minutes. Cool quickly. 

5. Same length of time as milk. 

Milk and Typhoid. — X. Y. Z. writes: "I have been taking milk and 
cream daily from a milkman who has a case of typhoid fever in his home. 
He tells me the doctor says there is no danger at all of the disease being 
carried to the customers. Please advise me." 

Reply. — You should not use milk from a milk dealer who has typhoid 
fever in his home, unless you know "for sure" that the man who handles 
the milk does not see the sick person or touch anything which goes into 
the sick room. It is possible to handle raw milk with safety on premises 
where there is typhoid fever, if the dealer is very intelligent and very 
careful, but ninety times out of a hundred it is too risky. 

Typhoid Vaccination. — G. W. M. writes: "Why is it that typhobac- 
terin is not recommended for use in persons over 40 years of age?" 

Reply. — There is no reason why a person over 40 who has not had 
typhoid and who is to be exposed to it should not be vaccinated against 
typhoid. At the last meeting of the American Medical Association such 
vaccination in old people was reported. Generally speaking, old people 
do not need it so much as the young ones. 

Cesspools and Typhoid. — J. W. D. writes : "In your paper you have a 
department for typhoid fever? We have had considerable typhoid in 
our vicinity. I claim part of the sickness is from not having sewers, but, 
instead, having cesspools, and that our drinking water is bad by having 



318 



CONTAGIOUS DISEASES 



JACK- JILL. 



Jack and Jill I Jack pell sick 

Went down the Mill Of Typhoid, quick, 

To get a Drink or Water. And Jill came following after 



- And This Is The Reason Why - 




Typhoid fever in the bouse -J" 



i Ljpbotd Germs 119 the Drain -pipe 



oid Germs in the Creek _ 



Typhoid Germs seepiorf into the Wei I - 

Typhoid Germs 11? the Well Water 




TYPHOID GERM5 IN JACK AND JILL ! 



BEWARE OF 
LOW-LYING 
5MALL0W- 
DU& WELL5 



Chicago Health Department -educational Poster MS 134 



iKATHEfllNE FIELD WHITE -191*1 



Fig. 140. 

cesspools dug down to running water. I would like to have your opinion 
on the matter/' 

Reply. — The conditions you describe are usually responsible for typhoid 
fever. Cesspools reaching to or nearly to the strata which carry the water 



TYPHOID FEA 7 ER 319 

which supplies your wells are reasonably certain to give you polluted water. 
This water from time to time will become infected. When cesspools and 
wells are located near each other there are usually found other causes of 
typhoid not closely related to these. A community which has a good deal 
of water typhoid usually has more than the average amount of milk, fly, and 
finger typhoid. The better care of sewage and the better protection of the 
drinking water also helps to decrease these other forms of typhoid infec- 
tion. And also when typhoid rates fall other disease rates fall. 

Developing Typhoid Fever. — J. 0. 8. writes: "Kindly tell me if any- 
thing can he done to prevent typhoid fever. The patient threatened with 
it a week ago has taken nothing hut liquid foods since. Shall she con- 
tinue with the liquid diet?" 

Reply. — Vaccination, boiling the water, boiling the milk, screening 
against flies are the most important methods of preventing typhoid. How- 
ever, with your friend it was too late to talk about preventing the disease 
at the time you wrote your letter. The typhoid bacillus gets in the body 
and stays there ten days before any symptom develops, and two weeks 
before the symptoms look much like typhoid. After the patient begins 
to have fever or to get weak it is too late to prevent the disease. 

Avoiding Typhoid Germs. — Drummer writes: "What am I, a travel- 
ing man, to do to he sure of avoiding typhoid? I'm afraid of that disease, 
hut traveling constantly I cannot boil the water I drink or guard against 
the carelessness of cooks and waitresses in the hotels." 

Reply. — Get vaccinated against it. If you are from Wisconsin, the 
state board of health will furnish the serum. In any event your physician 
can get it for you. 

Protection of Typhoid Vaccination. — H. C. asks how long the typhoid 
inoculation lasts and if it protects against malaria. Vaccination lasts for 
seven years, he is told. 

Reply. — Typhoid vaccination requires twenty to thirty days. Beyond a 
temporary redness at the points of injection there is no inconvenience or 
other ill effect. It will not protect you against malaria. The way to pre- 
vent malaria in the tropics is to protect yourself against mosquitoes. This 
properly done is effective after you strike a district where the mosquitoes 
are infected. Your danger of malaria will be proportioned to the number 
of mosquitoes which bite you. The inoculation against typhoid will pro- 
tect you for five months. It will make you reasonably safe for an addi- 
tional seven months. 

Filters. — A. W. W. asks the following questions: "Is there a filter 
made which can he attached to the faucet, which will destroy typhoid 
germs?" 

Reply. — Any of the artificial rock filters which attach to the faucet will 
filter out typhoid bacilli. All parts of the filter must be kept clean. At 
short intervals the candle must be baked out. Otherwise the typhoid 
bacteria grow through it and the filter does more harm than good. 

Winter Cholera.' — 0. C. sends the following clipping from the Tribune 
and suggests the advisability of furnishing more information on the 
subject: 



320 



CONTAGIOUS DISEASES 



"Waukegan, III. — Jan. 2. — [Special.] — Winter dysentery among 
infants has been discovered in Chicago by scientists and is said to be 
prevalent in northern Illinois. When a Waukegan physician who 




n/"«- ' ->»;/' / T .',,'/ "•/•/'■' .it 1 '' *'!'" ' '•'■>>'/'' ''"'. M r 






SCREEN THE EUES OUT CLOSED WELLS ARt SAffR 




CLOSED PRIVIES PREVENT TYPHOID 

North Carolina Health Bulletin. 

Fig. 141. — To Prevent Typhoid. 



had charge of a six-months-old son of Mr. and Mrs. Walter Ellis 
called a Chicago laboratory by telephone he was informed they had 
had many inquiries about similar cases. 

"It is said to be an entirely new disease. 

"The child died this morning." 

Eeply. — Winter diarrhea, also called winter dysentery, is typhoid 
fever. In 1908, Dr. Breitenbaeh reported to the section on preventive 



TYPHOID FEYER 321 

medicine of the American Medical Association a so-called epidemic of 
winter diarrhea in a Wisconsin city. The people were trying to fool 
themselves and everybody else by calling their epidemic winter diarrhea. 
The proof was conclusive that the disease was typhoid and due to polluted 
water. Many such reports are on record. 

Cause of Typhoid. — D. A. Carson writes: "In your article in the 
Tribune of today you do not come out and squarely say that bacteria causes 
typhoid fever, but you say: 'It is a bacterial disease. The bacteria are 
taken in with food and water/ and hence I am forced to believe that you 
mean to assert that bacteria are the cause of the disease. I have heard 
other doctors make this assertion and I have asked many of them how 
they know that bacteria cause typhoid fever or any other disease. I have 
not been able to get a satisfactory answer to my question from any of 
them. The best they can do is to say bacteria are found in the discharges, 
etc., of typhoid patients. That proves really nothing more than the fact 
of its presence. Several doctors have told and the books tell me that the 
same bacteria that are found in the discharges of typhoid patients are also 
found in other diseases. As this has never been denied as far as I can 
learn it is strong testimony against your theory that typhoid is caused 
by the so-called typhoid bacteria. 

"I think you should in your Tribune articles prove your assertion as 
to the cause of typhoid. It will not do to merely prove its presence in the 
typhoid patient nor to say the theory must be true because 'it was made in 
Germany/ Unless you prove your assertion all your talk will go for noth- 
ing and no thinking person will believe one word of it." 

Reply. — Typhoid fever is due to the typhoid bacillus. The proof is : 

1. The bacillus is found in the blood and organs of people having 
typhoid fever. It is also found in certain of the excretions of those having 
typhoid fever or who have had typhoid fever. 

2. It is not found in the blood or organs of anyone who is not suffering 
from typhoid fever. It is not found in the excretions of anyone except 
those who are suffering from typhoid or who have been infected with 
typhoid at some time. 

3. It is not found in the blood or in the excretions of animals which 
do not have typhoid. 

4. The blood of a person having typhoid fever will first clump and later 
destroy typhoid bacilli. It will not cause this effect with other bacteria 
under like conditions. 

5. Typhoid bacilli cultured from the blood of a person in an early stage 
of typhoid will be first clumped and later destroyed by blood taken from 
another person who is in the midst of a developed typhoid. 

6. These bacilli will not be clumped by other blood when applied under 
like conditions. 

7. It has been proved that people with typhoid infect other people with 
the disease. 

8. It has been proved that under certain circumstances people with 
typhoid infect water, milk and other food substances. It has been proved 
that people with typhoid had consumed food in which there were typhoid 
bacilli. 

Koch laid down certain laws which must be conformed to and the fact 
of conforming proved before it could be proved that a certain bacterium 
caused a certain disease. 

Typhoid fever meets every one of these requirements. 



322 CONTAGIOUS DISEASES 

FOOT AND MOUTH DISEASE 

Foot and mouth disease is a malady of cloven footed animals. It be- 
longs in Europe. Eosenau tells us that it has invaded this country on several 
occasions prior to the last. 

When the disease was discovered the Bureau of Animal Industry took 
active charge of the invaded districts and within a few weeks the disease was 
under control. Its complete suppression necessitated the killing of a large num- 
ber of cows and was done at great expense. 

In this epidemic the same bureau assumed charge as soon as the diag- 
nosis was made and the situation is being handled in its usual masterly 
way. The disease will shortly be under control and before long it will be 
eradicated but the expense to farmers and to governments will be great. 

The cause of the disease is a microbe too small to be seen with any 
microscope. It passes through the pores of a porcelain filter and therefore it is 
classed as a filterable virus. This was the first ultra-microscopic filterable 
virus to be discovered. 

The virus can be transmitted to human beings by the milk. Although 
the disease in animals is violent and often fatal, in the human subject it is mild. 
It occasionally produces death. 

Children sick with foot and mouth disease have fever and vomiting; 
small blisters appear in the mouth; swallowing is difficult; sometimes slight 
blisters appear on the fingers. 

Eosenau says : "Man is infected through the ingestion of raw milk, but- 
termilk, butter, cheese, and whey from animals suffering with foot and mouth 
disease. It may also, though more rarely, be transmitted directly from the 
salivary secretions." 

Eosenau also says that foot and mouth disease cannot be transmitted by 
vaccination or any other variety of skin wound. 

The virus is easily killed by heat. Experiments made in Denmark and 
Germany have proved this. Milk pasteurized at 140° for twenty minutes 
is safe. 

There is no reason for alarm. So long as the disease continues all milk and 
milk products from the infected districts should be pasteurized. Any consumer 
of milk who is not certain of his supply should pasteurize at home. Physicians 
in the district or near it should inquire carefully into their cases of stomatitis. 

FIGHTING FOOT AND MOUTH DISEASE 

From three to ten days after exposure the infected person is attacked by 
chill followed by general aching. The fever goes to about 102°. There is 
vomiting and diarrhea. About three days after the beginning of the fever 
the mouth becomes inflamed. 

The most frequent affection in the mouth is a crop of small, clear 
blisters. These appear on the inside of the lips and cheeks, on the gums and 
tongue. They seldom appear on the hard or soft palate. 

In most cases the crop of blisters is preceded by a fall in the fever. If 
the fever keeps up it is a sign that a second or even a third crop of blisters 
will follow, coming at intervals of three to four days. 



FOOT AND MOUTH DISEASE 323 

The worst epidemic of foot and mouth disease on record was one occurring 
in Berlin and reported by Sergei. In that epidemic there was much swelling 
of the gums and the tongue swelled so as to protrude from the mouth. Many 
of the cases of that epidemic died as the result of pneumonia, Bright's disease 
and extreme wasting. 

The disease is usually spread by the drinking of raw milk from in- 
fected cows. To settle the point Hertwig drank some infected milk and gave 
some to his assistants. The disease resulted. 

To prevent the disease from spreading Nicolaier says that the follow- 
ing procedures should be followed : 

All infected and exposed cows should be quarantined. 

All infected people should be quarantined. 

All milk from sick cows should be destroyed. 

The general milk supply should be thoroughly pasteurized. 

These are provisions of the German law. That law does not require 
that butter from infected animals should be made from pasteurized milk. In 
this Mcolaier thought the law was faulty. 

It is generally agreed that the disease may be dangerous, especially to 
children. An infected person may infect a susceptible person- by contact, 
such as hissing. 

• 

FOOT AND MOUTH DISEASE EASILY AVOIDED BY PEOPLE 

When Mediaerr wrote about foot and mouth disease in the human 
subject he was able to gather together histories of one hundred and forty 
cases. In the medical history of the entire world there had been recorded 
less than two hundred cases of human foot and mouth disease. 

Nicolaier said he was sure there had been more cases and with this 
Sergei agreed. In fact everyone who has written on the subject has agreed 
that the physicians have failed to recognize many of the cases of foot and 
mouth disease. How could it be otherwise with a disease so rare and so little 
understood ? How can you expect an American physician to make a 
diagnosis ? 

But after due allowance has been made the fact remains that foot and 
mouth disease is not now and never has been much of a menace to human 
beings. It is not at all to be compared with consumption, typhoid fever, 
pneumonia, scarlet fever or any other of a dozen diseases which are always 
with us. Aside from the fact that it has rarely affected persons there is the 
ease with which human beings can protect themselves against it. 

Meat is not a menace. Meat from government controlled slaughter 
houses is not a menace in the raw state. Cooked meat is absolutely safe. 
Pasteurized milk is safe and any citizen can get pasteurized milk. The 
man who purchases raw milk is needlessly endangering the life of his 
family. 

Butter from pasteurized milk — usually called pasteurized butter — is also 
safe. There is plenty of that on the market. Anybody who wants pasteurized 
butter can get it. 

The foot and mouth disease is a stockman's peril. The consumer of 
milk and meat has no reason to be panicky. 



324 CONTAGIOUS DISEASES 

Human Foot and Mouth Disease. — K. J. M. writes: "Being interested 
in science and my brother man, I send you this report that, should you 
think it advisable, you can warn your readers to 'boil the milk.' 

"I am satisfied since reading your article giving symptoms of hoof and 
mouth disease that I am recovering from an attack of that plague. I give 
you my case. 

"Twelve days ago I felt badly and noticed a slight sore throat. Fear- 
ing I had 'caught' some one's tonsillitis or 'grip,' I gargled several times 
with listerin. Toward evening I had a slight chill and some fever; only 
took temperature once, 100 1-5; do not think it went higher. 

"For several days my throat got worse and I wondered what made 
blisters on back of my throat, tonsils, inside of lips and cheek, and on soft 
palate, none on roof of mouth or on gums, though latter were swollen. 
I don't think there were more than a dozen or so of these blisters, but all 
the time other red places came out inside my lips and cheeks, which 
seemed to bleed slightly, as I noticed in expectorating (there was constant 
flow of saliva) there were streaks of blood and I found these bled easily. 

"As my throat got worse my tongue did, too, not on surface, but at 
'root' or back it was swollen and hurt to move it. This more than sore 
throat made swallowing very painful for a week. 

"The front edge of my tongue and under it, back of mouth and throat 
are still much inflamed and inflammation has reached my chest, making 
me feel like I had a severe cold there, though I have had no signs of a 
cold. I had no vomiting, no diarrhea. 

"Now my husband is on his fourth day of infection, with exactly the 
same symptoms. I have not consulted a physician, as it seemed more 
(painful than alarming, and I am one of those that 'take three days to 
decide to go to a doctor and then back out.' As a precaution we have 
avoided everyone for several days. Do you think we have this disease? 
Should we fumigate, and with what?" 

Eeply. — If you have the disease, boil or burn all handkerchiefs, towels, 
and clothes that come in contact with your mouth secretions. Use no 
cups, spoons, or plates used by others. Use chlorinated lime solution 
freely around the room. 

When you have recovered wash all woodwork with 5 per cent, solution 
of carbolic acid. Air and sun your rooms well. 

That you have recovered does not prove that you did not have the 
disease. The fine stock at the yards recovered, all of them, and they cer- 
tainly had it. 

Prevalence of Human Foot and Mouth Disease. — Veterinarian writes: 
"In your article on foot and mouth disease I believe you have not only 
underestimated the human susceptibility for the disease but also the num- 
ber of cases on record, both mild and fatal. 

"Hutyra and Marek, a late work on veterinary science (Vol. I), quote 
Bussenius and Siegel, 'Sixteen epizootics occurred in man in the years of 
1878-1896, in the course of which entire families, sometimes all inhabitants 
of certain houses, and even townships, became affected. During different 
outbreaks the cases terminated fatally in thirty-six, twenty-six, and six- 
teen instances respectively.' " 

Eeply. — Nicolaier, whom I quoted in my article, quoted Bussenius and 
Siegel at length. In fact, most of the 140 cases collected were from that 
source. I have just read Hutyra and Marek's article. They say that the 



EOCKY MOUNTAIN FEVER 325 

disease is not of great importance from the human standpoint. "This 
disease develops in man usually in a mild form, except in children, in 
which an associated gastro-intestinal catarrh may lead to death. During 
some of the outbreaks, however, adult persons also became severely 
affected." 

ROCKY MOUNTAIN FEVER 

In the Rocky Mountain states there exists a disease known as the Rocky 
Mountain spotted fever. Within recent years cases have been reported in 
Montana, Idaho, Wyoming, Washington, Oregon, California, Nevada, Utah, 
and Colorado. The disease is not especially severe. The death rate is less 
than that of typhoid fever. Wlien a man gets sick with typhoid fever he 
expects to get well and the chances are about fifteen to one that he will. 

From the epidemic standpoint the disease is not very important. The 
Public Health Service was able to get track of only 440 cases of it during 1914. 
Of these twenty-nine died. 

There are a few counties in Montana, Wyoming and Idaho that do not 
settle up because the people are afraid of tick fever. This last fact is one 
of the reasons why the government is actively working to eradicate Rocky 
Mountain spotted fever. 

What seems to be a more important reason is that it wants to make two 
demonstrations. First it wants to show the people how a centralized national 
agency for the conservation of human beings could — shall we say can? — 
operate to eradicate an endemic disease. What could be done with this 
disease could be done with any other endemic disease which had been repressed 
to the proper point for work for suppression. ■ 

Second, it wants to demonstrate the method of suppression applicable to 
this particular disease. This fever is spread by wood ticks. The ticks live on 
gophers, squirrels, coyotes and every other species of wild animal. To sup- 
press this fever it is necessary to get rid of the ticks. 

To rid a region of ticks the government advises killing the wild hosts, 
dipping all domestic stock, cleaning out the undergrowth and sheep grazing. 

Of these measures, the most effective is sheep grazing. When sheep graze 
over a piece of ground they gather up all the ticks. 

Ticks will leave any animal for a sheep. When they get into a sheep's 
wool between 80 and 90 per cent, of them die. 

To get the other 10 to 20 per cent., the government recommends that the 
sheep be grazed high up the mountain side. A flock of sheep start grazing 
in the valley. The sheep graze up the mountain side. By the time the sur- 
viving female ticks are fully grown and gorged with blood the sheep are above 
the range of gophers, chipmunks, squirrels and wild animals generally. The 
females drop off, lay their eggs and die. The larvae hatch out and finding 
no small animals to live on, die. 

It is common information that there is no tick fever on the east side of 
Bitter Root Yalley. Many years ago 40,000 sheep were put on this slope. 
The method of grazing was just that described. The "snoozers" cleaned that 
side of the valley of ticks without trying or having any idea of the good 
they were doing. 

Apparently it is within the power of the sheepmen to redeem the coun- 



326 CONTAGIOUS DISEASES 

try. This should improve the standing of the "snoozer." It might make 
O'Henry sit up in his coffin. 

Rocky Mountain spotted fever is an American disease. It is not found 
outside of the United States. If we annihilate it here the world will be 
permanently rid of it. Our responsibility toward it is the same as that of the 
few countries in which yellow fever is left. 



TYPHUS 

Typhus is, or was, the war disease. Hirsch begins his chapter on typhus 
as follows : "The history of typhus is written in those dark pages of the world's 
story which tell of the grievous visitations of mankind by war, famine, and 
misery of every kind. . . . The history of typhus in war affords further 
classical proof of the influence of overcrowding, filthy and unventilated spaces, 
upon the development of the fever." 

The history of this disease shows that war has been the chief agency 
of its spread. In fact, Mexico was free of it until the Spaniards, bent on 
conquest, brought it with their armies in 1570. 

While most of the records of typhus relate to wars of a hundred years or 
more ago it has come down to our day. It was responsible for a heavy death 
rate in the Crimean War and also in the Eusso-Turkish War of the late ; 70's. 
It was troublesome among the French troops in the war of 1871. There is 
information that in the Madero revolution of five years ago the disease was 
quite prevalent. It has raged in Serbia. 

In Mexico typhus fever is* always present in the tierras f rias, the colder 
plateau lands south of Torreon. This tableland is the normal habitat of 
typhus in Mexico; but it is reasonably certain that the disease can be carried 
by the Mexican troops wherever they go in Mexico. They carried it to 
Juarez; they can and will carry it to whatever tropical district they go. 

A physician who had practiced medicine in Mexico for many years was 
asked what were the worst diseases that we might expect in case of war 
with the southern republic. His reply was that the greatest menace to life 
would be typhus. Venereal disease would be the greatest disabler. 

The typhus that we shall encounter there will not be of the mild type 
found here. There the disease is violent. It has a case mortality of 80 
per cent. We in this section have no personal knowledge of so violent a form. 

Where's the hope? There is good evidence that typhus is spread by 
lice. We may prove that this is the only method of its spreading. At any 
rate we shall work cleanliness and louse killers to the limit to protect our 
men. Those sick with typhus will be protected against lice. The well will 
be examined for lice frequently. Louse killers will be distributed freely. 

Typhus is a disease of bad sanitary conditions. It has never thrived 
where there was any sort of sanitary standard. It may not be a filth disease, 
but it comes nearer being one than typhoid, and is infinitely more a filth 
disease than smallpox. 

Nobody has it except people housed in filthy places. It develops in filthy 
jails, filthy construction camps and filthy army camps. 



CHAPTER XX 



Habit-Forming Drugs 

Farmers' Bulletin No. 393, Department of Agriculture, is on the sub- 
ject .of habit-forming drugs. I do not know why this was issued as a farm- 
ers' bulletin, except that there is no place in our scheme of government for 
people's bulletins. Farmers have no more drug habits than the general 
run of people. On the other hand, it has been said there are more drug 
habitues among physicians than any other class. 

This bulletin says it is estimated that there are more than 1,000,000 
drug addicts in the United States. 
Another statement is: "The amount 
of opium imported into the United 
States so far during the present decade 
indicates that the amount per capita is 
about the same as for the preceding 
ten years." 

Crothers says that two-thirds of 
the morphin used is consumed by ad- 
dicts. 

There are three reasons for this 
article. The first one is that the mor- 
phin disease is no trifling matter. 

The morphin habit is always ac- 
quired under an alias. A man seeks 
to escape a pain and justifies himself 
in talcing morphin by saying a dose, or 
a few doses, will do him less harm than 
the pain. His mistake is in not seeing 
that he is really deciding between the 
pain and the habit. 

A man seeks to get a needed 
night's sleep with morphin. He weighs 
one night against one dose. He should be able to see the end of the string 
and know that he is weighing a habit against a temporary discomfort. A 
man is temporarily in straits and feels that he has not the grit to carry 
himself over. He takes a dose of morphin, forgetting he is only "laying the 
question on the table," and that when he takes it up tomorrow the morphin 
will have left him with even less grit; the difficulty to be met has grown 
as it lay unmet. 

The second reason for writing this article is to call attention to the 
score or more of paths that seem innocent enough, but that lead to fiend- 
dom: cough medicines, sleep medicines, refilled prescriptions, opium cures, 

327 




Fig. 142. 



North Carolina Health Bulletin. 
Taking Patent Medicine by the 
Clock. 



328 HABIT-FORMING DRUGS 

which contain opium, morphin, or codein, medicine for pain, and the like. 
The man who begins with these does not fight out the question, "Will I be 
an opium fiend ?" While he is strong he cannot conceive of any answer but 
no. But let him consider what his answer will be when the question is put — 
that is, when the time has come that his will is weak and his grit has gone. 

A large part of the opium addicts are neurasthenics by inheritance. A 
large part are neurasthenics from lack of training in self-control. Another 
part become mentally disturbed by the drug. Certain types of criminality 
are frequently found in drug fiends. 

The third reason for writing this article is to set forth the justice of 
taking morphin into consideration in judging the motives of addicts, and to 
suggest that opium fiends cannot be cured or helped by punishment. They 
must be patiently and persistently helped and then retrained. Cure is not 
effected when morphin is no longer used. They are not cured until they 
have got a grip on themselves and a new hold on affairs. 

It is the duty of the physician to examine closely and find out not only 
what is the organic basis, but also its relative value. For him to become 
impatient is to miss the point. He must catch the patient's point of view 
and then, through suggestion, analysis, reason, bring him to a better view- 
point, and patiently hold him there until he can stand alone. 

Even in organic diseases, while the basic organic changes cannot be 
altered, the physician who is wise, sympathetic, and patient can steady 
his patient and assist the weak organ to do its work. He cannot cure 
the leaking heart, but he can stay the mental trepidation, which means 
more frequent and more painful periods of palpitation. And this is what 
the patient wants — he judges by symptoms. 

DOPE FIENDS OF ONE CITY 

Jacksonville, Florida, has an ordinance requiring that drug users shall 
register with the department of health. Druggists, physicians, and other 
dealers and dispensers are allowed by law to sell the needed drug to a person 
registered as a dope user. 

The purpose of the Jacksonville authorities was to concentrate their 
efforts on the prevention of the habit. In order to get a record of drug 
users, their number, the drug used, the amount, the reason for the habit, 
and other items concerning them for careful study, they passed and are 
enforcing this ordinance. 

The Tennessee legislature made a similar measure into a state law. The 
Tennessee law is enforced by the state food department. 

Dr. Terry, the efficient Health Commissioner of Jacksonville, reports 
that of the total population of that city drug users compose about 1.5 
per cent. The percentage of drug users among grown people is much higher 
than that. These are distributed by color and sex as follows : 

White males 32.69 Total males 43.74 

White females 36.98 Total females 56.26 

Colored males 11.04 Total white ' 69.67 

Colored females 19.28 Total colored 30.33 



DOPE LAW WEAKNESSES 329 

The population of Jacksonville is about equally divided into white and 
colored. It will surprise some people to know that white people, as compared 
with colored, are more than twice as liable to become dope fiends. This 
does not hold true of cocain. Negroes are especially prone to use cocain. 

There are a few more women than men in Jacksonville, but this dis- 
proportion is not as fifty-six to forty-three. The conclusion is that women 
are somewhat more disposed to use dope than are men. 



Please Do Not Ask Us 

f ANY OLD ] 
What is J PATENT [ Worth? 

ImedicineJ 

For you embarrass us, as our honest answer must be that 

It Is Worthless 

If you mean to ask us at what price we sell it, that is an 
entirely different proposition. When sick consult a good physi- 
cian. It is the only proper course; and you will find it cheaper 
in the end than self -medicine with worthless "patent" nostrums. 



The report from State Food Commissioner Brown of Tennessee is 
that the proportions between female and male addicts and white and 
colored are about the same in that state as in the figures given by Dr. Terry 
for Jacksonville. 

An analysis of the replies given by 250 users as to how they started 
is as follows: 

Prescriptions of physicians 48.8 

Through dissipation 30.4 

Through advice of users 18.8 

Chronic and incurable diseases 2. 

Investigation on this point did not go back of the reply returned 
on the blank. For instance, how many of the 48.8 per cent, who put the 
blame on prescriptions of physicians made a misstatement to cover their 
own shortcoming is not known. Nor is it known how many cases were due 
to indefinite refilling of prescriptions or counter-prescribing, and how many 
were due to physicians' prescriptions, so considered. Indirect . causes given 
were in the order named, rheumatism, pelvic inflammation, accidents, head- 
aches, surgical operation, stomach trouble. About 15 per cent, of the dope 
fiends were prostitutes. 

Dr. Terry thinks that every community should provide a free sanitarium 
for the cure of the drug habit as well as enforce laws to prevent it. 



DOPE LAW WEAKNESSES 

The Treasury Department began the enforcement of the Harrison law on 
March 1, 1915. While this bill relates to the purchase and sale of opium and 



330 HABIT-FORMING DRUGS 

coca leaves and preparations made from them, it is capable of being made a 
national measure for the control of drug habits, being limited, however, to the 
opium and cocain habits. 

Under rulings made by the commissioner of internal revenue the law, 
properly enforced, will make it impossible for any drug habit victim to get 
an adequate and continuous supply of his drug. It therefore will force 
the drug habit victims to be cured. 

The law, properly enforced, will be highly effective in preventing 
people from being drug addicts. Prescriptions containing opium and coca 
preparations cannot be refilled and records of the purchases of drugs 
must be kept. These provisions are calculated to prevent the formation of 
habits. 

However, there are two weak points in the law. Physicians, den- 
tists, and veterinarians who register as such are allowed some leeway. 
Up to date, applicants have been permitted to register as physicians, den- 
tists, and veterinarians without being required to make proof that 
they were such. Nothing is easier than for the collector to require 
each applicant to show the license granted him by the authorities of his 
state. 

The Commissioner of Internal Revenue writes: "It devolves upon the 
collector of internal revenue to see that no other persons [than legal prac- 
titioners of medicine, dentistry, and veterinary medicine] register under this 
law." 

This weakness in the law, as it has been administered up to date, is 
purely one of administration. It lies within the power of the department 
to purge the lists of any improperly registered, to supervise those who are 
properly registered, and to require legal proof of right to practice as a requi- 
site to registration. 

The second weakness is far more important. Section 6 of the law 
prescribes that patent medicines containing opium and cocain do not come 
under the law. If an ounce of the patent medicine contains less than two 
grains and a fraction of opium, or one-fourth of a grain of morphin, or one- 
eighth of heroin, or one grain of codein it may be sold freely without any 
of the limitations imposed by this law. 

These are not inconsiderable strengths. For instance, this law would 
not prevent a man from buying a ten-gallon jug of paregoric without having 
any record made of the purchase. Section 6 makes easy the formation 
of habit. 

The law as a whole is an excellent measure against self -drugging. At 
the point where the need is for great strength we find this fatally weak section. 
It is a crawfish hole in the levee. 

Section 6 did not get into the law by accident. The patent medicine 
people put it there. While it was not their purpose to make drug fiends of 
people, they were quite willing to be the beneficiaries of the provision which 
makes drug fiends. 

It is possible that the Pure Food and Drug Act of 1906 or the Sherley 
Law of 1912 or state and local laws may be so administered as to cover 
this point of weakness. So far as this law is concerned the only remedy 
\s to amend it by striking out Section 6. 



WHAT IS THE DRUG FIEND TO DO? 



331 



WHAT IS THE DRUG FIEND TO DO? 

On March 1, 1915, the Harrison bill went into effect. It is a federal 
law and, therefore, applies in every part of the United States. The federal 
government has a way of enforcing its law. Furthermore, drugs are in the 
hands of druggists — a law-abiding class. All in all, the chance that the 
law will be enforced is excellent. 

Section 1 gives the Commissioner of Internal Revenue, with the ap- 
proval of the Secretary of the Treasury, the right to make rules and regula- 
tions for carrying the provisions of this act into effect. 

Section 2 requires that no drug of the kinds specified in the law shall 
be sold to anyone except upon a written order, said order to be on a blank 
provided by the collector. The collector has ruled that blanks shall not 
be issued to addicts. 

The person who has a drug habit 
nowadays can get his supply through 
physicians only. As a means of getting 
a supply this will prove unsatisfactory. 
Some physicians will be careless. 
Some will be worse than careless. 
The great majority will refuse to 
act as mediums for the evasion of 
the law. 

There are more than a million 
opium and cocain users in the United 
States. What can they do? 

Some have made more or less 
permanent connections with improper 
sources of supply. Physicians, den- 
tists, and veterinarians tempted to 
supply drugs to addicts, whether im- 
pelled by cupidity or weakness, should 
bear in mind that the federal govern- 
ment is strong and compelling. 

Some addicts have found temporary supplies to tide them over a brief 
period. 

Some have undertaken cures. They will find it easier to break off than 
they thought. Cures are fairly satisfactory. They will be doubly satisfactory 
now that relapsing is to be a difficult matter. 

It is common knowledge that some criminals are broken of their 
habits by short jail sentences. Deprived of their drug, they suffer severely 
for a few days and moderately for a few weeks, but at the expiration of their 
sentences they go out freed of the habit. As they are, generally speaking, 
neurotic or feeble-minded, they relapse. But the jail experience has proved 
that breaking off is not so unpleasant as was expected. 

Perhaps now that a strong government proposes to act in lieu of a strong 
will the cures may be without relapse. 




North Carolina State Health Department- 

Fig. 143. — Penny Wise and Pound Fool- 
ish. Headache Medicine. 



332 



HABIT-FOKMING DRUGS 



MORPHIN CURE 



A ruling by the Commissioner of Internal Bevenue shuts off drug users 
from their supply. Evasion of a federal law is a risky procedure. Taking 
the cure is painful and troublesome, but settling with the federal authorities 
is worse and more of it. 

There are hundreds of thousands of drug users. In the entire coun- 
try there are not 5,000 beds available for cures for drug users. Those 
who can do so should go to institutions. Taking the cure outside an in- 
stitution is far more risky and far less satisfactory than inside one. But where 
the number of institution beds is so small and the number of those in need is 

so large many must be cared 
for in private homes under 
the close care of physicians 
and nurses. 

In view of this situation 
an article by Dr. W. K. Mc- 
Laughlin in the Chicago Med- 
ical Recorder for February, 
1915, is useful. We give his 
statement of the Towns mor- 
phin cure method: 

"Start Sunday morning 
at 8 a. M. Give five com- 
pound cathartic pills and five 
grains of blue mass. At 2 
p. M., unless the bowels have 
moved freely, a dose of salts 
is given. Some time during 
the middle of the afternoon, 
the bowels having moved 
three times, the patient is 
given two-thirds his total 
daily dose of morphin. It 
is given by mouth or by hypo- 
dermic as the patient wishes. 
"The amount of the drug is divided into three parts. One-third is 
given at, say, 3 p. m., one-third at 3 :30. Unless the patient is fully under 
the influence of his drug he is given the last third at 4 p. m. At 4 p. m. he is 
given six drops (not minims) of the following belladonna mixture : Tincture 
of belladonna (15 per cent strength), 2 ounces; fluid extract of xanthoxyli, 
1 ounce; fluid extract hyoscyamus, 1 ounce. 

"Give six drops of the belladonna mixture at 4, 5, 6, 7, 8, and 9 p. M. 
Then increase the dose to 8 drops and give one dose every hour until 3 a. m. 
Then increase to ten drops and give every hour until 9 o'clock Monday 
morning; then twelve drops every hour until 3 p. m., then fourteen drops 
every hour until 9 o'clock Monday night; then sixteen drops every hour 
until the throat becomes very dry from the belladonna. 




\ ~ ^jr,*^ 



AMEBIC** MEDICAL AI60CIATI0N PRIZE CARTOON SERIES. I8I3-N0- 8. 



YOU CAN'T FLOAT A SALOON WITHOUT GAS. 

North Carolina Health Bulletin. 
Fig. 144. 



MORPHIN CURE 33o 

"This is dangerously powerful drugging and it should not be under, 
taken except under close observation. 

"Ten hours after the first dose of morphin ( about 1 o'clock Monday morn= 
ing) give five compound cathartic pills and five grains of blue mass. At 9 
o'clock Monday morning give a dose of salts unless the last cathartic has acted 
freely. When the bowels have acted freely — say about 5 o'clock Monday 
morning — give the second round of opium. Half the amount given on 
Sunday afternoon is the amount to be given. It is divided into three 
doses. These are taken at 5, 5 :30, and 6 o'clock Monday morning. 

"Ten hours later, say at 4 in the afternoon, five compound cathartic 
pills and five grains of blue mass are given. After these have acted thor- 
oughly, say about 10 at night, a third dose of opium is given. The amount 
given should be one-sixth the twenty-four-hour quantity used by the drug 
user. The next morning (Tuesday) at 6 o'clock five compound cathartic 
pills and five grains of # blue mass are given. At noon a dose of salts is 
given. About 4 o'clock in the afternoon two ounces of castor oil is given. 

"In most cases the belladonna can be stopped on Tuesday night. During 
Tuesday it is necessary in some cases to give a simple sedative. Care in 
diet and good nursing for several days after Tuesday are necessary." 

We repeat the advice given at the beginning of this article. 

SCELETH DRUG TREATMENT 

During 'the last fifteen years the hospital connected with the Chicago 
House of Correction has treated 3,000 cases of drug addiction, in the main, 
morphin. Since the need for a cure is so great and so immediate just now, 
we give the treatment employed by Dr. Sceleth. 

The patient upon arrival at the hospital is given a full saline purge. 
The medicine used as a bracer during the period of drug hunger is com- 
posed as follows : 

Scopolamin hydrobromid gr. 1-100 

Pilocarpin hydrobromid gr. 1-12 

Ethyl morphin hydrochlorid (dionin) gr. V2 

Fluid extract cascara sagrada M, 15 

Alcohol M. 35 

Water q. s Ad 1 fl. drachm 

If the patient was accustomed to taking more than ten grains of 
morphin a day he is given of this mixture sixty minims every three hours, 
night and day, for six days. On the seventh day the dose is reduced to 
thirty minims; on the eighth, fifteen minims; on the ninth, fifteen minims 
three times a day instead of every three hours. On the tenth day the mixture 
is discontinued and one-thirtieth of a grain of strychnin nitrate is given three 
times a day. On the eleventh day and for six days thereafter one-sixtieth 
of a grain of strychnin nitrate is given three times a day. 

If the patient used less than ten grains of morphin a day the doses 
of the mixture should be one-half those given above. If he used less than 
five grains he can start with fifteen minims of the mixture. 

The use of the remedies must be varied somewhat, according to the 



334 HABIT-FORMING DRUGS 

patient. The best policy by odds for a man who must continue the use of a 
drug is to go to a sanitarium for a cure. If for any reason this is not 
feasible he can succeed in a fair proportion of cases under the care of physi- 
cians in his own home. 

When the drug is withdrawn from a cocain addict he goes crazy. His in- 
sanity lasts a few days and then his mind clears. Cocain users need re- 
straint above every other element of cure. 

Heroin addicts generally suffer from something of the same quality 
of mental degeneration. Watching and restraint are very necessary with 
them. 

In handling morphin and codein users drugs are more important and re- 
straint is somewhat less so. Dr. Sceleth says that when the morphin dose 
is more than ten grains a day close medical supervision is required and 
that at the best some will die. 

Commissioner Brown of Tennessee says thaj; the average daily dose 
of morphin of the morphin addict in that state is 8.8 grains. 

These drug cures are for drug hunger. After the cure comes the need 
for mental and moral training. 

Do Not Take Morphin. — H. H. writes: "The writer is troubled with 
wakefulness for two or three hours every night just after going to bed. 
Usually I drop into a deep, unbroken sleep after that until about 6:30 a. m. 
I retire usually at 10 P. M. or thereabouts. It often seems, no matter how 
late I retire or how dead tired I may be, I must lie wide awake till sleep 
finally comes on. I do not wish to take too extreme measures, but would 
you recommend morphin or opium cigarettes, as I would be rid of insom- 
nia at any price?" 

Reply. — You do not go to sleep until you relax mentally. You must 
stop working- after supper, or whatever else keeps you keyed up. After 
supper take a walk with some agreeable companion, talk about incidental 
things, then play cards for a while, or read something which interests you 
but entirely apart from your day's work. Sometimes a hot bath before 
retiring helps. Don't worry. Worry means mental tension and that means 
insomnia. But as you value your future, take no morphin or any other 
sedative. 

Drug Habit Danger. — F. A. C. writes: "If a strong young man insists 
on taking quarter-grain codein tablets at the constant rate of two or three 
daily, is there any danger of this excessive use of them proving fatal? How 
long could an ordinary heart stand six or seven grains of codein a week? 
What, if any, bad effect would antikamnia- codein tablets have, to replace 
the plain codein? He takes the tablets for headaches, caused, I think, by 
too much eye work, and insists they are not harmful." 

Reply. — Probably they would not prove fatal, and certainly not by 
paralyzing the heart. But the man will soon become a drug fiend and drug 
fiends shortly become so inefficient, incapable, and usually so immoral that 
life is not worth living. Antikamnia and codein tablets are liable to pro- 
duce the drug habit. However, they are more certain to produce constant 
headaches. They poison the nerve cells and the blood cells so that they 
bring about the condition they are supposed to cure and that they do 
sometimes relieve. 



MORPHIN CURE 



335 



Morphin Habit. — C. C. writes: "Do you think it possible for a person 
taking from two and a half to four grains of morphin sulphate daily to 
overcome this habit?" 

Reply. — I do not think it possible. The morphin habit is a worse dis- 
ease than the whisky habit. The person should go into a good institution 
prepared to stay long enough to get built up. Drug users are usually 
neurasthenics and they need mental and nerve upbuilding. 

Must Give Up Morphin. — Mrs. M. C. C. writes : "During an illness and 
afterward for insomnia, a doctor prescribed morphin. Since then I have 
been unable to sleep without it. One-eighth of a grain will insure sleep 




North Carolina Health Bulletin. 



Fig. 145. — Sunlight. 



for two nights. Kindly inform me if this dose will harm me and what will 
be the effect on my system? Can I effect a cure at home? 1 am a woman 
past middle life." 

Reply. — You are taking a small dose. Nevertheless you must stop it. 
You will have no difficulty in curing yourself. Eat sensibly; take a purge; 
repeat in a day or two. Take a warm bath at night; stay in the bath long 
enough to get quiet. Remember that it makes no great difference whether 
you sleep or not as long as you worry and fret. Go to bed and sleep if you 
can, or stay awake if you must, but do not worry. 

Bars Morphin Users. — R. W. writes: "I have three friends who are 
more or less addicted to the use of morphin, and they fear the humiliation 
of exposure when the new law goes into effect on March 1. What should 
they do?" 

Reply. — The Commissioner of Internal Revenue has ruled that drug 
users shall not be allowed to buy the blanks necessary for the purchase of 
drugs. 



336 HABIT-FORMING DRUGS 

Your friends should take a cure. They should have all the moral sup- 
port their friends can give them during the period of readjustment after 
the cure. 

Sleep Caused by Drugs. — F. B. N. writes: "What is the effect on a 
person who for years takes from seven to ten grains of veronal every 
night to produce sleep? Is it harmful to the system in any way?" 

Reply. — It is. It is better to lie awake than to get sleep from drugs. 
Have your physician discover why you do not sleep and then teach you 
mental control so that you can sleep. 

See Doctor First. — H. K. writes: "I was once upon a time troubled 
with insomnia. A doctor prescribed sleeping powders for me to take at 
bedtime about every third day. Would it be advisable for me to take 
them again, perhaps twice a week? Could they do any harm to the heart 
or any other organ of the body?" 

Reply. — Do not take sleeping powders on your own account under any 
circumstances. 

Don't Take Soporific. — M. E. S. writes: "When I work hard I cannot 
go to sleep for from two to five hours after I go to bed. I have been taking 
veronal. Is it dope? Shall I form a habit? I am a woman of 67." 

Reply. — 1. Veronal is not dope in the sense that the word is generally 
used. Its use is not regulated by the Harrison Drug Act. At the same time 
my advice is that you do not use veronal to produce sleep. It will not help 
you, but will harm you. This statement holds true of every medicine used 
to produce sleep. 

Be quiet after sundown, and you will sleep as much as you need to. 
Eat a light supper. 

A woman of 67 does not require much sleep. If she will retire quietly 
after a quiet evening, determined to be content with whatever comes in the 
way of sleep, she will find that sleep will arrive. 

Don't Take Bracers. — G. T. writes: "I understand nux vomica is a 
good stomach and nerve bracer. Will strychnin tablets give the same 
results? Same thing, isn't it? What's the dose? Are caffein tablets as 
good a stimulant as coffee?" 

Reply. — 1. The effect is about the same. One-sixtieth grain. 
2. Yes. 

Let me advise you as emphatically as I can not to use nux vomica, 
strychnin, or caffein, or any other drug as a stomach and nerve bracer. 

Heroin Derived from Opium. — A correspondent sends us a clipping 
from a Pittsburgh paper in which it was stated that the school children 
of that city were becoming addicted to the use of heroin. The correspond- 
ent wants to know what heroin is. 

Reply. — Heroin is derived from opium. It is as dangerous and as 
prone to cause a habit as is morphin. 

An Opium Fiend. — H. L. M. writes: "Will you kindly write of the 
effects of codein upon the system and character of a person who uses codein 
tablets at frequent intervals to quiet pain." 

Reply. — Codein is derived from opium. Its effects are not very dif- 
ferent from those of morphin. To make matters worse a good part of the 



COCAIN FIENDS 337 

codein on the market contains a considerable percentage of morphin. 
A codein addict can figure that he is an opium fiend. 

When to Use Codein. — Anxiously Waiting: "A nurse wants to know 
why codein is frequently combined with morphin in prescriptions." 

Reply. — There is no reason. It would be wiser, when morphin is 
needed, to give it in its proper dose. Codein is derived from opium, as is 
morphin, and has about the same effect. 

Starts Drug Habit. — M. G. writes: "Will you please tell me whether 
common baking soda, taken frequently for distress in the stomach, is 
harmful?" 

Reply. — It is. It begets a drug habit. It makes the original condition 
worse. It substitutes an improper curative method. 
Relief — a proper one — removal of the cause. 

Drug Habit Effect. — A. F. G. recites the story of a painter arrested for 
stealing. The defense of the man was that for eight years he had been a 
drug fiend, using morphin, cocain, heroin, and aspirin. A. F. G. wants to 
know if the use of aspirin would cause the effects claimed above. 

Reply. — Any drug habit will cause moral degeneration. Cocain is 
especially effective in this way ; so is morphin. Aspirin also causes a habit. 
However, the probability in this case is that cocain and morphin are 
responsible. 

COCAIN FIENDS 

There is no excuse for the cocain habit. Cocain has no place in medicine 
and but a limited place in surgery. Any discomfort relieved by cocain will 
be worse in three hours than it was before cocain was used. When a team 
is laboriously dragging a wagon uphill, from time to time the driver will 
"scotch the wheel" to give his team a chance to catch their wind. Some 
medicines "scotch the wheel" to give nature a little resting spell. Not so 
cocain. 

Any man who uses cocain to relieve any discomfort or allows it in 
any proprietary or patent remedy used by him or allows any doctor to use 
it on him is just an everyday fool. A surgeon may use it to remove a 
cinder or to operate on an eye or nose, but that is no reason why a patient 
should use it or allow it to be medically used. The only excuse for the 
cocain habit that has any standing is that the subject is a neurotic and if 
he does not do one half crazy thing he will do another. Developed "coke" 
fiends are willing enough to admit this as the reason for their habit, but 
no potential "coke" fiend would care to offer it as a reason for taking the 
drug. 

There is more deliberation, even what we might call malicious intent, or 
weak, wabbly, neurasthenic indecision about cocain addiction than there is 
about opium or alcohol use. 

Many take opium because they have not the grit to stand pain, and 
they fail to recognize where they are going. Most cocain fiends know 
well enough where they are headed for, or think they do, but their miserable, 



338 HABIT-FORMING DEUGS 

poor-working minds tell them it is better to fly the ills they have and take 
what comes. 

The cocain fiend, when in his drug, is able to forget, and that is about 
all that can be said in its favor. There is none of the grandeur of alcoholism 
or the dreams of morphinism or the fantasies of hasheeshism. No literature 
or anything else has ever been produced by the "coke" in his drug. He is 
negative, that's all. Deprived of his drug he is as free from any conception of 
rights of property and morality as is the opium fiend and nearly as free 
from any conception of the right of life as is the man suffering from acute 
alcoholism. 

Therefore, whether you look on the one side or the other, the "coke" 
addict does not present an attractive picture. 

We quoted Dr. Crothers as saying that one-third of the opium is used 
for legitimate purposes. Not one-thirtieth of one-third of the cocain is 
so used. 

What can be gained by warning against the careless use of cocain is 
small, as compared with the use of morphin. Nevertheless, some people 
get the habit through carelessness. Asthmatics and hay fever sufferers 
are in some danger. Snuffs, sprays, and cures sometimes contain cocain. 
Occasionally a physician will prescribe it. 

Again — no circumstances warrant the medical use of cocain. Its surgical 
use is never warranted, except for a definite operative procedure. 

Can a cocain fiend be cured? Yes, it is one of the easiest of all habits 
to cure while under treatment. The method is as follows : 

Confinement is necessary. The man deprived of his cocain will probably 
become delirious. He may become maniacal and definitely insane. He may 
develop a tendency to run amuck and kill and destroy. He must be under 
close, compelling control. He should have very free, in fact excessive, 
purgation. For his nervousness he may have morphin or other sedatives at 
the discretion of his physician. After two or three days the drugs will 
be out of his system. He will be freer from craving for drug than the 
man just cured of the alcohol habit or the morphin habit. 

The cocain fiend is the craziest of all fiends when his drug is first 
withdrawn. He loses his craving quicker than does any other fiend. But, alas, 
he is most apt of all fiends to resume his habit. 

He was a neurotic before he began the use of the drug. Having been 
cured of his drug habit, he is still a neurotic. He is very apt to dig up an 
excuse for again becoming a fiend. 

Cocain Habit. — W. O'D. writes: "1. Is there any cure for the cocain 
habit? 2. Is a person so addicted and having a violent temper liable to do 
anyone injury? 8. Kindly give me the name and address of a journal 
on nervous diseases" 

Reply. — 1. Yes; sanitaria for the cure of drug habits cure the cocain 
habit sometimes. Of all habits it is about the most difficult to cure perma- 
nently. 

2. Yes. 

3. Journal of Nervous and Mental Diseases, published in New York 
City. 

Do Not Use Cocain. — Miss C. writes: "In your article on insanity last 



THE ALCOHOL HABIT 339 

Sunday you referred several times to cocain. I am troubled with hay 
fever, and for a number of years I have been talcing treatments each season 
from a physician who uses each day a spray in my nostrils containing 
cocain. He also gave me some to take home, to use when my 'nose is 
stuffed' He did not tell me it was cocain until I asked him as I had heard 
it was harmful, and I found I had to use it more often each year, and on 
dusty days as well as during the hay fever season. The doctor assured me 
there was no harm or danger so long as I used the 'pure drug.' He said 
there is no such thing as the 'cocain habit/ It is the 'morphin habit' that 
is bad. He says anyone can easily stop using cocain if he wishes to. Are 
his statements correct? The spray is so soothing that I do not wish to stop 
unless it is harmful." 

Reply. — The most dangerous of all habits is the cocain habit. Do not 
use cocain regularly, regardless of who tells you to. Stop the spray. 

THE ALCOHOL HABIT 

The alcohol habit is much more appealing than the other habits. It 
narcotizes certain adverse impulses, puts "bogies" to sleep, and infuses "Dutch 
courage." There are certain mental attitudes and certain types of mind 
that are harmonized into greater effectiveness by it. 

While I cannot see why cocain should tempt anyone, I can under- 
stand why even a fairly smart man could be lured "into the marsh" by 
alcohol. It is much easier to escape its clutches than it is to get loose 
after opium has you. This point is no mean factor, as a large part of the 
"addicts" genuinely feel that they can break away when they get ready. 
Some of them do. Most of them could, but they never get ready. Some of 
them suffer from an egomania due to alcoholism. Their drink makes them 
weak minded, and, at the same time, gives them an exaggerated idea of their 
power over themselves. 

A man with the alcohol habit is a sick man, however much he may 
think to the contrary. He is mentally sick. He may have inherited a 
mental make-up which makes it strongly probable that he will be a drunkard, 
or it may be the fault of bad social training. Usually, however, the disease 
develops as the result of what it feeds on. The man's mentality becomes 
perverted through chronic alcohol poisoning. 

Alcohol has fuel value, but no food value. Its poisonous qualities over- 
shadow its fuel value. It has no toxin neutralizing power. It is no longer 
used by well informed people for snake bite, or consumption, or blood poison- 
ing. Where it is a question of keeping a person alive for, say, four hours 
in some crisis disease, its use may be justified, but to keep a patient upon it 
for days or perhaps weeks in typhoid or pneumonia is unwise. Even as a 
stimulant, aromatic spirits of ammonia is better. 

There is mighty little, if there is any, place for alcohol in medicine. 
But alcohol as a medicine is not an important source of drunkenness. 
Drunkards are made by the drink which is taken because it makes one feel 
good. 

The harm of addiction to headache powders is pretty nearly limited to 
the habitue. Alcohol is different. A pebble dropped into the water causes 
a ripple that affects the entire mass. The alcohol habit ripples out, affects 



340 HABIT-FORMING DRUGS 

the family, and then society. The crimes of alcoholics are crimes against 
society. 

The drug end of cures does not amount to a row of pins. Just as whisky 
affects the mind of the drunkard and the lives of those around, the cure of the 
habit is mental and social. The drug end of "jag" cures is a minor detail. 
The items which count are suggestion and mental training followed by proper, 
continuous, and sustained social help. 

WHISKY AND HEAT 

The scene was a sleeper on a Frisco train between Memphis and Birming- 
ham. It was 11 o'clock on a hot morning in June. The thermometer 
had registered over 90 for several days. A fairly fat passenger sat in the 
smoking compartment. He was in his shirt sleeves. By taking things easy 
he managed to keep fairly cool. When the train stopped at Tupelo he 
bought a lunch from a basket. 

"Do your sandwiches contain a whole chicken apiece?" he asked. 

"Some of them have a half chicken," was the reply. 

"Then give me one with half a chicken in it." 

He bought his lunch and returned with it to the smoking compart- 
ment. , 

The "butch" came along and sold our fairly fat friend a bottle of 
a non-alcoholic beverage. He opened his grip; took out a full quart 
of whisky; poured three fingers into a cup; filled the cup with the pur- 
chased beverage, and drank it down. He offered me a pull at his bottle. I 
declined. 

He ate his lunch, including the half a chicken. Then he began to sweat, 
and the sweat fairly rolled. In half an hour he was as hot as a broiled 
lobster, and as wet as a dishrag. 

Now, why did he do it? He was not on a jag. He did not have a 
"still on." His mind was as clear as a hell. He knew what he was doing. 
It was not sociability, or to he a good fellow, or to he swagger. He did it 
because it was coming lunch time and he was of the opinion that a nice little 
drink and a lunch would make him happy, comfortable, and contented. His 
judgment was poor, and he paid the price. 

To drink whisky on a hot day is like throwing kerosene on a fire. 
Within a few minutes the whisky was circulating in his blood and burning 
to form heat. Furthermore, it was sending the blood into the skin, and 
an excess of hot blood in the skin makes one feel hotter than he is. Whisky 
cannot make anything but heat and energy, and, when a man sits quietly 
in a sleeping car, all of the whisky goes to heat. Then he added the meat 
lunch. 

There are those who claim that the act of digesting makes heat. The 
best opinion seems to be that, while the act of digestion does not of itself 
produce heat, in the process of digestion foods, especially meats, immediately 
liberate some heat. At any rate, after eating the amount of heat made 
by the body increases. 

This man had to spend some hours in that hot car. He should have 
figured on how to keep cool. He could not get any exercise except the exercise 



THE ALCOHOL HABIT 341 

of breathing, sitting up, and a few similar acts. He needed little food to 
repair waste. He 'certainly needed no whisky. 

Had he been a man of good judgment he would have gone without his 
noonday meal or eaten an apple or orange and drunk a lemonade. He would 
have drunk about six glasses of water between breakfast and supper. By 
following that plan he would have had a comfortable ride. 

RULES FOR GETTING DRUNK 

Mike, my Italian fruit peddler, told me some time ago that when the 
former mayor of Chicago was defeated at the primaries he, Mike, celebrated 
by getting drunk. He said, furthermore, that if a certain candidate were 
elected in April he proposed to celebrate that victory by getting drunk. He 
had already put aside ten dollars for the purpose. 

If a fellow feels that he must get drunk he might as well go about 
it in the right way. The early spring is a bad time to go at it in the wrong 
way. Pneumonia is liable to follow a March-April drunk, and the natural 
sequence of drunk pneumonia is death. 

Now, the Mikes I know are good people. Their families need them, 
and I need a fruit peddler. Therefore I am going to lay down some rules for 
planned drunks. 

He should prepare for a drunk by taking a purge. 

He should not get drunk when he has a cold. It is not safe to go on 
a drunk even if the aching stage of the cold has passed and nothing is left 
but a hard cough. 

He should rest up for a day before starting in, or, to put it another 
way, not get drunk when tired. Great fatigue lowers resistance against the 
pneumonia germ, and one resistance lowerer is as much as a man should 
stack up against. 

He should eat from time to time while he is drinking. 

He should drink only in clean, well-ventilated places. To hang around 
a hot stove in a close room with a sawdust sprinkled floor, drinking booze, 
is to hang out the "Welcome" sign to pneumonia germs. 

Before his brain quits working he should arrange a place in which to 
spend his unconscious period. It should be a cool, well-ventilated room. It 
is necessary that he should not be chilled through, and therefore he must 
provide bedclothes enough. It is just as necessary that he should not be 
overwarm; therefore he must raise a window. 

He will save inconvenience and trouble and lessen his danger if he will 
vomit before he falls off. The disposition will be present. All he needs 
to do is to let it come up. 

When he wakes up he will have a headache, a dark brown taste, and a dry 
cough. His first act should be to take a purge; a second dose within that 
first twelve hours is advised. One should be a dose of calomel or some com- 
pound cathartic pills; the other can be a saline. He should drink freely of 
water, carbonated and plain. He should take one dose of headache medicine. 
This should not be repeated. 

It is time now to take some nourishment — a glass of milk, a cup of clam 
broth, and a cup of coffee; then a package of chewing gum. 



342 HABIT-FORMING DRUGS 

He should wrap up well and get some exercise in the open air. 

He should take no medicine for his cough. When the purge acts 
well his cough will go. 

He will feel "all shot to pieces" and his natural impulse will be for 
a bracer. The bracer he craves may be ale or sour beer or whisky. He 
should cut out his bracer. A cup of coffee or a pint of milk will serve him 
better. 

Periodic Drinkers. — S. B. writes : "I have a friend 30 years old who is a 
periodic alcoholic. He has taken two liquor cure treatments, hut was re- 
lieved for only a short time. The attacks, which at first were several 
months apart, are becoming more frequent. What is the best treatment 
for this trouble?" 

Reply. — There is nothing left to try but religion. A strong dose of 
that may save him. Periodic drinkers are mentally wrong. These cures 
nauseate and disgust and then clean out the alcohol, which steps simply 
clear the decks, clean off the ledger, or any other way you want to put it. 
Then comes the real treatment in such cures. It is applied psychology or 
the use of fear, shame, disgust, hope, family love, pride, and finally deter- 
mination and grit. What is being worked out is training of will. Often 
the combination succeeds; often it fails. If a man is capable of being 
powerfully gripped by religion, he can shortcut quickly from condition to 
cure. If a man is so made up mentally that he cannot be reached in any • 
of these ways, he cannot be cured. Some day the community will perma- 
nently detain the incurable periodic alcoholics. 

Whisky and Alcohol. — M. H. F. writes: "A few weeks ago I was called 
to the country to see a patient whom I found in a state of collapse. I felt 
the necessity of using an alcoholic stimulant in the case, but had neither 
whisky nor brandy with me. I had, however, a small bottle of grain alcohol 
and used that properly diluted. A few days ago the question arose as to 
whether the use of diluted alcohol by an habitual drinker would be more 
harmful than the same amount of whisky, the percentage of alcohol being 
the same. I find that the impression, even among the medical men, is that 
alcohol, no matter how pure it may be, is much more harmful than good or 
even common grades of whisky. What is your opinion?" 

Reply. — Alcohol diluted to the percentage of the alcohol contained 
in whisky is no more harmful than whisky. The alcohol contained 
being the same, the effect for the various purposes is only a matter of 
quantity. 

Aromatic spirits of ammonia is generally used now for a diffusible 
stimulant rather than whisky or other forms of alcohol. Emergency kits 
and ambulance and hospital equipments have nearly all been changed in 
this particular. 

Drink Habit. — Mrs. J. G. S. writes : "Is the drink habit a disease, and 
can it be cured by some treatment which can be taken in the home? If not, 
what treatment would you advise?" 

Reply. — It is a disease. Sometimes it can be cured at home. Fre- 
quently, it is necessary for the patient to stay in an institution until he has 
got his nerve back. Most drinkers are neurasthenics and need some mental 
upbuilding to be cured so as ito stay cured. 



SMOKING 343 

Cures for Liquor Habit. — E. R. writes: "I am S2 years old and a 
heavier drinker than I care to be. Do you advise the Keeley cure, the Neal 
Institute, or the Gatlin cure? What is the difference in treatment of the 
three? Are there undesirable physical effects, or any physical effect other 
than the quenching of a thirst for alcohol?" 

Eeply. — As these treatments are secret, it is impossible to answer sev- 
eral of your questions authoritatively. My opinion is that the basis of 
practically all treatments is to stimulate elimination and to provoke nausea 
or disgust with alcoholic beverages. To do this drugs are employed. After 
these ends have been accomplished the next step is to build up the determi- 
nation to quit. I am sure this important part of the treatment is psychic. 
Therefore residence in an institution where one is thrown with people who 
are determined to get well and who are getting well is of great advantage. 
The longer this psychic treatment is continued the surer are the results. 
I do not believe there are any harmful or undesirable physical effects. 



SMOKING 

The use of tobacco does no good. Therefore, there is no reason why 
any person should plan to use it. Used in small amounts by grown persons, 
it does no harm, and, accordingly, there is no reason why any adult should 
not use it in moderation if he so desires. It is just as useless and just as 
harmless to women as to men, and, therefore, there is no physical reason 
why women should or should not use it. There is no more logic in 
different tobacco standards for the sexes than there is in different morality 
standards. 

Heavy lasers of tobacco excrete it from all parts of their bodies. This 
means that every cell in their bodies is bathed in the products of tobacco. 
The cells of matured tissues will stand a great deal of this, and for a 
long time, before plainly diagnosed harm is apparent. The tissues in which 
harm is most apparent are certain nervous elements. 

Tobacco blindness is due to degeneration and final destruction of the 
optic nerve. Tobacco heart is a term applied to a heart which is irritable. 
It is the result of degeneration of the heart nerves. 

Tobacco juice in the mouth is not an antiseptic. It does not hill germs 
nor keep the tonsils or teeth clean. The same is true of tobacco smoke. 

Tobacco users are usually spitters, and thus, indirectly, harm is done. 

There are those who believe that they can sit down and think more 
deliberately and with better judgment when smoking than when they are 
not. There is nothing in the effect of tobacco which is responsible for this 
difference. It is suggestion, a psychological phenomenon. Nevertheless, 
to them it is a fact which cannot be questioned. 

There is no more harm in cigarettes than cigars or pipe tobacco. In the 
main, the tobacco in cigarettes is not of a high grade. No chemicals are 
mixed with it except a small percentage of glycerin. As it is a light smoke, 
there is a greater disposition to inhale than when cigar or pipe smoking 
is indulged in. 

The main objection to cigarettes is that they especially appeal to boys 
with immature, impressionable tissues and with habits in the forming. There 



344 HABIT-FORMING DRUGS 

are very grave objections to the use of tobacco by children and youths. This 
forms the strongest argument against cigarettes. 

This is about as judicial a weighing of the tobacco question as we can 
write. Young people should not smoke. Cigarettes should be discouraged, 
because of the moral effect on young people. 

Women have as much right to smoke as men. There is no reason 
why anybody should smoke. There is no reason why the average adult 
should not smoke if he wants to. 

When a smoker is becoming nervous or has an irritable heart or is 
going blind he must stop or pay the penalty. 

Tobacco and Capacity. — Dr. D. S. Hager writes that Dr. Evans has not 
studied the tobacco question, else he cannot understand why he, as a physi- 
cian, is not absolutely opposed to it. The immediate effect is nausea, 
vomiting, depression, and sometimes unconsciousness. The chronic effects 
are high blood pressure, arteriosclerosis, and sometimes apoplexy. Dr. 
Carjaval has written a book telling of the harm which tobacco does to 
Mexican youths. This book, issued by the Interior Department of the 
Mexican government, was recently reviewed in the Journal of the Ameri- 
can Medical Association. He says that the habit is acquired through ex- 
ample, and no man should lightly do that which his neighbors will ape him 
in to their detriment. 

Reply. — There is truth in Dr. Hager's criticism. Any man who steeps 
himself in tobacco will be harmed materially. The man who takes a mod- 
erate amount will be harmed a little. 

Athletes* in training are never allowed to use tobacco. No man who 
expects to be called on to use 100 per cent of his capacity is justified in 
using tobacco. The athlete making a jump which requires all his muscle 
power should not use it. The runner who is going to use up every ounce 
of stamina in a mile race should not touch it. 

Ordinarily, however, heart work, kidney work, muscle work is done 
on about 10 per cent of capacity, and 90 per cent is held in reserve — the 
principle which has been economical in the use of boilers. 

For the purposes of the man who is running under low pressure the 
moderate use of tobacco does no harm. To work under high pressure is 
worse than using tobacco. 

Whenever disease has knocked down capacity until the margin of re- 
serve is about used up tobacco in moderation is harmful. The point about 
example is well taken. 

Not Justified in Smoking. — N. S. C. writes: "Will you kindly write 
about the ill effects of cigarette smoking, especially upon a man of 25, 
broken down in health after an attack of pleurisy two years ago and then 
sent to Colorado, where the lungs improved? When better he resumed 
smoking cigarettes against his physician's advice, and has great throat 
trouble now. Is very thin, only weighing 120 pounds, though six feet tall. 
His father died of tuberculosis. He has a wife. Does not drink and has 
ability to work; only needs health. Cigarette smoking is undermining 
this." 

Reply. — A moderate amount of cigarette smoking does not materially 
harm a full-grown man in good health and living well within his physical 



SMOKING 345 

powers. If it gives him pleasure the harm done will not be enough of a 
disadvantage to offset it. But cigarette smoking does harm to: 

Boys and young men who have not attained their physical stature. 
Particularly does it harm adolescents. 

Athletes or anyone who must at times use his heart muscles or other 
muscles to their full capacity. 

Nervous people, particularly those with nervous hearts. 

A man who has broken down from pleurisy, weighs 120 pounds, and 
is six feet tall, has had to go to Colorado for his lungs, who has a tubercu- 
lous family history, is not justified in smoking. 

Giving Up Tobacco. — Repentant writes: "I am 66 years old and in 
fairly good health. I was married at 20. I have chewed tobacco ever 
since I was 21. I smoke a pipe a great deal. My wife, a refined woman, 
has always seriously objected and felt I wronged her and the babies by 
polluting the air they were compelled to breathe, and she has felt disgust 
for kisses from tobacco lips. In fact, tobacco has seriously marred our 
otherwise happy life. My daughters feel humiliated and ashamed of their 
old dad, and I am ashamed of myself, and would like to do one decent thing 
before I die and quit. Can I quit with safety? Will it impair my health 
or shorten my life? I want to quit, but am afraid my will power will not 
carry me safely through. Is there anything that will help me? Do I need 
a tonic? How long will it take to get the nicotin out of my system? 
Will my brain ever be as clear and quick as though I had not used the 
weed'?" 

Keply. — 1. Yes. 

2. No. Assuming that you are a tobacco fiend, continuing your habit 
may impair your health and shorten your life. Stopping will not. Those 
habit cases which show impairment after stopping were impaired by the 
drugs and not by the absence of them. 

3. All habit cures operate through the mind. You will succeed, if you 
have confidence in your success and determination enough to put up with 
the inconvenience while you are ridding yourself of the habit. 

4. Your physician must decide that. 

5. Practically speaking, you will have the "nicotin" out of your system 
in, say, three days. It will take some weeks, say two, for your poisoned 
nerves to get back their normal chemistry. You will be months getting 
your habits readjusted on a non-tobacco basis. 

6. The good effects of tobacco on the mind are the results of suggestion. 
As an illustration : The man who takes a pipe composes himself and thinks 
calmly; does it, not by reason of any medicine, but because of autosug- 
gestion. He has trained himself to the routine pipe — calm thinking. 
If, when he stops smoking, he retrains himself to the same degree of 
efficiency by using some other method of suggestion, his brain will work 
satisfactorily. Quitting and getting on a new basis are both up to the 
man. 

Woman and Tobacco. — M. L. writes : "Is cigarette smoking harmful to 
a woman s health? If so, how? Do you consider smoking among women a 
sign of degeneracy? Could one or two cigarettes a week bring injurious 
consequences in the future, either for oneself or one's children?" 

Reply. — 1 and 2. The degree depends on the woman's age and the num- 
ber smoked. If she is mature and the number smoked is not excessive, the 



346 HABIT-FORMING DRUGS 

• 
habit will decrease her capacity for extreme sustained exertion, but as the 
smoking woman is usually a loafer, she will not be troubled. If she is im- 
mature it will harm her more. If she is a fiend it may give her tobacco 
heart or tobacco blindness. 

3. No. 

4. The only injurious consequence in the future will be an increase of 
the habit, almost to a certainty. It will have no effect on the progeny. 

Should Stop Smoking. — W. J. writes: "I am a hoy 17 years old. I 
weigh 145 pounds and my height is 5 feet 10 inches. I had acute inflam- 
matory rheumatism last winter, and I was unable to use my right arm for 
eight weeks. I find when the weather is damp it troubles me now. I smoke 
cigarettes, sometimes two packages a day. I also smoke cigars. I am in- 
clined to be round-shouldered. I do office work. Will smoking weaken my 
lungs and heart, or what effect does it have on rheumatism, if any? I am 
also troubled with nose bleed. What exercise would increase my chest 
measurement?" 

Reply. — There is not much use in talking about exercises to increase 
the chest measure to a boy of 17 who smokes two packages of cigarettes 
and some cigars a day. The do-as-I-please-regardless frame of mind is 
pretty well established. But here goes. 

Your rheumatism comes from, your tonsils, teeth, gums, or nose in all 
probability. Go to your physician and have that attended to. It is certain 
that he will tell you to stop smoking. Then go to a gymnasium and have 
them put you to work at climbing, chinning, and bar exercises to develop 
your back muscles. They will also tell you to stop smoking. 

Quit Smoking. — Reader writes: "A friend who has neurasthenia has 
quit smoking, but, of course, still has the desire to smoke again. He has 
tried several times, but it seems to make him nervous; he can smoke out' 
side with apparently no ill effects, but when he smokes in the house or 
office it makes him nervous, although he believes that he brings it upon 
himself more than the cigar does. 

"The trouble seems to be all in his throat, chest, and back of his neck; 
he feels 0. K. but for the occasional worries and moods that make one who 
has neurasthenia so miserable. 

"Do you think that three cigars a day would harm him and do you 
think they would tend to make him worry more?" 

Reply. — As I understand your description, your friend is a neuras- 
thenic who is nervous over trying to make a decision whether to smoke or 
not, and he is nervous whether he smokes or does not. It seems to me that 
he is suffering from the typical indecision of the neurasthenic. When 
he definitely decides and .quits thinking about it his nervousness will 
end and that without much regard to whether he decides to smoke or 
not to smoke. 

The wise policy for your friend is to decide not to smoke — to decide 
it once for all and quit thinking about it, whereupon his worries will 
end. . 

Neurasthenics have no business tampering with drugs. Tobacco is a 
drug. 

Tobacco Stunts Growth. — Mrs. H. M. C. writes: "Please inform me 
whether smoking a pipe or cigar, when about 16 years old, will stunt one's 
growth. What other effect is possible?" 



SMOKING 347 

Keply. — 1. Yes. 

2. May cause nervousness, nervous heart, cough, indigestion, and to- 
bacco habit. 

Cigarettes of No Benefit. — B. C writes: "Please advise a cigarette 
smok&r of years the reason and remedy for quitting it. Can it he done 
without much physical discomfort? 

Reply. — Cigarette smoking does nobody any good. Many who smoke 
cigarettes never feel the harm done; others do. To quit requires grit. 

Inhaling Smoke. — R. W. H. writes: "I. Kindly explain the harmful 
effect on the lungs of inhaling tobacco smohe. 2. Also please state the 
amount of nourishment in bananas." 

Reply. — 1. The harmful effect is not exerted on the lungs. The warm 
smoke unduly dries the upper breathing apparatus, but not the lungs 
proper. The harmful effects of tobacco are exerted especially on the nerves. 
The nerves most frequently affected are those of the heart. 

2. We eat about two-thirds of the banana. About one-quarter of what 
we eat is sugar and starch. As a food it compares fairly well with potatoes. 

Smoking Harms Sight. — T. L. J. smokes pipes and cigars and inhales 
the smoke. He wishes to know if it harms the sight. 

Reply. — Excessive smoking may harm the sight. It is an occasional 
cause of blindness. Careful eye specialists can detect the effects on the 
eyes of tobacco excess. Generally cases of partial tobacco blindness begin 
to improve within two weeks after the drug is stopped. 

Will Alone Suffices. — J. W. J. writes: "When about 12 years of age I 
began smoking cigarettes and continued to do so until I was 22 or 23, 
at which time I substituted a pipe and strong tobacco. Since then, ten 
years ago, I have begun chewing also. I now chew and smoke strong 
tobacco. I have both the will power and inclination to quit the use of 
tobacco, but fear to do so without first taking something to rid my system 
of nicotin. Would it be harmful to quit abruptly without taking anything 
to rid my system of nicotin?" 

Reply. — If you have the will power to quit, quit. Your system will 
take up the job of ridding you of nicotin. It has been doing it, and it is 
well trained by now. It will not be harmful to quit abruptly. The will 
power's the thing. If you have that, you need use nobody's remedy. 

Chewing Tobacco. — J. H. K. writes : "I know a man who chews tobacco 
without spitting. He has poor eyesight. Otherwise he appears to be in 
normal condition. Is it likely that there is any connection between his 
habit and the condition of his eyes? If so, in what way does the effect 
reach the eyes; and what is likely to be the effect on the general 
health?" 

Reply. — The man probably chews slowly, and some of the juice is swal- 
lowed and some absorbed. I do not know whether or not his poor eyesight 
is due to his habit, but the use of tobacco frequently impairs the sight, 
and sometimes causes blindness. The tobacco solution gets into the blood 
and is carried to the different tissues in the body. The tissues are able 
to stand a pretty good dose of it. It acts especially on the nerves. The 



348 HABIT-FORMING DRUGS 

optic nerve carries sight impulses from the eye to the brain. Sometimes 
tobacco causes this nerve to degenerate, and, rarely, it causes blindness 
through atrophy of this nerve. 

Tobacco and Weak Heart. — E. W. S. writes: "1. Would 5 cents' worth 
of chewing tobacco a week be injurious to a person with heart leakage? 
2. Is a person with a weak heart liable to be troubled with insomnia? 3. Is 
a person with a weak heart apt to be troubled with nervousness? Jf. Should 
a person with heart leakage take much exercise, and what kind is best? 
5. Which is more injurious, smoking or chewing tobacco? 6. Would one 
or two glasses of beer daily be injurious to a person with a weak or 'leaking' 
heart r 

Reply. — 1. No. 

2. No; not until heart asthma comes on. 

3. No; not particularly. 

4. A person with a leaking heart valve must take enough exercise to 
keep his muscles strong. He needs individual medical counsel. . 

5. Generally smoking, though it depends on the quantities consumed 
and the habit as to inhaling. 

6. No. 

Tobacco Heart. — A. M. S. writes: "I am 32 years old and have the 
appearance of being in the best of health. I have a good appetite but have 
suffered with rheumatism nearly fifteen years. During the day my heart 
beats at least 100 times a minute. I smoke a lot, but when I was not 
smoking I was in the same condition. I also have pains at my heart. I 
drink a lot of water and this seems to make me feel better. I seldom use 
strong drink." 

Reply. — Any man whose heart beats 100 should have an examination 
by a physician capable of discovering the reason why. My guess is tobacco 
heart, but this is only a guess. If you will quit smoking, quit drinking 
strong drink, and eat less, you should lose some flesh. Slow up your pulse 
and have less of what you call rheumatism. 

Tobacco and Hearing. — D. 8. H. writes: "As a specialist on the ear, 
nose, and throat, I am thoroughly convinced that an enormous amount of 
damage is done by constant irritation to the pharynx, and therefore to the 
eustachian tube. In fact, I am convinced that if the irritation from ton- 
sillar inflammation, bad teeth, and the irritating effects of tobacco were 
eliminated, men and women would retain their hearing much longer and 
have a better quality of sound perception. I helped to examine 7,000 train- 
men on the Sante Fe railway two years ago for sight, color sense, and 
hearing. I was told beforehand that trainmen, from the noises they 
were subjected to, had bad hearing, but after this examination I 
was compelled to think that the aforementioned causes had more to 
do with the loss of hearing in these men than had ever been thought of. 
Illustrating: Nearly every man whom I examined, no matter how long 
in the service, if he had good, clean teeth and was a non-user of tobacco, 
had good hearing, while the reverse was true of the chronic conditions 
from either bad teeth, bad tonsils, or tobacco irritation. It is not an infre- 
quent occurrence to have patients in the specialist's office with sore throat 
that can immediately be attributed to excessive tobacco irritation." 

Graving That Persists. — J. W. R. writes: "Will you please tell me 
about how long one must abstain from the use of tobacco in order to cease 



SMOKING 349 

craving for it? I began smoking at 17. At 27 I left off entirely for four 
years. At 31, still craving the drug, I resumed smoking and have smoked 
ever since. I am now 51." 

Reply. — The kind of craving you had would not stop in 100 years, 
assuming that you kept going that long. When one stops the use of a drug 
the cells affected by that drug cry out. It is a species of hunger. In a 
few days, say two weeks at most, that craving has passed. 

The craving that persists is a form of mental unrest. It is not a crav- 
ing for tobacco especially. It is a form of mental perversion which calls 
for something, some drug maybe, and, if so, any other drug will answer, 
or any habit. You are 51. Be a man. 

Danger from Cigars. — W. T. N. writes: "Will you kindly state whether 
there is much, if any, danger of disease being transmitted through the 
putting of cigars in one's mouth?" 

Reply. — Some cigarmakers still practice the nasty habit of shaping 
the cigar end by moistening and rolling it between their lips. Again some 
smokers put their cigars in their mouths and then clip the end with the 
cutting machine. The next man does the same thing. In this way the 
cigar cutter may become a source for the spread of disease. 

Cigarette Habit Cure. — R. T. B. writes: "Will you kindly advise where 
Dr. Kress's cigarette cure can be purchased? If it is not on the market, 
please publish the prescription. I am sure it would do much more good in 
this manner than that in which it is being tried out now in the anti- 
cigarette crusade." 

Reply. — The treatment is as follows : 

"The mouth wash calls for six ounces of silver nitrate solution, one- 
eighth to one- fourth of 1 per cent. Use as a mouth wash after each meal, 
not to exceed three days ; then after breakfast only for not more than four 
days. Do not swallow any of the solution. 

"Chew gentian root (not the powder) whenever the desire for smoking 
appears. Gentian root is slightly tonic and an aid to the digestion. It 
may be used for several weeks without injury. 

"The diet for the first two weeks consists exclusively of fruits, well- 
baked cereal foods, and milk. The moderate use of nuts, well masticated, 
is of value. At the close of each meal use fresh, slightly acid fruits, such 
as peaches, pears, apples, pineapples, etc. Drink sweet milk, buttermilk, 
malted milk in place of coffee, tea, or cocoa. 

"In some special cases an entire milk diet for a few days may be bene- 
ficial, especially if there exists an irritable stomach, bordering on ulcera- 
tion, with excess of hydrochloric acid. Where the digestion is slow and 
there is a deficiency or absence of free hydrochloric acid, a diet composed 
entirely of fresh fruits for a day or two preceding the grain, fruit, and 
milk diet, may be of benefit. 

"Baths, preferably the Turkish bath, will assist in rapidly getting rid 
of stored-up nicotin. As a rule, it takes from three to six weeks to elimi- 
nate entirely the desire for tobacco. The time depends upon how closely 
the directions are followed." 



Use of Snuff. — 31. B. writes: "Has the use of snuff any effect on one' 
health or nervous system? 



,-)!> 



350 HABIT-FORMING DRUGS 

Reply. — The use of snuff is one of the mild vices of mankind. The 
habit is not a commendable one. Moderately used, it is not positively in- 
jurious. The catarrh snuffs frequently contain cocain and are therefore 
highly injurious. 

COFFEE 

Coffee is a drug. Those who are addicted to its use are drug addicts. 
The people of the United States are among the largest users of coffee of all 
the people of the world. Its use is on the increase. 

From the standpoint of public hygiene the coffee question is worth while. 
It is much the most widespread form of drug addiction. Some people are 
certain that coffee is of service to them. Some are equally certain that it 
harms them. Many are much interested, though they are in doubt as to 
whether it benefits or harms them. The largest number enjoy their cup of 
coffee, and they care not at all whether ii^ harms them. From the standpoint 
of individual hygiene the coffee question is worth while going into very care- 
fully. 

Two-thirds of the coffee entering the markets of the world comes from 
Brazil. That country exports twenty times as much coffee as the Dutch 
East Indies, the coffee from which is commonly called Java. Little coffee 
is exported from Arabia, and practically none from the small Mocha district. 
Of the small amount of Arabian coffee exported the best goes to Turkey and 
Egypt, near-by markets. 

The world's use of coffee per year amounts to about 16,000,000 bags. In 
fact, the disposition to overproduce in Brazil is so strong that the govern- 
men exerts itself to maintain the price of the berry. 

The only approximately accurate figures on the use of coffee we have 
are those for the United States, the countries of western Europe, and Australia. 
The people of Holland in normal times use about fifteen pounds of coffee 
per capita a year. Norway and Sweden follow, each using about fourteen 
pounds. The per capita use by the people of the United States is twelve 
pounds. The German people use about seven pounds, and the British, 
Canadians, and Australians about one pound. 

Some of the peoples use tea instead of coffee. Probably the Chinese and 
Indians are the most inveterate tea drinkers, but there is no way of know- 
ing the per capita use of the drink by these peoples. The New Zealanders, 
Australians, and nations composing the United Kingdom are the heaviest 
users of tea. They consume more than 6.5 pounds per person. The Canadians 
use 4.3 pounds; Hollanders, 1.45 pounds; Russians, .94 pound; Americans, 
.89; Germans, .11; and French, .06. 

Tea contains about twice as much caffein as does coffee. By multiplying 
the per capita amount of tea by two and adding it to the pounds of coffee, we 
get a fair idea of the relative use of caffein-containing beverages by the 
races for whom we have statistics. 

We find that the Hollanders lead with seventeen pounds. They are 
followed by the Swedes and Norwegians. Next comes a group composed 
of the people of the United States, the British, including English, Scotch, 
and Irish, and the Australians. Their rate of consumption is around fourteen 



COFFEE 351 

pounds. The Canadians use nine and six-tenths pounds. The Germans use 
about seven, and the Russians about four. 

Legends tell us that the Chinese used tea 8,000 years before the birth of 
Christ. Europeans began to use it in the sixteenth century. In the seven- 
teenth century its use in England was fairly well established. By the eight- 
eenth century the English people were using it at one-third the per capita 
rate now prevailing. 

For centuries governments have always exerted themselves to promote 
the traffic in tea. During the 5,000 years prior to the time when trading 
and plantation companies, backed by government grants, strove to develop the 
planting and merchandising of tea, its use as a beverage seems to have been 
limited to rather a small part of the Chinese people. 

On the other hand, coffee has had its troubles. The legend is that the 
use of coffee was discovered in Abyssinia. A flock of sheep which fed on 
coffee berries was wakeful and restless at night. After a while these coffee 
jags attracted the attention of one shepherd after another, and presently 
some of them investigated the cause and tried the berry. 

The Arabians began the use of coffee before the fifth century. Its 
use was becoming so general in the time of Mahomet that the Koran pro- 
hibited its use. 

Hollingworth, who in 1912 published the best study of the effects of 
caffein which has come to my attention, says that the average cupful of hot tea 
(five fluid ounces) contains one and five-tenths grains of caffein. An after- 
dinner cup of black coffee (two fluid ounces) contains one and five-tenths 
grains of caffein. An average glass of iced tea contains two grains of 
caffein. An average cup of good coffee and milk (three ounces of coffee and 
two ounces of milk) contains two and five-tenths grains of caffein. 

Professor Hollingworth's study was made on a "poison" squad of sixteen 
people. The test lasted forty days. Its purpose was to find whether moderate 
doses of caffein had a good or bad effect on persons who took it. 

Generally speaking, he gave doses of less than six grains a day. Let 
us say that most of his subjects took less than three cups of coffee a day. 
His conclusions, therefore, apply to people who take two cups of coffee a day. 

When more than six grains a day was the dose the subjects were harmed. 
He did not study the subject of the prolonged use of coffee nor its effects 
on digestion. 

It has been well established that coffee is a good muscle and nerve stimu- 
lant; "that it lightens the sensation of fatigue and sustains the strength 
under prolonged and severe muscular exertion/' "that coffee squads come 
in first in endurance tests, water squads second, and alcohol squads last;" 
that coffee produces "a feeling of buoyancy and exhilaration comparable to 
a certain stage of alcoholic intoxication, but which does not end in depression 
or collapse." 

Elvers' study establishes the point that the stimulation from caffein is 
not followed by the letting down which follows the use of alcohol and other 
stimulants. 

Hollingworth found that there was no secondary reaction following 
the use of caffein in the tests made by him. Even when the dose given 
was large enough to produce bad direct effects, there was no "katzen jammer." 



352 HABIT-FORMING DRUGS 

The Hollingworth tests were to determine the effect of caffein on the con- 
trol of the muscles, the motor nerves, the nerves of coordination, and on certain 
kinds of mental activity. 

A type of result was that shown by a test known as the tapping tests. 
The effect began ninety minutes after taking a small dose and forty-five 
minutes after a large one. It lasted for one to two hours for a three-grain 
dose (a large cup of coffee) and for four hours and a half after six grains 
(two very large cups). No secondary effects followed within seventy-two 
hours. 

Another test was to determine whether coffee made the hands tremble. 
One to four grains of caffein caused a slight tremor. Six grains (two 
very large cups) caused an appreciable unsteadiness of the hands, coming 
on about an hour after taking and increasing for three hours. 

Muscle movements requiring several muscles to work together with 
proper relation to one another were better and more thoroughly carried 
out when a smail dose of caffein was given than without it. On the 
other hand, a larger dose, six grains of the drug, produced a retarding 
effect. 

It was found that typewriting was speedier after one- to three-grain doses 
of caffein (half a cup to a full cup of coffee), but that it was slowed up by 
two full cups. Typewriting was freer from errors when the operators took 
coffee. This was true even after two large cups. 

A series of tests to determine whether the mind .worked better with or 
without coffee showed in a general way that mental processes were improved 
by coffee. The effect came on from two to four hours after the drug was 
taken, and it lasted into the next day. The stimulation was not followed 
by mental depression. 

These studies prove that a man can increase the volume and the quality 
of the work, both mental and physical, by taking one-half to one cup of 
coffee a day. When he takes two large or three ordinary size cups of it, he 
improves some of his capacities but lessens others. 

The groups of people experimented on were not specially fatigued or 
tired. In this connection it is well to recall the experiments by Rivers, 
which prove that, when a man is fatigued, coffee will increase his capacity 
for work either mental or physical. 

However, this is only one side of the question. Various other phases are 
of some importance. A great many people are interested in knowing the 
effect of coffee on sleep. Hollingworth came to the conclusion that the 
sleep of the average person was not disturbed by taking one to four grains 
of caffein (one-half to one large cup and one-half of coffee) a day. Some of 
the people experimented on slept poorly from even that quantity. When 
one cup of coffee a day was taken for several days sleep was disturbed 
on the second or third day in certain instances in which there had been no 
disturbance on the first day. 

Most of the people who took six grains a day (a little more than two 
large cups) slept poorly; in consequence, when the coffee was taken with the 
food, the harmful effect was much less than when it was taken alone. Fat 
people stood coffee better than thin ones. The morning cup of coffee did 
not disturb sleep so much as coffee taken later in the day. 



COFFEE 353 

The age of the individual did not affect the effects of caffein on the 
people experimented on; nor did previous coffee habits. 

One subject investigated by Hollingworth was the influence of caffein 
on the general health. At the end of forty days of this test "the subjects 
quite uniformly report improvement in health, spirits, and general efficiency. 
This is, perhaps, due to the regular regime of life followed during the forty 
days." 

When we examine the reports of the individuals we find that some of 
them were definitely nervous at times, had headaches, palpitation, and in- 
digestion. This rarely happened with a small daily dose. Some form of 
disturbance was frequently noticed when the dose equaled six grains a 
day. 

When we apply these results to the habitual use of coffee, we must 
bear several facts in mind : 

First, the work was done with pure caffein. A cup of coffee contains 
several other ingredients, some of which have physiological effects. 

Second, when the caffein is translated into terms of cups of coffee the 
dosage used is not large. 

Third, the tests extended over forty days. Most of the people who 
want to know about coffee have in mind the use of coffee for forty months 
or forty years. 

Fourth, the tests were, in the main, to determine whether coffee im- 
mediately increased mental and physical power and whether there was 
sag within a few days. 

A little information was gained as to cumulative effects, headache, 
sleeplessness, and one or two other incidental questions of prolonged effects. 
The broad question of ultimate effects of prolonged use was not inquired into. 

Bearing these limitations in mind, the following conclusions seem 
justified by the work of Hollingworth and that of Eivers so frequently 
quoted : 

1. Caffein in small doses (one to four grains) increases the quantity and 
quality of mental and physical work. 

2. Caffein in larger doses (six grains and over) decreases the above 
capacities as often as it increases them. 

3. Caffein increases the capacity for work of a tired brain or tired 
muscles. 

4. Caffein produces a sense of buoyancy and well-being. 

5. The stimulating effects of caffein are not followed by the depression 
which follows the use of other drugs. 

6. The amount of caffein in one full cup of coffee does not produce 
sleeplessness or nervousness. Many took the amount in two cups without 
discomfort. Many were disturbed by two cups. When the amount taken 
went beyond the amount of caffein in two full cups the majority were 
harmed by it. 

7. The effects of caffein are less in fat people than in thin ones. 

8. The effects are much less when the drug is taken with food. 

9. The drug is somewhat slow in exerting its effect. Generally more 
than an hour was required. Often two or three hours passed before the effect 
was felt, and some of the effect commonly held over until the next day. 



354 HABIT-FORMING DRUGS 

INGREDIENTS OF COFFEE 

The London Lancet in 1913 published the report of a commission that 
had investigated the effects of coffee. For their chemical analyses the mem- 
bers made use of the brew in the cup rather than the berry. To their minds 
it mattered little what the berry contained, as long as some of the ingredients 
remained in the grounds. For instance, coffee berries contain 12 per cent oil, 
but there is only a very small percentage of oil in a cup of coffee. 

The analysis of coffee made from a high roasted average grade Costa 
Rica coffee showed: 

Total extract 24.30 i Caffetannic acid 3.9 

Ash of extract 4.66 | Caffein 1.23 

A cup of coffee is practically without food value. Analyses show a 
trifling quantity of dextrin, sugar, and traces of alcohol. There is no starch. 
It contains 1.25 per cent of protein. There is .6 per cent [six parts in 
10,000] of a nitrogen-containing oil — caffeol. 

However, if coffee without sugar and cream is without nourishing 
qualities, it does not follow that it is without effect on the system. In the first 
place there is a considerable percentage of caffein, 1.23 per cent, a powerful 
medicine, the effects of which have been described already. Caffein is closely 
akin to xanthin, and xanthin is a chemical substance produced in the human 
body supposed to be related in some way to the cause of gout. 

Most analysts are of the opinion that coffee contains a small amount 
of pyridin. Pyridin is formed when paper is burned. It is held to be the 
substance responsible for the benefit which asthmatics get from smoking 
asthma cigarettes. When roasted coffee is treated with chloroform a chemical, 
noncrystalline and nonsoluble in ether, is extracted. It has the strong but 
pleasant aroma and bitter taste of coffee. 

Caffein, pyridin, caffeol, and this flavoring substance are responsible for 
the effects of a cup of coffee. 

Coffee taken into the stomach is rather quickly absorbed therefrom. 
It differs in this particular from tea, since tea is not absorbed until it gets 
into the small intestines. Therefore, the effects of coffee begin to show 
themselves after a brief period. The person who has partaken feels the 
influence within a half hour. Hollingsworth's tests showed effects plain 
enough to register his subjects in an hour, sometimes less, sometimes more. 

On the mind the first effect is drowsiness, quickly followed by wakeful- 
ness. The wheels of the mind work easily and truly. 

In so far as there is any effect on digestion, coffee is of some slight aid. 
Especially is this true of the after-dinner cup of coffee, taken at the end of 
a full meal. The stimulating effect of some of the ingredients is somewhat 
more than an offset to the restraining effect of the caffetannic acid. The great 
outstanding effect of a cup of coffee, though, is the stimulation to brain, nerves, 
and muscles — a stimulation without a closely following sagging. 



COFFEE 355 



COFFEE EFFECTS 



Coffee has been accused of harming the digestion. Is it guilty of the 
charge ? I do not think so. The charge rests upon the fact that people with 
indigestion are able to taste the coffee taken at the previous meal. This merely 
means that coffee has an aroma and a taste, which facts needed no proof. 
For the same reason every aromatic and every positively tasting food in the 
list of foods has been accused of causing indigestion. 

The blame has been laid on the oil. The amount of oil in a cup of coffee 
is small. It is not to be compared with the amount of grease in a piece of 
meat or a piece of buttered bread. 

The blame has been laid to the caffetannic acid, but coffee is not an 
astringent. It does not pucker the mouth. The small astringent effect of 
the tannic acid present is more than offset by the dilating effect on the blood 
vessels of the heart. 

7s the use of coffee of service? Yes. When? When one is tired, fatigued, 
unable to concentrate, and yet must keep going or must keep up for some 
supreme effort. 

Does the daily use of coffee as a beverage, continued for a series of years, 
do harm? Yes. A horse cannot be whipped daily for years without being 
harmed. A man cannot be nagged continuously for years without being 
harmed. The very fact that, when fatigue is slowing muscles and brain cells 
down, coffee will whip them on, the very fact that under the stimulus of 
coffee capacity is unduly excited, is proof that harm will come if the process 
is kept up for a series of years. 

That no immediate secondary sagging is noted proves nothing. It is the 
old question of the cost of something for nothing. 

When, through the influence of coffee, you become able to do and do 
more than you would otherwise, you must settle some time or other. That is 
just ordinary sense. 

Can the scientist tell you how you are to settle ? I think not. The state- 
ment that you settle in terms of high blood pressure may be true, but proof is 
lacking. The same can be said of kidney disease, caused by coffee. But then, 
there's mighty little we know of the cause of high blood pressure, worn out 
arteries, frazzled kidneys, or frayed hearts. 

Health departments are just beginning to study the wear diseases. A 
hundred years after the writing of the "One Hoss Shay" we shall begin to 
know what it was all about. 

Shall one take his morning cup of coffee ? Perhaps. To sleep in a well 
ventilated room were better. To take a cold plunge, or a shower, or a ride, 
or a walk were better ; but, failing these, a man may use coffee to get himself 
together for the day. 

Should a man take coffee at other hours ? Yes, when he needs a bracer in 
order to meet a need ; then not regularly, or by the clock. 

Should he take an after-dinner cup? Yes, if he has eaten like a glutton 
and needs help. 



356 HABIT-FORMING DRUGS 

COFFEE MAKING 

The National Coffee Roasters' Association a year or so ago appointed a 
committee on better coffee making. This committee has issued its report, 
from which the following is taken: 

First of all, the ease of extraction of the virtues of the coffee bean is 
directly proportioned to the fineness of the grinding. The first essential, and 
the most important, is that the coffee should be finely ground. To grind 
finely is also economy, as less coffee is needed. Finely ground coffee does 
not keep its strength. Therefore grind your own coffee, but in a high grade 
mill. 

Water at 212° (boiling) is twice as efficient in extracting color and 
more than twice as efficient in extracting aroma as water at 150°. Cold water 
is very efficient in extracting the caffein and the tannic acid. 

The committee tried seven methods of preparing coffee : 

1. Coffee placed in cold water, brought to a boil, boiled five minutes, coffee 
ground medium. 

2. Same method, but coffee used was ground fine. 

3. Coffee placed in cold water, brought to a boil, taken off the fire and 
allowed to steep. Medium ground coffee used. 

4. Same method, but finely ground coffee used. 

5. Percolation three minutes. 

6. Percolation five minutes. 

7. Filtration; pulverized coffee used. 

To get the flavor and only a moderate amount of caffein, use method No. 
7. Method No. 6 yields ten times as much tannin as No. 7. 

If one wants some flavor, but must avoid the stimulating effects of caf- 
fein, method No. 3 is best. It gives less than one-sixth the caffein given by No. 
2, and a little more than a fourth as much as method No. 7. 

Boiled coffee has the least to commend it. It is high in caffein, tannic 
acid, and bitter matter. Long continued boiling makes the coffee weaker, not 
stronger. After about five minutes of boiling the aroma is driven off, without 
extracting from the coffee any desirable matter. 

The report says that most of the deleterious effects of coffee are due to 
excessive boiling, or to the use of grounds a second time mixed with some 
fresh coffee. 

In the steeping method the extraction comes mainly just as the water 
boils. In using a percolator the water does not heat above 150°. The ap- 
parent boiling is not really boiling. The condensed vapors percolating through 
the coffee are not hot enough to extract the best of the flavor of the coffee. It 
does extract the tannin. Percolated coffee is about 25 per cent higher in 
caffein than filtration coffee. It requires more coffee than does the filtration 
method. 

In the filtration method the finely pulverized coffee is placed in a close 
mesh muslin bag. Boiling water is poured through it slowly. Nothing is 
gained and something is lost by pouring the water a second time. This 
method uses least coffee. 

In the comparative tests the experimenters used 1,200 grains of coffee in 
a pint and a half of water. 



COFFEE 357 

The experimenters favor the filtration method, except for those overstimu- 
lated by coffee. They should used the steeping method. 

THE COFFEE OR TEA HABIT 

A victim of habit is willing enough to admit that there are habit victims, 
but unwilling to admit that he is one of them. This is fortunate. Just this 
mental attitude saves many. It is like trying to stay in bed with a cocklebur. 
This constant self -asking, Is mine a drug habit? — this constant assertion, I 
can quit — made to convince oneself and not others — this mental unrest some- 
times makes a man grit his teeth and pull out of the mire. All in all, it does 
no harm for the woman who always carries a headache tablet in her pocket- 
book or for the man who takes his morning brandy to say that she or he has 
no habit. 

The most difficult of all places to draw the habit line is among tea and 
coffee drinkers. The use of these drugs has much to commend it. When a 
man's mental energies are at "sixes and sevens," when the different faculties 
of his brain are not doing good teamwork, a cup of coffee or tea may har- 
monize things. 

Or, better yet, let us say that the little harm it does is more than com- 
pensated for by good in other directions. It indicates that he or she still has 
pride. The denial of a habit by the addict indicates that he still has pride. 
For a man to pull out of the mire of opium requires teamwork by his mental 
impulses. Unless he has pride as one of the wheel team he will not get out. 

Eecently there has been some research work decidedly favorable to tea. 
The writer says a man does better work with it than without. Such benefit 
is not because of any food value, because neither tea nor coffee has enough 
food or fuel value to take into account. It is because of better teamwork. 

Another advantage of tea is that it is a pleasant way to drink sterile 
water. No wise man drinks water from unknown sources. Our country is 
getting too thickly populated for that. Boiled water, unfavored, is not gen- 
erally liked. Boiled water, slightly flavored with tea, is the one drink that 
tastes well, hot, cold, or in between. The test is the in between. 

Tea and coffee may serve a purpose, and I think right there is the place 
to draw the line. 

For what purpose do you drink it? Do you drink it to make you feel 
warm? The hot drink throws the blood to the surface and warms the skin, 
but a warm skin loses heat rapidly and presently the loss more than offsets the 
gain. If you are of this group — quit it. 

Do you drink it at supper to hold you together for work after supper ? 

If a habit, it does harm and not good. The wise course is to train oneself 
to brain teamwork and to leave enough in one's energy bank to draw on for 
the evening's work. Do not drink it at night. 

There is no excuse for the noon or mid-afternoon cup except it be as an 
excuse for a break in the day's concentration. On that basis, it is the height 
of wisdom from the efficiency standpoint, but let the draft be very weak — 
scarcely more than flavored water. 

For the morning cup there is much excuse. The body has been storing up 
energy all night. In the morning it has some tendency to leak — to waste. 



358 



HABIT-FORMING DRUGS 



The first work of the morning is to hitch up the team. A cold bath, water or 
air, can do it. Some open-air work can do it. A cup of coffee or tea can do it. 
A well-trained man can do it without any help. 

But there are people who have headaches or "grumps" or are generally 
no account if they do not get their coffee. For them it must be strong. They 
are fiends. They are in the same boat as opium, cocain, or whisky fiends. 

A good rule is to quit anything that has become to you a crutch or that, 
you can figure out, usually becomes a crutch. 

To summarize: 

Morning cup. A cold bath or a round of exercise is better, but for most 
adults it is permissible — or even more. 

An afternoon cup — Yes, if you will make it very weak. 

The night cup — No. 

The noon cup — No. 

When traveling or camping, yes — if taken weak as a cup of sterilized 
water. 

To brace for a supreme effort, yes; as a habit, no. 



TEA AND WAR 

In the Russo-Japanese War, some part of the great result in preventing 
typhoid fever in both armies was due to the habit of drinking tea instead of 
water. The soldier, starting out on a day's march, would fill his canteen with 

weak tea. Tea is boiled, flavored 
water. From the sanitary standpoint 
it came back to this: the soldiers were 
drinking sterilized water. 

In the next war, however, the 
typhoid problem will not exist. The 
troops will be vaccinated against 
typhoid, and the experiences of the 
last three summers along the Rio 
Grande teach us that typhoid as an 
army menace is among the disappear- 
ing diseases. 

However, the soldiers of 1861 
remember the dysenteries with dread. 
Some of these ran an acute course 
and got well in a few weeks. Dr. 
Vaughan of the University of Michi- 
gan proved that most of these diar- 
rheas at Chickamauga were atypical 
forms of typhoid and probably the same is true of those of the Chicka- 
hominy. 

Major Whitmore of the United States army has been studying the dysen- 
teries with a view of finding a way to protect the army against them. Inci- 
dentally, whatever is discovered is available for the people at large. 

The chronic dysenteries of which the soldiers complained so much after 
1865, Major Whitmore says, were due to amebae. An ameba is a small animal 




Fig. 146. — Tropical Amebae cause Abscess 
op the Liver, Dysentery and Possibly 
Diarrhea. 



COFFEE 359 

belonging in the same class as the malaria parasite, but larger and different in 
many other ways. 

This form of dysentery sometimes kills by reason of the ameba getting in 
the liver and causing liver abscess. But, in the main, the harm it does is by 
producing a chronic disabling disorder — a producer of inefficiency. 

Many thousand people in civil life suffer from chronic amebic dysentery. 
The acute dysenteries or fluxes are due to infection with bacteria. 

Shiga, a Japanese bacteriologist, studied the bacteria of dysentery a num- 
ber of years ago. He found the group of germs responsible and then de- 
veloped a serum for the condition. The serum has not proved satisfactory 
for summer complaint in babies, but Major Whitmore says it is more service- 
able in dysentery of grown people. 

This form of complaint was not highly prevalent in the Japanese army 
because the soldiers cooked all their food, and boiled their water to make tea. 
But our people have never had the habit of drinking weak tea instead of water. 

So long as they are at home drinking water known to be good they should 
not drink tea, but they should not drink tea when hunting, camping, or 
going to war. They get dysentery from spring water, creek water, lake water, 
or from eating raw foods. The Japanese serum may prove of service to our 
people. 

Coffee and Sleep. — A. B. writes: "I teach, and the strain invariably 
tells on me. I find myself quite frequently in a state of nervous exhaus- 
tion. I use tea and coffee, drinking usually two cups of each a day. My 
friend, who also teaches, uses neither and does not suffer fatigue as I do. 
1. Do you think one less likely to suffer thus if tea and coffee are aban- 
doned? 2. If one is tired and therefore sleepless, would a little strong 
coffee be conducive to sleep? On the whole, is it advantageous or disad- 
vantageous to use tea or coffee?" 

Eeply. — 1 and 2. Yes. 

The above answers are apparently contradictory and explanation is 
needed. Tea and coffee are general stimulants. They are drugs. They 
stimulate judgment and control, among other effects. 

People differ radically in their susceptibility to fatigue. That your 
friend is less fatigued at the end of the day may be due to her better 
mental habits and therefore lessened susceptibility to fatigue. However, 
one who whips himself through the day by using four cups of a drug can 
blame some part of his fatigue on the drug taken. 

Sometimes insomnia is due to a racing mind, a mind that jumps around, 
here, there, and everywhere. A small dose of coffee for some persons will 
steady the mind and bring about sleep. A full dose of coffee will prevent 
sleep. 

Avoid Tea and Coffee. — K. L. D. writes: "What foods act as stimu- 
lants without being injurious? For years I have been a coffee drinker and 
feel the need of such a stimulant, but wish to discontinue tea and coffee 
and want something else to take their place. I am intensely nervous. I 
have been engaged in office work for a number of years. I do not seem to 
have the strength or vitality that I used to have and would be glad to know 
how to build up through proper eating and a light exercise. Long walks 
do not agree with me — that is, over six miles at a time. I think I recently 



360 HABIT-FORMING DRUGS 

overdid myself by walking more than this each day. I am a woman over 
28 years of age." 

Reply. — None of the foods except tea and coffee is stimulating. 
If you are being harmed by the stimulation of coffee, stop it. Substitute 
any warm drink which suits your palate. One is as good as another. If 
you are not in good condition, a six-mile walk certainly is too much for 
you. Get Galbraith's 'Tersonal Hygiene and Physical Training for 
Women," read it, and follow it. 

Harm from Coffee. — C. T. E. writes: "1. Can coffee be made harmless 
except by the removal of caffeinf 2. Should a person who has had an op- 
eration for gall-bladder infection, has neuritis and slight rheumatism, 
abstain from coffee?" 

Reply. — 1. In addition to the harm from the excessive dosage of caf- 
fein, the oils of coffee sometimes impair the digestion. However, the state- 
ment that to remove the caffein is the only way to make coffee harmless is 
reasonably accurate. Overcoming the effect of drug habits by the use of 
other drugs does not help. 

2. No more and no less than any other person. 

Coffee and Tobacco. — N. H. C. writes : "This statement is made : 'It is 
every bit as bad for one to drink a cup of coffee every morning for break- 
fast as it is for one to take a glass of wine every day for dinner — as a 
habit/ Also: 'The coffee habit is as bad as the tobacco habit/ Are these 
statements true? My son says he will quit using tobacco if I will stop 
drinking coffee/* 

Reply. — No one of the habits is a good one. I think I should rank 
them in the order of their badness — wine, tobacco, coffee. Moderately 
indulged in, none of them is a very bad habit. I think you had better agree 
with your son that they are almost on a par, concede him a little more 
than you ought to, and then contract with him to stop coffee if he will stop 
tobacco. 

Coffee and Caffein. — Mrs. A. C. H. writes: "I was very much inter- 
ested in your recent article on 'Coffee Making/ but there is one point I do 
not understand. Will you kindly explain? You say: 'Cold water is very 
efficient in extracting the caffein and tannic acid. ... 7/ one wants some 
flavor, but must avoid the stimulating effects of caffein, No. 3 is best. . . . 
Coffee placed in cold water, brought to a boil, taken from the fire, and 
allowed to steep. Medium ground coffee used/ It would seem to me that 
the cold water used in No. 3 ought, according to the first statement, to 
result in more caffein. How can I get the complete report referred to in 
your article?" 

Reply. — The condensed account affords more ground for your con- 
clusion than did the fuller account. Our article was based on a report in 
the American Food Journal, published at 15 South Market Street, Chicago. 
The Food Journal editor can tell you where to get a copy of the original 
report. 

Coffee Story False. — W. J. N. writes: "I have heard from many dif- 
ferent sources that by putting cream and sugar into tea and coffee the 
beverage is rendered more harmful than if it was drunk plain. Is this a 



COFFEE 361 

fact? Some say that they bring out the tannic acid in tea and the caffein 
in coffee/' 

Reply. — It is not a fact. 

No Food Value in Coffee. — C. H. C. writes: "Is %t liarmful to drink 
much coffee, either strong or weak? What is your medical opinion regard- 
ing substitutes for coffee?" 

Reply. — Yes. Coffee is a "habit-forming drug" with practically no food 
value. Coffee substitutes are hot flavored "waters." For those accustomed 
to drinking something warm with their meals they are all right. 

No "Weed"; No Tea; No Coffee.— A. B. C. writes: "Do you think a 
person of nervous temperament who is making an effort to overcome 
nervousness by exercise of the will should smoke cigars, cigarettes, or a 
pipe, and drink tea and coffee?" 

Reply. — No. 

To Make Tea. — J. writes: "A friend and I had an argument as to the 
hot water supplied in flats. I contend that the boiler and pipes cannot be 
cleaned, and hence corrode. Therefore, that tea and coffee, for instance, 
should be made with cold water brought to the boiling point in a tea- 
kettle which can be cleaned out. She says that the hot water supplied in 
the pipes is all right for drinking purposes. Who is right?" 

Reply. — I think you are both right. Hot water from hot water pipes 
is good for drinking purposes. However, making tea is an art. To make 
tea properly, heat water in a vessel until there is a vigorous boiling; then 
pour water on the tea, and permit the mixture to stand. 

Too Much Tea. — R. H. writes: "I am a woman, aged 35. I have head- 
aches at times, am troubled with insomnia, and am not physically strong. 
I drink three cups of tea at each meal, using plenty of cream and sugar. 
Do you think my tea drinking excessive and likely to do me harm?" 

Reply. — I do; very much so. 

The Coca Cola Habit. — Young Man writes: "Please explain fully the 
injurious effects of the coca cola habit." 

Reply. — Coca cola contains no alkaloid except caffein. Its effects are 
the same as those of coffee. People get the coca cola habit just as they get 
the coffee habit. 

A few days ago I stood at a soda fountain and heard two boys order 
coca cola, adding, "Make 'em strong, boy, you know. Make 'em strong." 
A little while ago I saw a sign, "Double strength coca cola, 10 cents." 

A certain portion of the coca cola drinkers now call for ammonia in 
their drink. These illustrations cover your point. 

The habit of taking stimulants is a bad one. A man gets up in the 
morning somewhat let down. Instead of cranking his machine by a cold 
water bath or a cold air bath or a few minutes of exercise in his bathroom, 
he takes a cup of coffee. 

At 11 o'clock and once or twice at other hours during the day he feels 
as badly as he did before breakfast. He steps to the nearest stand and 
throws down a coca cola. Almost instantly thereafter his machine speeds 
up. After a little while his glass has no kick. He then wants the boy to 
"make 'em strong." Next he buys double strength. Next he gets the kick 
by adding ammonia. 



CHAPTEE XXI 

The Mind 

The family physician of half a century ago was a very poor scientist, 
and, from a purely medical standpoint, scarcely worthy of his hire. Yet he 
was "mighty good for sickness." He looked at the patient's tongue, felt his 
pulse, asked some questions, and fixed up some medicine. 

The laboratory trained physician of the present day would say that he 
had done very little for his patient. Certainly he had made no chemical 
or bacteriological tests, no blood pressure determinations, he had not taken 
off his coat and worked over his patient. Yet there must have been some way 
in which he had done good, for certainly so great an institution as the medical 
profession could not have been built up on any basis other than utility. 

The explanation is that he had a fair knowledge of personal hygiene and 
right living, — and he was a rattling good mental healer. He begot faith and 
courage, and radiated sympathy and cheer. 

It is a far cry from the science of symptoms, which found its flower in the 
writings of Trousseau, to the science of causes, using symptoms but inci- 
dentally as it flowers, in the writings of Osier. As the practice of medicine 
has gone beyond the expressions of disease into its causes, it has left the 
field of symptoms poorly attended. 

Let it be understood that it is the physicians who have moved. People 
have stayed where they were. Meanwhile symptoms, like branches, have 
grown up more luxuriantly in this nerve-racking, self-centering, neurasthenia- 
engendering age than in any other time. 

In order to fill the field which was left when medical men moved out, 
several agencies have flourished. One of these is social service associated with 
or separate from medicine; another is Christian Science. 

In saying that these agencies have come into an unoccupied field I do not 
wish to say that their motives are the same, or that there is any kinship 
between them. Each developed because society abhors a vacuum. 

This field, vacated by medicine, has had its borders extended. There 
may be fewer diseases than in olden times but there are more symptoms. 

It was inevitable that, when the doctors developed the plan of concen- 
trating on disease and neglecting the patient, there should grow up a number 
of specialists dealing with symptoms primarily and disease secondarily or 
not at all. 

The mind of the prospective parent cannot cause birthmarks or physical 
deformities. 

There is a field for hypnotism, suggestion, autosuggestion, the mixed 
suggestion and mental training of Du Bois, the analysis and mind training of 
Freud, the methods of the mental healer, spiritual healer, faith healer — re- 
lated methods all — as well as for the pills taken with faith. 



THE MIND 363 

This being so, is it not wise for those who have not given the matter 
thought to read what mind can and cannot do to the human body? 

What are some of the errors and some of the facts? 

A common error relates to heredity. The mind of the mother has no 
power to mark her unborn babe. The mother's cell, the breeding cell from 
the mother, is given its type and its power to fix the character of the offspring 
by the mother; the cell from the father gets its type and its power to determine 
type from the father. These two cells come together and start the new cell 
called the child. 

When they come together the last entry is made in the book of inheritance, 
and the developing child clicks off his changes in regular routine, regardless 
of what is going on in the outside world, just as a piece of machinery running 
its routine is uninfluenced by the wind which blows outside the building. 
No shock, no unusual sights, no dreams, nothing which enters the mind of 
the pregnant mother can mark or deform the baby. 

Another error, though not of much consequence, relates to the influence 
of mind over life and death. Is it possible for the mind to prevent death? 
Or, to put it differently, can any mind or body ever be developed into any 
state where life will be perpetual ? No, Dowie, Mrs. Eddy, the story is always 
the same. Your theory for perpetual life did not work in your case. It 
never has worked. It never will work. Mind can neither cause death nor 
prevent it. 

Human life and death are just as real as the lives and deaths of trees 
or cows, or as the wear on steel rails, and no philosophy will ever make it dif- 
ferent. The human body is real, just as all matter is real, and it obeys 
divine law, and wordy words, whether termed human or divine, cannot change 
this obedience. 

When it comes to diseases, the lines are not so sharply drawn. Disease 
is a hodge podge. In it are some elements with which the mind has nothing 
to do and other elements over which the mind has control. "It is the sick man 
who makes the disease/' This, interpreted, means that, while the real diffi- 
culty is due to morbid processes, the symptoms which express the disease are 
in many instances the interpretation given the condition by the mind of the 
patient. 

I have received many letters saying that when I write about disease I 
promote disease by engendering fear. This is true in some measure; untrue 
in greater measure. Sometimes the writers have made the mistake of detail- 
ing instances of diseases which were the result of fear, and at once they 
have gotten into water which was over their poor, foolish heads. 

They have usually specified infectious diseases. Therefore, what is the 
truth about fear in relation to such diseases as consumption, pneumonia, diph- 
theria, and scarlet fever, and many others of similar kinds ? • 

Occasionally it has been found that an animal, profoundly shocked by 
violent fear, has had its susceptibility to infection increased. As these infec- 
tions have been more closely analyzed and studied, the importance of this 
factor in infection has decreased until the opinion now is that violent mental 
shock only has a slight influence in changing susceptibility and minor emo- 
tions, and lesser mental states have none at all. 
• Most cults recognize these limitations after some sort of a fashion. That 



364 THE MIND 

susceptible children exposed to scarlet fever contract the disease in 60 per 
cent of cases is capable of a demonstration too mathematical to be denied. 
In consequence, they usually except contagion. 

Christian Scientists are told by their leaders to report contagious diseases. 

Surgery is a very limited field, but, within its limitations, it is much more 
exact than medicine. Demonstrations in the course of surgical procedure are 
much more convincing than those of medicine. In consequence, many of the 
cults, and those the wisest, also except surgical conditions. 

But there must be some basis for the growth of Christian Science and 
other kinds of mental healing. Among their adherents are bankers, whose 
minds work very accurately when it comes to business. It cannot be that, 
when it comes to the business of the human body, they go off mentally. 
Among them are judges capable of weighing evidence. If some part of these 
teachings cannot stand the acid, other parts must, or these judges would not 
go on accepting. 

Where is the explanation? 

The train dominates its sister organs in the commonwealth called the 
human body. It can furnish symptoms where there are none. It can exag- 
gerate existing symptoms. It can pervert and change symptoms, so that 
they bear slight relation to their beginnings. 

It is the mind that interprets. 

"It is in the mind that the poppy is red, the apple odorous, the music of 
the lark is felt." 

The statement that it is in the mind that the poppy is red does not 
mean that the flower has not certain pigments. It means that two differ- 
ent minds, seeing the same poppy, might interpret its color in different 
ways. 

Symptoms are conditions talking in the language they know, as the 
poppy speaks in mind-interpreted pigment. 

Let us illustrate with the symptom pain. One mind would interpret it 
as something scarcely worth noticing; another would writhe and cry out 
under it. 

The human machine cannot run without friction. With a car wheel, 
every turn means some heat, some noise, some wear. Every act of living means 
some heat, some noise, some wear. 

And so on with other phenomena. A function goes wrong, and, dwelt on, 
grows more wrong, and still more wrong. Studying human ailments might be 
compared to picking a duck. One strips feathers, and still more feathers, until 
he begins to wonder if the duck is not all feathers. If he persists, he will 
finally get down to duck. 

// one is stripping feathers from a mans symptoms, after a while he 
will get down to duck. Sometimes, when the feathers are all removed, he 
finds there is and has been no duck. 

Such cases are easily proper for faith cure. 

On the other hand, some birds have but few feathers, and in them there 
is but little field for faith. Between, there lies a mixed field — some part 
best cured by one method ; other parts by the other. 

After applying the law of probabilities, weighing the tendency of diseases 
to get well spontaneously even without care, the tendency greater with good 



"THE HUMAN MACHINE" 365 

personal hygiene, the conclusion is justified that the mind can modify the 
course of disease in some measure and its symptoms in great measure. 

In a summarized fashion : The mind cannot prevent life, influence the sex 
or the structure of the child, prevent infection, annul contagion, influence 
changes in organs, or make life everlasting. 

Fear and worry as causes of pneumonia are so insignificant that they 
deserve no thought. The same statement is true of other infections. 

That the mind can cure cancers, or limber up stiffened knees, or make 
blind eyes see, or change any of those conditions which are organic, is based 
on no evidence worth anything to the mind of a man accustomed to weigh 
evidence. 

"THE HUMAN MACHINE" 

Plato excluded from his Republic the men who were always busy dream- 
ing of imaginary ills. This group includes others as well as the developed 
neurasthenics. If you will remember, Plato proposed a safe and sane repub- 
lic, in which every citizen would be born and raised to a life of efficiency. 
There would be no drones, no incompetents, no defectives. 

Plato's republic would be devoid of genius, because, as Galton has 
shown, genius and feeble mindedness are closely allied. There would be 
no dreamers, no poets, no artists. 

On the other hand, laws and customs would be most logical and sane — 
the men would be level-headed; labor of every kind would be so productive, 
life would be so free from waste that two or three hours would be the work- 
ing day and the balance of the time could be devoted to the pursuits of 
leisure. 

Genius and dreaming are highly necessary, but the individual who de- 
parts from level-headedness misses genius and falls into the neurasthenia 
group pays more than his share for the community's opportunity. Of the 
hundreds who get off the plane of level headedness, one is a genius and the 
balance are neurasthenics or other kinds of mental misfits. 

The sensible policy for any man to pursue is to work to keep in the 
level-headed group. Averaging things — that's where the best pay is; that's 
where the most happiness is; that's where the community most needs to have 
men. 

Arnold Bennett has written a small book telling all about this matter 
of level-headedness. He has named this story "The Human Machine." It 
tells about the waste that comes from untrained brains, not brains that cannot 
read or write or figure, but brains that cannot take up a job, proportion the 
mental effort just right, do the job without worry or undue tension or over- 
effort, and then arrive at a sane, logical conclusion. That is what he means 
by untrained brains. 

A part of the same subject is the uncontrolled brain that must run off in 
anger or in prejudice or in some other sluiceway. It takes a good many pages 
to tell of the waste to the individual and to the public from untrained brains. 

"The Human Machine" goes even farther than that. It proposes that 
a man give thirty minutes a day to systematic efforts to get the brain under 
control. Efforts to hold the brain centered are like efforts to hold a pig tied 



366 THE MIND 

by the leg — first in this direction, then in that, but a constantly recurring effort 
to run away. 

The thirty minutes a day set aside for the single task of getting mental 
concentration will result also in a more level-headed doing of the day's work. 

If any reader gets this booh, let him remember this. Reading it is not 
what is needed. Studying it, thumbing it, applying it — that's the thing. 

There are those who assert that there are toxins of anger; that when a 
man is angry or violently excited new chemical compounds are formed within 
him and that these are powerfully poisonous. Observers have noted that men 
who have been violently agitated turned gray, had headaches and other pains 
and, many different disorders. Experimenters have found that after anger 
certain secretions had a heightened toxicity. From this and a few similar 
bits of evidence they have patched together a theory of the "toxins of 
anger." 

Under the influence of anger the brain may "run red." Stirred by strong 
emotion, there may be a temporary binding together of mental faculties, but, 
taking it all in all, all strong emotion makes for disharmony — a lack of co- 
ordination of mental faculties and a lessening sum total of mental activities — 
certainly of mental efficiency. As the result of the greater waste, more fatigue 
toxins are made, but they are fatigue toxins and not a special brand called 
anger toxins or emotion toxins. Mental tension burns tissue to ash, smoke, 
and waste, and emotional mental tension does all this without a proper return 
in effective work. 

But, if there is no established scientific basis for the theory of anger toxins, 
there are some ways in which emotions disturb the body equilibrium. For 
instance, near the kidney there is located a gland called the adrenal. An 
increase in the secretion of this gland causes the small blood vessels to get 
smaller. A decrease in its secretion causes the muscles of these small blood 
vessels to lose their tone. Emotions influence the secretion of this gland. This 
much has been proven definitely. 

Now, the blood is in the vessels and there it must stay. The blood is 
no more compressible than is the water in a hydraulic ram. Therefore, for 
instance, the vessels of the face dilate and a blush mantles the cheek ; the 
extra blood supply there is compensated for by a diminished supply in some 
other organ. Emotion then substitutes for a physiological distribution of 
blood — the distribution best for the work in hand — one determined by the 
emotions — one not best for the work in hand. Call it harmony; call it 
sparing the body from toxins; call it by whatever name you please, the fact 
remains that the body does its work best when equanimity prevails. 



HUMAN BETTERMENT ADVICE 

The Massachusetts Society for Mental Hygiene issues a circular which 
I quote as it is, although with some items I do not wholly agree. For 
instance, if closely related people are of good stock, free from inheritable 
vices, they can marry with safety. Or, for instance, there are circumstances 
under which one feeble minded parent does not greatly hazard the offspring. 
Or, again, feeble mindedness is of as many degrees as drunkenness. 



HUMAN BETTEKMENT ADVICE 



367 



Cervical region 



Dorsal region 



"Only the mentally and physically fit should beget and hear children. 

"The marriage of closely related persons should be avoided. 

"Children of grossly intemperate parents are liable to be imbecile or 
epileptic, and may inherit a nervous system unable to cope successfully with 
the conditions of our complex civilization. 

"Children of feeble minded, imbecile, or epileptic parents are liable to 
inherit a constitution that tends to insanity; and may, though apparently 
normal, transmit to their children this predisposition; the liability is greater 
if both parents are or have been thus affected. 

"Train your child to thorough cleanliness both of mind and body. Bad 
companions as well as common towels, 
common drinking cups and the like 
should be avoided, because there is 
danger of contagion both physical and 
mental. 

"Give your child a variety of well 
cooked, wholesome food in ample quan- 
tity at regular intervals. 

"Train your child to healthful habits 
of sleep in fresh air, giving opportunity 
for at least nine hours, and for more than 
that before the age of 12. 

"Avoid conditions that tend to pro- 
duce overstrain or precocity. The special 
business of a young child is to grow, and 
to play with other children. 

"Give your child opportunity for a 
variety of wholesome activities and in- 
terests. 

"Train your child to work hard in 
some regular occupation suited to his 
ability and talents, but to avoid extreme 
fatigue by alternation of work and rest. 

"Train your child to give attention 
to the present situation and not to worry 
about the past or the future. 

"Train your child to strict obedi- 
ence in a few important matters, and let 
him alone in regard to other things. 

"Train your child to avoid drugs and stimulants of all kinds. 

"Protect your child from shocks. Do not frighten him yourself or 
let other people do so. 

"If your child becomes worried and sleepless, or has muscular twitchings, 
or the like, consult a competent physician at once." 

The recommendations of the Massachusetts Mental Hygiene Society 
continue as follows: 

"The best method of training is example; and what is good for your 
child is usually good for you. 

"Take advice of a competent person concerning the peculiar, sensitive, 




Lumbar region 



— , Coccyx 



Fig. 147. — The Spine. Lateral aspect. 



368 



THE MIND 



or nervous child in order to correct a possibly bad inheritance by proper 
education and environment. 

"The intemperate use of alcohol is a contributing or causative factor of 
several forms of insanity in the individual predisposed thereto. 

"The habitual use of the habit-forming drugs, especially those of sedative 
and hypnotic type, may cause delirium or insanity. 

"Kemembering that syphilis, typhoid fever, scarlet fever, measles, tuber- 



SECRETORY, 
VISCERAL .TROPHIC 



PAIN AND TEM- 
PERATURE SENSE 



TACTILE 
SENSE 



f^l J DEEP SENSIBILITY(JOINT- MUSCLE) 

= — X J^ ^— -=^-^A-FR0M LEG ANDLOWCRTRUI 



DIRECT AND 
CROSSED REFLE 



AND LOWER TRUNK. 
B-FROM ARM AND UPPER 
TRUNK. 




DIRECT 
PYRAMID. 



COMMISSURE 
CELL 



Anterior horns below; posterior abov* 




Anterior horns below; posterior above. 
Fig. 148. — Tracts in the Spinal Cord. Location of certain diseases. 



HUMAN BETTERMENT ADVICE 369 

culosis, influenza, heart, kidney, and other diseases are not infrequently con- 
tributing factors in insanity or mental and nervous breakdowns, it behooves 
you to see that the health regulations of your community are kept abreast of 
modern standards of efficiency and to seek early a physician's advice when 
illness invades your home. 

"A contagious and infectious germ disease, known as syphilis, is the 
direct cause of three kinds of brain disease, which represent at least one-tenth 
of the admissions to insane hospitals. 

"Most of them are characterized by a progressive failure of mind and 
body, which ends in death in a few years. 

"Syphilis has other ill effects on the individual, and may be transmitted to 
the next generation. Most cases of insanity caused by syphilis are incurable 
by any means now known to medical science. 

"Do not allow diffidence or similar feelings to prevent you from promptly 
seeking competent medical advice concerning sexual, ethical, emotional, or 
mental problems which perplex you. 

"Remember that the mental equilibrium of many persons is endangered 
by the high pressure of our twentieth- century civilization — be thoughtful of 
them. 

"Try to get a little recreation every day, and a vacation oftener than once 
a year. 

"Try to keep your weight up to that regarded as 'standard* for your 
height. 

"Cultivate a cheerful, generous, and charitable disposition. 

"There are many forms of insanity; a large percentage is preventable 
and a considerable proportion curable. 

"Observe the few well established and simple rules of health concerning 
food, sleep, exercise, bathing, and recreation. Avoid alcohol, drugs, immoral 
living, venereal diseases, great mental or physical stress and excesses of all 
kinds/' 



CHAPTEE XXII 

Sympathetic Nervous System 

Every structure in the body has nerves. Every nerve in the body con- 
nects into central. The nerves of such organs as the liver, kidney, lungs, 
and heart are known as the visceral nerves. They, too, connect into central. 
Whatever happens to them is telegraphed in over certain of these nerves, 
passes through two relay stations and finally rings a bell at central ; impulses 
start out from central, pass through at least two relays and finally deliver the 
message to the organ. 

As these nerves pass in and out they come in close contact with other 
nerves. In consequence we can sometimes learn something about some obscure 
organ by some sign that is more frequently displayed. Sometimes we can 
treat some less easily reached organ by applying this same principle. That 
is one door that is opening in what appeared to be a blank wall. 

This sympathetic system is divided into at least two systems. Some of 
the component parts of these systems have been pretty well studied. The 
effects of action by these parts have been investigated, and medicines influenc- 
ing them have been experimented with. That is the second door that is open- 
ing in this a-while-ago blank stone wall. 

Probably you have noticed that in cleaning your ears with a hairpin you 
caused a slight fit of coughing. When one introduces a match into the ear 
canal and presses on a certain point on the floor of the canal, he feels an 
irritation in his bronchial tubes, and a cough results. 

One of the causes of chronic, dry coughs is trouble in the external 
ear. The visceral nerves of the bronchial tubes have a nerve connection with 
the external ear. 

The nose men discovered that in certain cases of asthma there were 
polypi in the nose. When these polypi were removed, the asthma got better. 
Then it was discovered that many cases of asthma got better if the nose was 
burned, though there seemed to be nothing wrong with the nose. 

At first they said the burning should be done at certain spots. Then it 
was found that burning at most any point would give results. The explanation 
is that there is a nervous connection between the visceral nerves of the lungs 
and the nose. 

When there is disturbance with the nutrition, ulcers appear in or around 
the mouth. A frequent kind is the small aphthous ulcer. The pain of this 
ulcer shows that it is not an ordinary sore, that it is a neuralgic affair. 
(Shingles is the best known neuralgic sore.) There is a connection between 
the visceral nerves of nutrition and the mouth. 



370 



TO PREVENT NERVOUSNESS 371 



DISTURBANCE AREAS 



The nerves supplying the internal organs, after passing through one 
or more relay stations, reach the spinal cord. The centers for the different 
organs in the cord are sometimes close to and sometimes connected with cen- 
ters for sensation or for motion in areas on the skin or superficial muscles. 
When an impulse comes in from some organ, that impulse overflows into some 
near-by center, and a painful sensation is felt at some point in the skin. 

We have all heard of one-armed men suffering pain in the lost fingers. 
The pain is in some nerve high up or in the cord itself, but it is "referred" 
to the fingers. If there are no fingers there, it is easy to guess that the pain 
is higher up. When there are fingers and pain is felt in them, it is not so easy 
to prove that the seat of pain is elsewhere than where it is felt. 

As the result of much study, Head and other investigators have found 
some areas to which internal organs are prone to refer their disturbances. 
Sometimes the disturbance expresses itself as a pain, sometimes as a muscular 
spasm, and sometimes as a local edema or swelling. Some of the more im- 
portant of these relations are as follows: 

Liver — In the back near the point of the right shoulder or under the 
shoulder blade ; in the pit of the stomach at the end of the breast bone. 

Kidneys — On the edge of the ribs a little above the level of the navel; 
in the small of the back; in the male genital organs. 

Lungs — Anywhere over the chest; in a circle four inches in diameter 
around the navel. 

Diaphragmatic pleura — Over the pleura; under the collar bone toward 
the shoulder in front; in the backbone just below the juncture of the neck 
and trunk. 

Heart — In the left shoulder ; down the left arm ; over the heart and along 
the breast bone above the heart; occasionally in the pit of the stomach. 

Uterus and tubes — In the nipple and breast; in the abdomen below the 
navel; on the top of the head; in the base of the brain; "in the spine/' low 
down ; in the thighs both front and back. 

Pain in the legs due to disease of the uterus and tubes may be the result 
of pelvic pressure on the nerves as well as to impulses transmitted in the cord. 

Ovary — The transmitted pains, the result of changes in the ovary, may 
run to the same areas as those from the uterus and tubes. Pain in the heel 
is one of the odd indirect results of ovarian disease. 

Hip joint pain is frequently referred to the knee joint. The pain of dis- 
ease in the lower vertebra is felt in the legs. 



TO PREVENT NERVOUSNESS 

It is important that a child should not come of neurasthenic stock, yet 
Oppenheim thinks that association with neurasthenic parents produces more 
neurasthenia than does inheritance. To save children from the "dangers of 
psychic infection in the parental environment," he thinks they should be re- 
moved from their own homes to better environments. "All these neurasthenic, 



372 SYMPATHETIC NERVOUS SYSTEM 

hysteric, worried, and fear controlled adults came up through childhood. In 
many of them their troubles could have been prevented had they had proper 
training in childhood." 

The most important point is that the child be stimulated to play with 
other children. Nothing so helps a child to find himself as ordinary everyday, 
rough-and-tumble play. 

On the subject of food, Barker of Johns Hopkins says: "The child that 
learns to eat and digest all wholesome foods and who is not permitted to 
cultivate little food antipathies makes a good start and avoids one of the worst 
pitfalls of life, namely, a finical anxiety concerning the effects of various foods 
all too likely to develop into a hypochondriacal state." 

Barker thinks it important that the child should undergo a process of 
mental hardening. "Nothing can be more harmful than the gratification of 
caprice. Especially when a child shows a tendency to be nauseated by certain 
smells and tastes and to complain of noises or of sensitiveness to bright light, 
the family physician should be consulted and, provided no actual disease of 
the sense organs or brain is found, the process of psychic hardening should at 
once be begun." 

The child must be trained to disregard these abnormalities by counsel and 
precept and also by discipline. If he is convinced that he is just like other 
boys, he will forget his caprice, for caprices are manifestations of an exag- 
gerated ego. Pain and suffering have their place in the training. Unless a 
boy gets hurt occasionally in boxing, wrestling, aye, in fighting, he goes 
through life with an exaggerated fear of pain and suffering. The best way 
to rid him of this exaggerated fear, even of fear itself, is to have him get 
hurt occasionally. 

Fear is powerful in its capacity for producing ill health, as well as for 
making men incapable. Barker thinks that the foundation for abnormal 
fears and timidity is laid by the practice of frightening children. 

In Greece and Eome the children were frightened with stories of female 
demons. At the present time use is made of goblins, witches, ghosts, and 
"hants." 

Children must be protected from such stories, and when through them 
morbid fears exist they must be trained into better mental states. 

What is to be done with the child that flies into tantrums ; with the child 
that, when it wants anything, cries and cries until he gets it? In the first 
place, if training is begun early and is properly carried out, the child will 
never develop into this type. If, through neglect, such habits have been 
developed, the habit of self-mastery must be substituted for emotional out- 
breaks, even though it be difficult. 

The mother must ignore the temper, and, after calm has come, she 
must wait a while and then gratify the wish or request, if it is proper to 
gratify it. Not much Montessori in the plan, but it is proper just the 
same. 

A striking symptom present in most neurasthenics is indecision. Some- 
times obstinacy or explosive decision is the form that the vacillation takes. 
Some children of the "hair trigger" type need to learn deliberation. Some are 
given to fear, doubt, and indecision. 

The parent can do much to help this latter group to a habit of decision. 



INFLUENCE OF THE MIND ON DIGESTION 373 

This recommendation is much more in line with the Montessori method, since 
overcontrol is largely responsible for the fault. 

Barker quotes a page from Arnold Bennett's "Human Machine/' in which 
there is set forth the folly of blaming people and the wisdom of running one's 
own life and allowing others to run theirs. The pernicious habit of blaming 
the child learns from its parent. 

The sensitive, nervous system of the child must not be overprotected. 
The policy of over protection begets a capacity for keen suffering. Pouting, 
sulkiness, harboring a grudge and bearing malice must not be transformed 
into more persistent moods. Left to grow as weeds these lead to envy, suspi- 
cion, a morbid sense of neglect, and perhaps in time, to delusions of persecution 
and paranoiac states. 

The habit of flying into violent tempers in older children can sometimes be 
broken by showing the child that he is making himself ridiculous. Even 
children have a horror of making donkeys of themselves. 

Finally the article deals with the joy of work and its ability to bring 
health to the nervous. The education to idleness is education to nervousness. 



INFLUENCE OF THE MIND ON DIGESTION 

When the animal body was planned it was arranged that certain proc- 
esses necessary for the growth and maintenance of the body and for the 
perpetuation of the race should go on without process of mind. There was 
economy in this in that it left the higher nerve centers to do certain other 
things. The functions over which the mind has little control are digestion, 
nutrition, circulation, respiration, and the growth and development of the 
unborn babe. Yet all of them are in some measure capable of being affected 
by the mind. 

This is true of digestion. The understanding of the digestion may be 
said to have begun with the observations of Dr. Beaumont of Mackinac 
Island on Alexis St. Martin, a French Canadian, who had been wounded in 
such a way that the stomach secretions could be studied. Following Beaumont, 
investigations have piled discovery on discovery. 

Eecently a Eussian, Pawlaw, has taught us a lot about digestion. One 
of the things which he has taught us is that, when the eye sees and the nose 
smells food, the mind goes to work and stimulates the stomach to secrete. I 
give just enough of this to make the point that what the mind can start it 
can stop. 

Certainly 60 per cent of dyspepsia, indigestion, and stomach troubles is 
in the mind. Of the remaining 40 per cent, about one-half, 20 per cent, is 
the expression by the stomach of organic trouble located elsewhere in the 
abdomen, for while in telephone language the brain is "central," the stomach 
is an important "branch." Therefore, as Dr. Will Mayo puts it, "When the 
stomach telephone bell rings, one should always inquire, 'Who's talking V " 
It may be brain, it may be appendix, it may be liver. When you get the 
feathers off the stomach diseases there is mighty little duck left, not over 
20 per cent. In plainer speech, not over one-fifth of the cases of indigestion, 
"stomach trouble," "dyspepsia," are due to stomach disease. 



374 SYMPATHETIC NEEVOUS SYSTEM 

A good stomach specialist is a good nerve specialist, a good mental 
therapist, a good "suggester" — for most stomach troubles can be cured by 
sensible eating (as to articles, quantity, and method), combined with mental 
therapy. It is said men dig their graves with their teeth. Dyspepsia grows 
by what it feeds on. Most cases would get well if the subjects would eat 
simply — and forget. 

THE INFLUENCE OF MIND ON NUTRITION 

Of course, the fat man is jolly and the thin man is a "born worrier. " 
Can it be concluded from these truths that the mind influences nutrition and, 
carrying it a step further, that the mind can influence the nutrition of any 
particular organ, say the lung or a structure more under the will — a muscle 
of the arm? 

Being fat or thin depends upon how much or how little fat or grease 
is slipped into spaces here and there. The deposition of fat in an organ is 
quite different from nourishing its cells. The food which the body takes up 
is used first to nourish the healthy cells, to repair wear and tear, and then 
the surplus is deposited as fat. The fat man has all of his organs nourished 
and some to spare. Therefore, he ought to be happy and he frequently is. 

Many things work together to make a man thin. If he worries he burns 
up a lot of food energy and just the amount used in that way may mean 
that, in his ledger, his "fat" account shows more liabilities than assets. There 
is no doubt but that some men worry themselves thin. The way it is done 
is by the useless burning of food, not through any direct influence of the 
mind on the tissues. Fat is always a foreign body among the cells proper 
to the organ. 

To influence the nourishing of the cells proper to any important degree 
is beyond the power of the mind. The mind can round out the arm. If a 
man eats and digests well and does not worry, he can increase, let us say, his 
biceps measurement. It increases because the surplus nourishment fat is de- 
posited under the skin as fat. But no amount of thinking can make the 
biceps muscle have more fibers or grow larger ones. 

Nourishment comes through use rather than through mind. This 
illustration applies to all the cells of the body. Mind influences the features 
greatly; it has not much influence on the essential tissues. The fact is that 
the frame of mind has little influence on the nutrition of those tissues that 
have work to do. Nor can concentration of the mind on any particular organ 
or its work in any material way modify its nutrition or its working. 

A man can worry himself thin or, by being even-tempered, he can promote 
rotundity. But he cannot by any direct mind action increase the size of his 
muscles, or the state of his health or nutrition of his lungs, heart, liver, kidney 
or any other organ. 

THE MIND AND THE HEART AND CIRCULATION 

The rhythmical movement of the heart is automatically regulated. The 
size and carrying capacity of the blood vessels is also automatic, regulated 



INFLUENCE OF THE BODY ON THE MIND 



375 




by the needs of the area for which each particular vessel carries. God did not 
propose that a process as necessary as the circulation of Mood should be con- 
trolled by so weak, vacillating, and incompetent an agency as the human 
mind. And yet the fairly independent state called the circulatory apparatus 
belongs to the federation of states called the human body, and it must have 
its capital. 

The brain, through the mind, can influence the heart and blood vessels 
in some degree. Blushing is frequently a mental process. That fact has 
always been recognized. And yet Darwin taught us that the capacity of the 
brain to dilate the blood vessels of the cheeks is highly developed as the result 
of special training, and the same change cannot be 
made in the blood vessels of other parts of the 
body, at least not to any considerable extent. 

That emotion can make the heart beat fast 
or slow or irregularly everybody knows, but not 
even the most violent emotion can mate a healthy 
heart stop beating. Sometimes the brain tries 
hard only to fail. Men go into cataleptic states, 
hypnotic conditions, major hysterical manifesta- 
tions, with many functions suspended in whole or 
in part, but the heart beats away regular in its 
rhythm, neither faster nor slower. 

If a man has a heart disease the mind can 
make his heart asthma worse. If he has lime in 
his valves and palpitation is a result, dread, fright, 
and worry can make his attacks more frequent and 
more agitating. In other words, the mind can 

help in perpetuating a vicious circle, but when that is said there remains 
nothing else of consequence to say. 

It is a long way from these manifestations to the curing or preventing of 
leaking heart valves or poorly nourished heart muscles. It is a long way 
from blushing or blanching of the cheeks to increasing or decreasing to any 
material degree the blood in, say, the kidneys or lungs. 



£IJ§ 



Fig. 149. — F. Site of Fron- 
tal Sinuses. A. Site of An- 
trum of Highmore. Pres- 
sure on the skin over these 
points may show tenderness 
in inflammation (sinusitis) 
in these cavities. 



INFLUENCE OF THE BODY ON THE MIND 



How does the body influence the mind? 

Man is not an individual. He is a community, consisting of millions of 
individuals called cells. 

Some of these are doing nerve work — we call them brain cells; some are 
doing muscle work — we call them muscle cells. Nothing can affect Illinois 
without affecting Texas ; nothing can affect one organ without affecting the 
other organs. The more one organ comes to being "central" for all the other 
organs the more it is affected by them. 

On this principle the body affects the mind more than the mind affects 
the body. For one thing, it is "central"; for another, it is sensitive, it is 
delicately poised, it puts out a thousand "feelers," while the other organs are 
as oysters in their shells. 



376 



SYMPATHETIC NEKVOUS SYSTEM 



Let this statement stand out: The body affects the mind more than 
the mind affects the body. 

When impulses travel from sick organs to "central" they stimulate more 
than the centers which immediately control them. New impulses spread 
from the new focus. The state of mind incited by a diseased organ may react 
to disease that organ further. A vicious circle is established. 



Constipation 
Fatigue. 



{Defective Vision, 
Indigestion, In-) mtmi 
sufficient Blood ( 




( Poor Blood Supply, 
\ Excitement, Worry 



._- — E y e 

^.-.-j/-- Decayed Teeth 
.-- "~?5Ear Disease 



Fig. 150. — Showing Location of Headaches, According to Their Causes. 

It is the fashion to call all sorts of things neurasthenia, to ascribe symp- 
toms to a state of mind. That is good as far as it goes, but much harm will 
come unless the so-called neurasthenics are closely analyzed to eliminate those 
wrongly in the class, and also to find the organic basis, sometimes large and 
sometimes small, of many of the cases. 

Pretty nearly everybody recognizes the dependence of mental and emo- 
tional states on conditions of health and disease. When a man's tissues are 



SOLE OP FOOT 



Neuralgia of the Sole; 
Neuralgia of the Met- 
atarsus (lower ankle) ; 
Flat-foot; Disease of 
the Prostate. 







Gout, Neuras- 
thenia, Ova- 
rian Diseases, 
Pain in the 
Tendo Achillis 



Fig. 151. — The Possible Causes of Pain in the Foot and Heel. 



nourished he takes a kindlier view of things, while, on the other hand, the 
irritability of the dyspeptic is the offspring of his physical condition. 

Here we see a man able to conceive and carry out large enterprises, radi- 
ating vitality and dominating situations, because of his capacity to eat thick 
steaks and burn them into mental energy. There we see another — narrow, 
pessimistic, unjust, jaundice-eyed, incapable of inspiring others to action, as 
he is incapable of action himself, because of physical deficiencies. There is 



THE MIND m MENTAL DISORDEKS 



377 



a third man, he who is able to shield his mind from the influence of his 
body. 

The greatest service which mental therapy, called Christian Science, or 







PAIN OK TENDEBNESS AT VARIOUS POINTS 




ALONG THE SPINE 




wkwm 


Hysteria and Neu- 




n jfj^=M 


rasthenia. Very 




r~ V^ 


much the most fre- 
quent causes of 




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"backache," espe- 




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cially at the base of 




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• the shoulders and 




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at the base are fa- 




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tigue and neuras- 




m£ 1 am 


thenia. 




W y l m 


Other causes some- 
what frequent are 




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Pott's disease, spinal 




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curvature, ulcer of 


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f 


the stomach, small- 


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pox and other 


mm/ Iff/// 


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fevers. 











Fig. 152. 

some other name, has rendered society is in increasing the members of this 
third group. In teaching how to shield the mind against the body they are 
more successful than in curing the body through the mind. 

THE MIND IN MENTAL DISORDERS 



There is a group of people whose disorders are out of proportion to their 
physical bases. At one end of the line are the insane, at the other the self- 
centered; and in between there come the cataleptics, the hysterics, the neu- 
rasthenics, the neurotics, the alcoholics, and the drug fiends. 

The insane have gross changes in their brain structure; others have very 
little. Generally speaking, the symptoms are out of proportion to the changes 
which are present. In all forms of insanity, except those advanced cases 
where the nerve structures are badly degenerated, music and pleasant sur- 
roundings as means of suggestion, supplemented by patient talks and counsel 
from those in attendance, are the best agencies for helping the patient to 
sane and calm moments. 

In nearly all functional nervous disorders the symptoms are out of pro- 
portion to the organic changes. In hysteria, while authorities vary from the 



SUSIES 




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Ulcer of the Stom- 
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Hernia, Disease of 
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THE MIND IN MENTAL DISORDEES 



379 



group who think the generative organs have little to do with it, to Freud 
and his school, who think they have much, they all unite on the ground that 
the symptoms, as expressed, are out of proportion to the organic changes. 

In neurasthenia, as a base there is usually some overtire, or, maybe, some 



Renal Colic, Perirenal Ab- 



Lumbago, Pelvic Disease 



POSTERIOR AND LATERAL 
ASPECT OF THIGH 



Sciatica (unilateral tract 
of nerve), Both Sciatica; 
Locomotor Ataxia, Lum- 
bar Abscess, Growth in- 
volving Cord or Both 
Sciatics in Pelvis, Impact- 
ed Feces, Cancer or Ulcer 
of Rectum 



Cramp due to Chronio 
Nephritis, Overexertion, 
Diabetes, Gout, Alcohol- 
ism, Hysteria, Deep-seat- 
ed Varicose Veins 




JOINTS IN GENERAL 



Acute and Chronic Rheu- 
matism, Arthritis Deform- 
ans, Gonorrheal Arthritis, 
Synovitis, Postfebrile 
Arthritis, Rachitis, Syph- 
ilis, Tuberculosis, Scurvy, 
Hysteria, Gout, Tumor, 
or Compression of Neu- 
ralgia Cord, Locomotor 
Ataxia 



DIFFUSE PAIN IN EXTREM- 
ITIES 



Multiple Neuritis, Mus- 
cular Rheumatism, My- 
ositis, Locomotor Ataxia, 
Spinal Meningitis, Myel- 
itis or Apoplexy, Scurvy 
or Hemophilia, Lead- 
Poisoning, Rachitis, Trich- 
inosis, Influenza 



Below Knee, Unilateral,- 
Non-Inflammatory, Pre- 
monitory of Cerebral 
Hemorrhage 



Fig. 155. — The Possible Causes of Pain in Various Pabts of the Body. 



organic diseases, but what constitutes a neurasthenic is an exaggeration of his 
disorder — for instance, making over a capacity for being easily fatigued into 
a virtue instead of a vice, believing in it, bowing down to it, and trying to 
persuade others to do the same. 

Neurasthenics and hysterics being largely mind caused, the main line of 
cure must be mind cure. To relieve them the underbrush of malnutrition, 
constipation, anemia, poor physical development, underoxidation must be 
cleared away so that hypnotism, suggestion, auto-suggestion, faith cure, and 
mental training may have a chance to chop the trees. 

The function of hypnotism is to give relief, but, wisely done, it can be 
used to train to self-dependence. The greater advantage of the analytical 



380 



SYMPATHETIC NEEVOUS SYSTEM 



method employed by the Freud school, the mixed suggestion and mental train- 
ing of Du Bois, the psychology of Christian Science, and that of mental 
therapy is that they have power to beget self-dependence, independence of 
others. 

They help a man to see himself as he is, not as he thought himself to be. 
But seeing is not enough. To see and stop there leads to still greater helpless- 



T7PPEB JAW 



Periostitis, Disease of 
Antrum, Dental Af- 
fections, Neuralgia of 
Superior Maxillary 
Nerve 



LOWER JAW 



Mumps, Salivary Cal- 
culus, Dental Affec- 
tions (caries, pulpitis, 
alveolar abscess, or 
periodontitis), Neur- 
algia of Inferior 
Maxillary Nerve 



AURAL AND PARIETAL 



Otitis Media or Internal Furuncle of Meatus, For- 
eign Body in Meatus, Mastoid Abscess, Polypus, 
Caries of Teeth, Pulpitis, Alveolar Abscess, 
Dentition, Eye-strain, Neuralgia, Temporomax- 
illary Rheumatism, 
Syphilitic or Other 
Disease of Maxillary 
or Temporal Bones, 
Cancer or Irritable 
Ulcer of Tongue, In- 
juries 




Tonsilitis, Follicular or 
Phlegmonous Pharyn- 
gitis, Postpharyngeal 
Abscess, _ Scarlatina, 
Diphtheria, Laryngitis, 
Carcinoma, Foreign 
Body, Irritant-Poison- 
ing 



Myalgia, Sprains, Cer- 
vical Caries, Cervical 
Abscess, Inflamed 
Lymph Glands, Aneu- 
rism of Irmominate 



Fig. 156. — The General Diagnostic Indications to be Derived from the Seat of Pain 

in the Face and Neck. 



ness. Where relief is permanent it is through mental training. The hysteric 
may be temporarily relieved by hypnotism, but, if she stop there, she has re- 
newed attacks. The drunkard (all drug fiends are neurotics) may be cured 
by suggestion (called cured), but if he stop there he will "fall from grace." 

All neurasthenics who would be cured must patiently, persistently, cour- 
ageously work out their own salvation, helped by competent trainers, build up 
a resistance to fatigue, cure self-centering by broadening their interests, gain 
calm and an abiding optimism. 



PEBSISTING NEUEALGIAS 



381 



PERSISTING NEURALGIAS 

Had the inventor of the submarine cable been an anatomist, he -would 
have saved himself a lot of trouble. He could have studied a nerve and had a 
working plan for his cable. As it was, he probably puzzled his brain for years 
over the plan, using for his planning brain cells and nerves built exactly as a 
cable is built — nerves built on the proper plan. 



PRECORDIAL 
REGION 



Angina Pectoris (ra- 
diates down left 
arm), Pseudo-an- 
gina (aneuric, gas- 
tric, neurasthenic, 
grippal, toxic), Func- 
tional Disorders of 
the Heart, Valvu- 
lar Defects (aortic 
in particular), Gas- 
tralgia (cardialgia), 
Gastritis, Poisoning 
by Arsenic, Flatus 
in Splenic Colon, 
Anemia, Hysteria, 
Epilepsy, Locomo- 
tor Ataxia (more 
common in axilla) 




Colon, Diaphragm 



LEFT HYPOCHON» 
DRUM 



Impacted Splenic 
Colon, Colitis, Gas- 
tritis, Gastric Car- 
cinoma, Gastric Ul- 
cer, Dilated or Pro- 
lapsed Stomach, 
Enlarged Spleen 
(Malarial Leuke- 
mic), Renal Colic, 
Exercise, Anemia, 
Acute Rheumatism 
(especially in chil- 
dren) 



LEFT ILIAC 



Colitis, Impacted 
Sigmoid, Hernia 
(Patulous Internal 
Ring) , Varicocele, 
Ovaritis, Muoous 
Colic 



Fig. 157. — The Possible Causes of Pain in Various Parts of the Body. 



I presume that, occasionally, a telegraph operator will transmit an inquiry 
about something that he, the operator, could inform both the sender and the 
recipient of. But his duty is to transmit, and he holds his peace. I can 
imagine the nerves in the inventor feeling about it about like the operator does. 

In the center of the nerve is the wire that runs from the sending office as 
a continuous unbroken cord. Around this is a lot of insulating, and around 
the insulation is the wrapping for strength and protection. The impulse 
travels from the center to the muscle to be moved. 

In the spasmodic disorders so frequently noted, the seat of the trouble is 
not in the jerking muscle nor in the nerve which makes it jerk. The impulse 
is transmitted, unchanged, from some nerve cell, and the muscle jerks because 
it is powerless to disobey orders — which makes plain the absurdity of treat- 
ments directed to the muscle or even to the nerve in its course. 



382 



SYMPATHETIC NERVOUS SYSTEM 



An old book directed that, when a baby's head was jerking in convulsions, 
it should be held still. The absurdity of such a plan anyone can see. As nobody 
would be so foolish as to believe it, nobody is so foolish as to advocate it. 

However, though the curtain is lifted and the imagination makes us see 
beyond the jerking head, it is not wholly lifted. We are still prone to stop 
short of the center where the trouble is starting and prone to forget that back 
of the disturbing cell lies that which has disturbed the cell. 

Eye and Teeth Anemia and Neurasthenia 



Neurasthenia 




Ocular Neurasthenia 
and Melancholia 






Fig. 158. — The Causes of Localized Headache, According to the Exact Site of the Pain. 

Failing in other and better measures for control, the surgeon steps in and 
cuts the nerve. 

At once the jerk stops, or the pain stops, if pain were the trouble. Or he 
kills the nerve by injecting alcohol into it. 

No external expression of the nerve cell change can be given, but back of 
the cut the nerve cell change goes on. 

The methods of cutting the wires with the knife and with alcohol injec- 
tion replaces an older, less efficient, and much more harmful method. It was 
the drug method— the use of alcohol, or morphin, or cocain. 

These acted like nippers in cutting the nerve. The cut was not a perma- 
nent cut. In a few hours, the line had been repaired, and down it telegraph 
messages were going again. 

Again, unlike the act of the nippers, the cut was not a clean one. Mor- 
phin, cocain, and alcohol, in their efforts to cut the line, smash things gener- 
ally. They lay out all the cells reached by the blood and amenable to them. 
It is from this action drug habits are born. 



NEURALGIA 



383 



The use of sedative drugs ts horn of a partial view, not so foolish as hold- 
ing a hdby's head for fits, out nearly so. 

i\ sufferer from a persistent neuralgic pain should try to locate the 
cause of his trouble and remove it. The cause may be connected with the 
nerve itself — a pressure, for instance. It may be on some other nerve. The 
pain is reflex. It may be due to absorption of infection from some 
distant area — the teeth, tonsils, nose, gall bladder, appendix, prostate, fallopian 
tubes. 




Chicago Medical Recorder. 
Fig. 159. — Trifacial Nerve. Nerve of sensation, with branches to teeth, nose, orbit and 
sinuses in the upper jaw showing. 

If relief cannot be secured in this way the question of relief by cutting 
the wires comes up. Is it better to suffer the pain than to suffer the remedy ? 
If it has been decided that the pain is the worse evil the question comes up : 
Shall the cable be put out of commission by the knife or by injection of alcohol 
or a similar drug into the nerve, or shall it be done by the use of morphin 
or other drugs ? The answer is : Do not use habit-forming drugs to relieve 
persisting neuralgias. 

NEURALGIA 



The men who analyze the origin of words tell us that neuralgia 
means nerve pain. Following out this general idea we call those cases 



384 SYMPATHETIC NERVOUS SYSTEM 

neuralgia in which there is pain but no other evidence of disease in a nerve. 

Perhaps about as good a way to divide neuralgia from neuritis is by 
calling neuralgia all those cases in which the pain conies and goes. If 
the ache is steady day and night for weeks, months, or years, the probability 
is that if we looked at the nerve we would find it inflamed — neuritis. If the 
pain comes and goes the probability is that if we got the nerve out and 
examined it with the unaided eye we would find nothing abnormal. Such 
cases we call neuralgia. 

The pain in neuralgia is paroxysmal. It gets much better and much 
worse, or disappears and reappears. Sometimes it occurs with clocklike 
regularity. Such periodicity in neuralgia may be due to malaria. More 
frequently it is not. The pain is apt to shift from place to place. It comes 
on suddenly and is apt to leave just as suddenly. While the pain is deep, the 
skin over the painful areas may become tender. In some cases of neuralgia 
the skin swells as in nettle rash. In others blisters and sores appear; for 
example, shingles. 

It is in this disease that painful points or tender points are found. In 
neuritis the nerve is tender along its entire course. In neuralgia there may be 
one or more tender points along the nerve, or where it comes out of the 
spine or where it crosses some bone. The one outstanding symptom in 
neuralgia is pain. A nerve of sensation is disturbed and it is crying out 
in the only terms in which it is able to talk. 

What is to be done about it? Naturally, the first call is for relief 
from pain. This is where the chiropractor, osteopath, and masseur come 
into their own. They find these tender points, and in many instances, by 
manipulating them, relieve the pain. It is natural for neuralgic pain 
to stop suddenly, and there is every reason to think that skillful massage 
and manipulation of the muscles, bones, joints and ligaments can bring 
relief in some of these cases, though no one can tell in advance which 
cases can be relieved. 

The physicians who give medicine have many drugs in their quivers. 
Preparations of opium, morphin, and codein should never be given. The 
danger of habit is too great. Some people take whisky for neuralgia. 
Though physicians cannot be blamed for that practice, possibly some would 
say that alcohol as a neuralgia remedy belongs, in the physician's quiver. 
Alcohol should not be given in neuralgia for the same reason that morphin 
is forbidden. 

Among the effective drugs which do not produce habit are acetanilid 
and other coal tar preparations, salicylates, gelsemium, cannabis indica, and 
aconite. None of these should be given except for short periods, and 
then only under physicians' control. A drug powerful enough to do good 
is powerful enough to do harm. 

The matter of relief having been attended to, the question arises : What 
is behind the pain? The answer is more important than the answer to 
the cry for relief. Malaria may be the underlying cause. Or it may be 
alcoholism, diabetes, lead poisoning, syphilis, gout, rheumatism, or Bright's 
disease. It may be that the neuralgia is really an expression of central 
disease — for instance, locomotor ataxia. It may be some local cause, such as 
a diseased tooth or a diseased ovary. In every case treatment must include 



SCIATICA 385 

treatment of the underlying cause. Neuralgia is never anything more 
than a symptom. 

SCIATICA 

Stedman defines sciatica as sciatic neuritis, neuralgia of the sciatic 
nerve, felt at the back of the thighs and sometimes running down the 
calf of the leg. The sciatic nerve is the great nerve trunk of the leg. In 
the public mind any pain in the leg not located in a joint is known as 
sciatica. In many cases thought to be sciatica the pain is not even in 
the nerve trunk. In many others the pain is in the nerve, but the seat of the 
trouble is elsewhere. 

In the Medical Record Dr. Hunt classifies cases of sciatica into four 
groups : There are the cases of sciatica in which the pain felt in the nerve 
is the result of pressure on the nerve at the point where it comes away 
from the spinal column. Injury to or disease in the bones of the lower 
end of the spinal column, or damage to the joint which joins the spine to 
the hip bones, affects the sciatic nerve and causes pain to be felt in the leg. 

Second, pressure on the nerve in the pelvis by a tumor, a pregnant uterus, 
or a distended bowel causes a neuralgia in which the pain is felt in the leg 
rather than in the pelvis. To the causes belonging in these two groups 
may be added the cases of sciatica in which the real trouble is disease 
of the hip joint. In these cases the injury to the nerves of the hip makes 
itself felt in the leg. 

Third, constitutional states such as syphilis, alcoholism, diabetes, and 
malaria. 

Fourth, damage to the nerve trunk from injury or exposure to cold. 

Plainly, the man who thinks he has sciatica and who wants to be 
rid of it should first find out what his trouble is. He should make certain 
the pain is in the nerve and not just somewhere in his leg. Next, he 
should investigate the possible conditions elsewhere in the body capable of 
causing pain in the sciatic nerve. What he is to do depends on what he 
finds. If the trouble is a broken arch he must treat his feet. If the hip 
joint is responsible treatment must be directed there and not to the nerve. 
If the pain is due to spinal cord disease, for instance locomotor ataxia, little 
is gained by treating the nerve. If the pain is the result of conditions in 
the pelvis attention must be directed to the organs in that locality. If 
syphilis, malaria, or diabetes is the cause the underlying disease is to be 
treated. Some men are called upon to choose between alcohol and sciatica. 

Neuritis — Neuralgia. — M. B. M. writes: "Can you tell me of some 
permanent relief for neuritis? I have doctored for it for fifteen months, 
taking medicines, hot water applications, and rubbings. Nothing seems 
to effect a cure. My right arm and across my neck seem the most affected 
and at times the pain is almost unbearable." 

Reply. — Your disease may be neuralgia. The fact is, I think it is 
neuralgia. A pain which just scatters around generally across the neck 
and down the arm is very apt to be neuralgia rather than neuritis. 

Neuralgia means pain in a nerve. Neuritis means inflammation of the 



386 SYMPATHETIC NERVOUS SYSTEM 

nerve. In neuritis the pain is located in the affected nerve. It sticks 
there rather closely. It hangs on steadily day and night for some time. 
In neuralgia the pain comes and goes. In neuritis the inflamed nerve is 
tender. 

You are suffering from pain in your neck and arm. You have had 
this for fifteen months and hot water bottles and rubbings have not relieved 
you. Why ? For one thing, you may be absorbing bacteria constantly from 
bad tonsils or bad teeth. If so, you will not get well until your teeth or 
tonsils are cleaned up. 

Another possibility is pressure from a bursa somewhere in your neck 
or shoulder. Again, there may be pressure on the nerve from an extra 
rib, one located about where the neck joins the body. Both neuralgia and 
neuritis are caused by the above causes, and so long as the cause persists 
there is no need in splitting hairs over names. Then again, your trouble 
may be due to lead poisoning or alcoholism. 

How are you to know whether you have neuritis or neuralgia? In 
neuritis the pain is rather steady day and night. In neuralgia the pain 
comes and goes. In neuritis the course of the inflamed nerve can be made 
out by the tenderness on deep pressure. Sometimes the tender nerve can 
be felt with the fingers. In a neuritis which has lasted sixteen months it 
will be found that the muscles supplied by the inflamed nerve have 
shrunken. Ah examination with electricity will show that the muscles are 
degenerating. 

Let us suppose that you have neuritis. What can be done about it? 
First, you must look for and try to remove the cause. Unless you can 
remove the cause you will not make much headway with the cure. In 
giving relief care should be exercised that drug habits do not result. A 
drug habit is worse than neuritis. 

There is not much chance of relief from osteopaths, chiropractors, and 
masseurs. If the case is obstinate by all means try them, but do not be 
disappointed if you fail to get relief. Salicylates, iodids, acetanilid, gelse- 
mium, and other neuralgia medicines may give relief, but they probably 
will not. Rest and electricity and light therapy offer more hope of relief 
of pain than do any other agents. 

While this was being written a man told me of his experience. He had 
had neuritis for four months when he broke a tooth and went to see his 
dentist. The dentist X-rayed his mouth and found that two crowned teeth 
which seemed healthy were decaying in their deeper parts. The teeth were 
drawn. His neuritis got well at once. He also had a slight albuminuria. 
This disappeared after the teeth were pulled. 

Adjust Your Mind. — A. J. W. writes: "I have had considerable trouble 
in sleeping. I can sleep, but I dream all night, hence I am not fully 
rested in the morning. Would a tablet of sodium bromid, ten grains, have 
any bad effect on the heart if taken nightly f" 

Reply. — Ten grains of bromid at night will not affect your heart, but it 
will not help you to sleep, except it help you by suggestion. You are not 
justified in taking bromid or any other medicine to make you sleep. No 
one is ever justified in taking sleeping potions on his own responsibility. 
When one gets in the proper frame of mind to sleep he sleeps. 

Everybody dreams all night. There is nothing wrong about that. 
Maybe you are not rested in the morning because you sleep too long or in 
a badly ventilated room. Maybe you worry about your sleeping- 



SCIATICA 387 

To sleep, fix your room right, and then go quietly to bed to sleep, if you 
can; to rest, if you cannot sleep. When you go to bed in that frame of 
mind you will sleep. 

Thinking Disease. — A woman writes: "I have come to believe there are 
a lot of people who think so much of sickness, especially tuberculosis, that 
they think themselves into disease, whereas if they had more to keep their 
minds busy and not think and listen to others trying to tell them they 
have such and such disease they would sleep better and live longer." 
The writer quotes this statement from a magazine: 
"Many have contracted, consumption and died of it simply because they 
thought they would die of this disease because their parents did." 

Eeply. — Your advice to think of other things than disease is excellent, 
but you are mistaken in saying that to think consumption will cause it. 
Thinking collision never made trains collide. It's getting on the wrong 
track or the wrong schedule that does that. Thinking consumption never 
made consumption. It is living wrong that does that. Your position on 
that point is as wrong as is the position of those you criticize. Live right 
and then let consequences come. The consequences will be right. 

Has Poor Memory. — L. A. W. writes: "I am married, SO years of age, 
and a traveling salesman. My health is good. In my work it is necessary 
to do a great deal of memorizing and it seems impossible for me to -remem- 
ber. Is there anything I can do to remedy this trouble? Can you suggest 
any treatment or anyone to whom I may turn for help?" 

Memory can be greatly benefited by training. To train one there are 
memory schools and correspondence courses. See the advertisements in 
papers and magazines. 

Nervous Indigestion. — H. B. writes: "Can you suggest a cure for 
nervous indigestion? As sleeplessness is a feature of the case, what is the 
best food to be eaten at the evening meal? The case has been in the hands 
of a physician, but he frankly says he does not know what else to do." 

Reply. — You will not make much headway trying to cure sleeplessness 
or nervous indigestion by a diet. Simple, light meals eaten slowly and 
calmly will help, but to try to divide foods into this you shall eat and this 
you shall not eat will not help you much. Above all, eat a simple, light 
supper. This is about as far as you can go in the diet cure of either 
nervous indigestion or sleeplessness. Both are conditions of mind. Find 
someone who can teach you mental control — how not to be stomach-cen- 
tered or sleep-centered, or tense, and who will then teach you to live on 
light, simple meals, and you will find a cure. 

May Imagine Illness. — B. R. S. writes: "Last January I was taken by 
nervous prostration and it is so I can't sleep without a vegetable to make 
me. I have been to seven doctors. What do you recommend? I am getting 
desperate." 

Eeply. — As you have been to seven doctors, and none has found any 
organic trouble, you probably have none of great consequence. Nervous 
prostration under these circumstances is the result of bad mental habits. 
When these are corrected the nervous prostration gets well. To start with, 
taking something to make you sleep is a habit that must be corrected. 
Some men can get themselves in hand by reading books on nerves, of which 



388 



SYMPATHETIC NEKVOUS SYSTEM 



there are many. Some need mental healers, of whom some varieties are 
in the medical profession and some outside. Baths, massage, electricity, 
exercise, and tonics are aids. The essential treatment is to be directed 
to the mental habits. 

Nervous and Run Down. — A. M. writes: "I am run down from over- 
work and am thin and weak and nervous. I have teen advised to take 




Chicago Medical Recorder. 

Fig. 160. — Nerve of Sensation to the Soft Palate, the Teeth, the Nose, the 
Eye, Orbit and the Sinuses of the Upper Face. 



three-grain hyponuclane tablets to enrich the blood and make me strong 
and healthy. Is there any harm in taking these tabletsV' 

Eeply. — I have not been able to find out what this tablet contains. It is 
not likely to hurt you. It may not help you much without feeding, plenty 
of sleep, and plenty of open air. Don't you think these will fatten you up 
and rest you? 

Should Go to Sanitarium. — Interested Reader writes: "I have a friend 
who is, I think, affected with neurasthenia. He is a man of about JfO 
years of age, of unusually fine mind, and temperate in every way. He 
has an idea that he is going to die and always says he is afraid of death. 
He complains of a dreadful pain in his head and says he thinks it will 
burst and that will be the end of him. He lies down a good deal in a dark 
room. Sometimes, when you tell him to get up, he says he is suffering so 
that he cant move and that he is afraid his back will break. I think, of 



SCIATICA 



389 



Trigem. I 



course, this is all imaginary, but it seems to be real to him. He is de- 
spondent. Doctors do not do him any good. How should he be treated — 
that is, should he be talked to severely or should we sympathize with himf 
He has had to give up his 
business, of course, and it 
is too cold for any outdoor 
exercise. He complains a 
great deal of not sleeping. 
Please advise something 
that can be done for him 

at home. I know he seems ^M &:-vlWIS»3:'.v!3 

better as long as he is oc- \m wi Trigem. ni 

cupied, but he is not 
capable of doing a great 
deal — at least he thinks he 

isn't; and he seems nerv- S ±fl 

ous and clenches his fists * 

and has a most distressed 
expression." 

Eeply. — The above de- 
scription is that of an in- 
dividual with an excessive 
neurasthenia — almost be- 
yond the limits of that 
condition. Ordinary 
medicine and ordinary 
medical service will not 
help him materially. He 
needs mental training and 
psychotherapy. He may 
be able to accomplish 
what he needs at home, 
but prolonged sanitarium 
treatment will be much 
more promising. 

Have Him Examined. 
— R. D. writes: "I have 
a son who is 20 years old, 
5 feet 6 inches tall, 
weighs 115 pounds, and is 
strong for his weight. 
He eats well and sleeps 
well, but doesn't like to 
get up in the morning. 
He doesn't feel tired, but 
listless and drowsy — more 
at the age of llf years. 



Trigem. I 



Trigem. II 
Trigem. m 




Fig. 



161. — Distribution of Nerves of Sensation 
of the Head. 



so in hot weather. He lost interest in school 
Nothing seems to interest him and he doesn't care 
for company, especially where there are women and girls. He has a poor 
memory and cannot keep his mind on anything. He has no confidence 
in himself. He won't look for work, but will work if someone gets it for 
him. He sits around with his head hung down in his hands and at times 
he thinks someone is going to hurt him. As I am anxious for his welfare, 
any advice you give me will be greatly appreciated." 



390 SYMPATHETIC NERVOUS SYSTEM 

Reply. — The boy is in need of help. Have him examined as to his 
nerves and mind condition right away. If he is off mentally he should have 
care in an institution. If he is temperamentally off, as frequently happens 
with boys at his age, he needs somebody to get him out of himself and 
interested in something. He needs both mental and physical training and 
interests. 

Boy Needs Control. — Mrs. -8. L. P. writes: "I have a son who first 
showed symptoms of hysteria in his thirteenth year. He would lie for 
hours in a seizure. When this condition ivas recognized the seizures were 
stopped in a short time. It is seven months since one appeared. He is 
now 16 years old. His disposition is not good. His will power is not 
strong, only in his own way. His family affection seems to be lost. What 
is the cause? Is the condition apt to come on again? Do habits that are 
not good — for instance, deception, or picking up others' money, or will- 
fulness — develop? Will one recover entirely from* this?" 

Reply. — Habits of deception, willfulness, and lax ideas of honesty are 
apt to develop in the wake of the condition noted. Fortunately, most of 
the mental and nervous disorders that develop during adolescence tend to 
remedy themselves. After the individual has readjusted himself the kinks 
disappear. Wise guidance and help in which sympathy and judgment are 
properly blended are of the greatest service. 

Study your boy and try to get for him the schooling and control he 
needs. Perhaps you can get helpful suggestions from Hall's "Adolescence." 

Has Sudden Fears. — 0. J. 8. writes: "Please explain what causes me to 
be extremely nervous at times, making my heart beat abnormally. Occa- 
sionally a sudden fear comes over me when I am alone. I feel scared, as 
if something were going to happen to me. I have been in this condition 
for four weeks, and have lost four pounds during this period. I am weak, 
yet my appetite is good and I sleep well. I am unable to work at my 
trade as a carpenter. I am 29 years of age, weigh lkh pounds, and am 
about 5 feet 10 inches tall. I have worked steadily and hard all summer."' 

Reply. — It is possible you have an organic disease. Go to a capable 
physician and have an examination made. If he tells you that you have 
no organic disease, and he probably will, then proceed to get control of 
yourself. You have worked and worried too hard and are tired. It is 
easy to worry off four pounds in four weeks. 

Go back to your trade. Carpenter work is good for neurasthenia. If 
you cannot govern your mind and banish these fears by yourself, some 
one of the books on nerves may help you. If you try a book, you must 
study it. Casual reading is not enough. You may need the services of a 
psychotherapist. 

Needs Mental Treatment.— A. 0. writes: "A young lady of my ac- 
quaintance has been, or appears to me to have been, mentally unbalanced 
for several years. These are some of her actions: She is highly nervous 
and will get extremely angry at times when others are not thinking of 
such a thing. She will throw knives or anything she gets hold of into the 
wall, or shove the dishes on the table, or slam the doors. She will jump 
up of a sudden and slam things on the floor and threaten to knock people 
over or to gouge their eyes out. She is of an exceedingly jealous nature, 



SCIATICA 391 

and has an evil look when in these spells. She is also forgetful. She has 
a brother in an insane asylum and her father s family seems to have insan- 
ity among the members. Does she inherit it from him, and can she be 
cured? She also takes spells of laughing and seems unable to control her- 
self. Is there danger of her doing any harm to those about her when in 
these spells? What in your opinion is the matter with her?" 

Reply. — In spite of the insanity in this girl's family I should not judge 
from your letter that she is insane. I do not think she will harm anyone. 
That does not mean that she does not need mental treatment. 

A few weeks in an institution should enable the girl to get herself 
under control. 

Relaxing Body and Mind. — Mrs. A. V. F. writes: "What is the best way 
to relax the body while lying down to rest? How relax the mind?" 

Reply. — 1. Just relax. 

2. A more difficult question to answer. Some employ monotonous for- 
mulae which fatigue the mind to rest. Much the better plan is to lie down 
in an indifferent frame of mind, resolved to sleep, if possible, but not to 
worry, if sleep will not come. When one accepts what comes resignedly, 
calmly, and cheerfully, sleep comes. To try to relax generally defeats the 
end sought. 

But Little Danger. — R. P. F. writes: "I am a subject to rapid heart 
beats. Rave I valvular heart disease, and are long walks injurious? Is 
there any danger of sudden death?" 

Reply. — You are evidently in a "funk," probably worrying about 
nothing. Have a physician examine your heart ; find out if you have heart 
disease and advise you what to do. As to danger of sudden death, there is 
but little danger whether or not you have heart disease. 

Stop Worrying. — J. A. II. writes that he has been nervous for three 
years. He says: "I worry and am greatly troubled with insomnia. I am 
an office worker and do not get much exercise, and I know that that has 
something to do with my nervousness. I should like to drink a large 
quantity of milk, but it gripes me. Will a bath in the morning help 
nervousness? Is bathing in the morning or at night best? Hot or cold 
water? What is the best way to avoid worry? What is the best way to 
regain lost weight? Will malt tonics, such as are sold in drug stores, help? 
Should I drink milk?" 

Reply. — All your troubles come from your worry — your insomnia, your 
indigestion, your loss of weight. You must stop worrying. That is the 
important thing; the other things are secondary. This is a mental process 
which you must work out for yourself. 

Worry is illogical. Nothing is more cause for worry than worry. Begin 
by cutting out all worry and all other forms of concentration after supper. 
The harm of worry comes from our concentration. Lackadaisical worry 
causes no more insomnia than lackadaisical inventing, merchandising, 
clerking, or keeping house. # 

A recent correspondent told of his method. It was to let his mind 
travel over the neighborhood where he spent his childhood. We recom- 
mend the adoption of some similar plan. The thing thought about 
must catch enough hold on the mind to drag it away from the worry 



392 SYMPATHETIC NERVOUS SYSTEM 

theme, and at the same time it must not be itself a worry theme. As you 
gain mental calm, contentment, and poise you will gain in weight. 

In the meantime nothing helps as much as milk and cream. Drink 
three to four pints a day. If you will heat it well you will not get "gripes" 
from it. Milk itself does not cause gripes. Bacteria in milk may. So 
cook your milk. Malt tonics sold in drug stores will help. 

Finally, get some exercise. Walk to and from work. If this is not 
feasible, walk up and down the stairs to your office. If you will walk up 
ten flights to your office each day it will help. 

Don't Worry About It. — A. K. writes: "I talk to myself in a whisper 
unconsciously. I do so more frequently while riding on a street car than 
anywhere else. I think this is done often without any muscular movement. 
Sometimes I am on guard against it, and I feel certain I am not talking, 
yet the action of the other passengers seems to indicate that I am. This is 
dreadfully annoying. What causes this, and what is the remedy? I am 
70 years old. I have arteriosclerosis, hut otherwise my health is fair for 
my age." 

Reply. — Why worry about it ? Even if you continue it will not disturb 
the passengers and should not worry you. Keep your bowels open and your 
digestion good, eat moderately and be in the open air as much as possible. 
Do not worry or fret about your arteriosclerosis or your little lapses. In 
this way you will decrease your annoyance and you will find it will prevent 
you from annoying others. 

Quit Worrying. — M. K. writes: "I am 46 years old and am told by 
some of the best doctors that I have slow Bright's and intestinal indi- 
gestion. My hands and feet are always cold except when I am in bed. 
I have pain in the back between shoulders all the time, and sometimes up 
in back of the head. I am terribly nervous; everything worries me. What 
would you recommend?" 

Reply. — Quit worrying. Keep your skin going by wearing warm 
clothes, especially warm socks and gloves. Did you read that Amundsen 
put his thought on how to wrap his feet for warmth? Keep your bowels 
open, eat lightly and sensibly. When you have regulated your life sensibly 
you have done all that you can; therefore, quit worrying. 



CHAPTEE XXIII 

Neurasthenia 

THE PHYSICIAN AND NEURASTHENICS 

Taking it all in all, people employ and reward physicians on the basis of 
symptoms and emotions. They, therefore, think more of that physician who 
relieves them or gives them positive optimistic suggestion than of the one who 
discovers causes. 

The sick man wants to lean — just plain lean — and lie does not want to go 
hack up the stream to the fountain of things. If he is wise, and he usually is, 
he wants somebody to work out causes for him, but meanwhile he is tired and 
he wants to lean. It follows that the physicians who, along with their min- 
istrations, brighten and cheer as they go, are those who have succeeded best 
in gaining clients. 

But aside from this the pill that has been given to a patient who had 
faith, who took his medicine believing it would do him good, has always 
had its natural efficiency increased. Who of us has not seen people who 
scoffed at hypnotism, rejected suggestion, but who unconsciously paid tribute 
to it when it came as a potion taken in faith? For there are cer- 
tain types of minds which are incapable of accepting a purely mental 
presentation, but who readily yield when this is supplemented by some 
physical act, such as taking medicine, laying on of hands or crystal 
gazing. 

Even the strongest man needs spiritual help in his strongest moods. 
He needs it more when he is sick. 

What then shall we say of the neurasthenic, the neurotic, the hysteric? 
They must have mental help and the physician must give it — admitted that 
the aches and pains are out of proportion to their organic or even 
their functional basis; admitted that the fifteen-story structure — the pa- 
tient's complaint — is one story fact and fourteen stories mental per- 
version. 

Let the medical counselor explore well the organic basis of the disorder 
and give to it every weight and care which it deserves — admitted that the 
physician sees clearly just how much of the disorder is real and that the 
patient exaggerates all out of proportion. But, is it not worth his while, 
from the purely medical standpoint, that the patient's concept is distorted? 
Should he not see in the wrong working of the patient's mind a demand 
for study, care, and help? If he observes clearly that the patient sees 
cloudily, is that a reason why he should dismiss the matter with a care- 
less word? Eather does it not oblige him the more carefully to clear the 
cloud ? 

393 



394 NEURASTHENIA 



SYMPTOMS OF NEURASTHENIA 

Neurasthenia is sometimes known as the American disease. It was first 
described by an American, Beard, and for a long time foreigners pretended 
that we had it copyrighted. It is cosmopolitan. Wherever men wear out 
their brain cells with work or worry or fear, there neurasthenia is present. 

The word means nerve exhaustion. When the di( i onary starts in to de- 
fine neurasthenia it refers to nerve exhaustion, and then, recognizing that 
that means nothing tangible, it proceeds to add a lot of symptoms, each 
of which may or may not be present. For instance, the Encyclopedia 
Britannica names eight groups of unnatural sensations and then five or six 
kinds of fear. Stedman, after saying it is nervous exhaustion, names eleven 
groups of symptoms. They could just as well have named eighty. 

The symptoms are the speakings of the exhausted nerve cells and they 
are liable to tell any sort of a story. The eleven given in one definition and 
the twenty given in another are just the eleven or the twenty stories most 
frequently heard. 

These most frequent ones are headaches, pain in the back, toothache- 
like pain in the end of the spine, exhaustion after a little work, easy fatigue, 
poor memory, mental confusion, insomnia, worry, fear, and susceptibility to 
drug habits. 

Some neurasthenics have one group and some another. I think the 
most important group are the drug crowd — the men who must get drunk 
when things do not go just right, those who have a little pain and must 
take morphin for it, repeating it until they are slaves; those who have 
a headache if they do not get their coffee or their soda fountain stimulant. 

It has never seemed to me that anybody could read a dictionary definition 
and decide whether or not he was a neurasthenic. On the other hand, almost 
anyone who will read fifty or a hundred pages in some book on nerves can 
get a line on himself. 

It has seemed to me much more important that a man should be able to 
decide whether he is of a mental makeup that develops neurasthenia under a 
little stress. Such an inquiry is the more profitable of the two. 

If a man's brain is not under control, the foundation is there for 
neurasthenia. If he has not trained his mind to do its work without fear or 
worry or fretting, using therefor just the units of energy to do the job, the 
foundation is there. If he cannot rest, or relax, or play, or laugh, or sympa- 
thize, the foundation is there. 

If he is erratic mentally, flies off the handle in anger or in prejudice, 
gets worked up or hysterical, he is of the neurasthenic type. 

If he is fearful or worried, or gets headache after a little exertion, or 
is always undecided, he has got fairly well out of the group of neurasthenia 
potentials and into potential neurasthenics. 

The less one is in the easier he can work himself out; but, whether 
in deep or shallow, the only way to get out is to work out. 



TREATMENT OF NEURASTHENIA 395 



TREATMENT OF NEURASTHENIA 

"A Constant Reader: 
the replyes that poor Nervous Sufferers get from your Health Corner is 
Simply heart rendering I clout the one that publishes them have ever had any 
Nervous trouble if they had they Never would publish Such Cruel things. I 
never would wish a dog Such Suffering, but I hope you people will have your 
shair some day. Speaking about a Neurasthenic Exaggerating thair suffering 
they never could make thair suffering known. I sourely know what I am talk- 
ing about, how easey it is to advise a poor sufferer about something that you 
never have had any experience your Self. I don't cair how well learned 
you are, you don't know what anuther surfers unless you have suffered like 



The above letter is published for several reasons. An idea prevails that 
neurasthenia is a disease of the rich and idle. The composition and spelling, 
reproduced as written, suggest that the writer has not had much opportunity 
for education, and therefore probably is not rich. 

The object of printing the letter with its errors is not in any way to 
expose the writer's limitations. It emphasizes the fact that neurasthenia is 
not a disease of the rich and idle. Being a result of nerve fag, it would be 
expected that those whose lives are hard would furnish many of its subjects, 
and they do. A great deal of neurasthenia is found among the poor. 

The second reason for publishing the letter is that it is a typical 
neurasthenic output; a disposition to be unfair to others, a tendency to 
criticize and ofttimes abuse others is a part of the infirmity. 

The third reason is that it sets forth the tendency of the person to 
exaggerate his sufferings, an inability to judge accurately of just how his 
suffering compares with the sufferings of others. 

The fourth reason is that it is proof of the fruitlessness of trying to 
generalize with neurasthenics. 

In order to understand these points better, let us see what neurasthenia 
is. In neurasthenia there is nerve tire. It may be that, through inheritance 
or poor food or a poor physique, the nerve cells are so constituted as to be 
easily tired. 

Some people are so constituted that exertion which leaves others fresh 
will fatigue them to the point of exhaustion. In others the volume of work 
is so great or the character of the work is so wearing that exhaustion comes 
regardless of a good inheritance or a good physique or a good poise. 

In still others the work kills, not because it is especially hard or 
fatiguing but because the individual has an untrained or an imperfectly 
trained mind. This lack of mental levelness, of control, causes the brain 
to exhaust itself in doing tasks which a better trained brain could do without 
fatigue. 

Of these groups I think the lack of brain training group is the largest 
and most important. Next in importance I place the bad inheritance group. 
Last of all is the straight work group. 

The individual who is neurasthenic has a physical basis for every ill he 



396 NEURASTHENIA 

has. His difficulty is in perspective. He cannot form good judgment as 
to the importance of his sufferings or the violence of his pains as compared 
with other people's sufferings and pains. He knows that he suffers like a 
dog, and he does. But what he cannot appreciate or understand is that 
somebody else is suffering like two dogs. 

Back of it all lie the exhausted nerve cells. The nerve cells interpret 
things. If the digestion is wrong, the nerve cells tell us about it. If 
the gall bladder is wrong, the story is told by the nerve cells. If the day is 
hot, the nerve cells speak for us. 

When the speaking is done by good, sound cells the story they tell 
compares about right with the stories told by the nerve cells of other people. 
When the speaking is done by exhausted nerve cells, the story is modified 
by the cells which tell it, and in consequence it cannot be taken literally, 
as can the story told by the better rested, better fed, and better equipped 
cells. 

To ignore the physical disorder of the neurasthenic is not wise. To 
take the position that his recital of his sufferings is a gross exaggeration 
and that all forms of deception must be frowned upon is not wise. To dismiss 
the neurasthenic with a generalization, be it in the form of advice or of 
medicine in a bottle, is unwise. 

The individual must be carefully studied, a diagnosis made, and then a 
prolonged treatment undertaken. The first object of the study is to find 
out what physical disorder is present — a much more difficult proposition 
than where the statement of the symptoms indicate accurately the condition 
of the organs. 

Ofttimes the nervous exhaustion is the result of serious disease. In 
such a case, to make a diagnosis of neurasthenia and to conclude that there 
is no organic disease may be to overlook some such condition as a chronic 
infection of the gall bladder which has produced nervous exhaustion as the 
result of years of slight suffering; or the disease may be cancer or something 
else. 

Assuming that the careful examination has ruled out important diseases, 
there still are the minor disorders present serving to nag and tire and also 
furnishing the nub of the symptom which the exhausted nerve cells are 
presently to touch up, change, exaggerate, and hand out as the symptom. 

The next inquiry should be to determine the type to which this nerve 
exhaustion belongs. Is inheritance at fault, or bad physique, or bad mental 
habits, or overwork? As the result of these inquiries, diagnosis is to be 
made. And now on this diagnosis the treatment is to be outlined. 

The dominating feature of the group is the exhausted nerves. To 
remedy this condition patient, plodding effort is required. 

The most important of all the groups are those who are neurasthenic be- 
cause of untrained brains. In this group belong most of the poor-sleeping 
neurasthenics, the worriers, the fretters, those who cannot pull because the 
harness frets them. 

I remember driving a pair of horses seven miles in the country a few 
years ago. One, quiet, steady, calm, pulled most of the load and kept cool. 
The other, nervous and fretful, pulled almost not at all; nevertheless he was 
lathered with sweat. 



TBEATMENT OF NEURASTHENIA 397 

It is easy for a person criticizing a neurasthenic to prove that he pulls 
but little, that he gets nothing accomplished. On the other hand, it is 
easy for the neurasthenic to show that he is always lathered with sweat 
and to argue therefrom that he is working. 

More units of nerve force are used up in an hour of work, more nerve 
exhaustion results from ill devised, neurasthenic, fruitless labor than from 
exertion rendering the full amount of returns. 

Therefore, the critic says, "You accomplish nothing." The neurasthenic 
replies, "I work harder than anybody and I suffer worse than a dog." 

Of course, there is no contradiction in their statements. If these two 
people, critic and neurasthenic, are to get on together they must learn to 
see the other's point of view. 

It is desirable that neurasthenics should get on with each other and the 
world at large. The inefficiency produced by neurasthenia will be greatly 
lessened by a greater capacity to make a superficial diagnosis of neurasthenia 
and to treat the individual thereafter as a neurasthenic, blaming him less 
than we do. 

Some of the revolutions, many of the queer freaks of men, many of 
the opinions for which men are rejected, maligned, abused, defeated, banished, 
imprisoned, or beheaded are the result of neurasthenia. 

It is important to be able to pick out neurasthenic men and neurasthenic 
opinions. It is also important to improve the condition of the neurasthenic. 
Some of them can be cured so as to gain much in efficiency. 

To help a neurasthenic several procedures are necessary. The first 
is to be certain of the diagnosis. The next is to recognize such physical dis- 
orders as are present and give to them just their proper values. 

The next step is to prove to the neurasthenic that you are able to see his 
point of view, to understand that tire is in proportion to work done, and 
not in proportion to results accomplished. 

To do this just right requires intelligence. To convince the neurasthenic 
that you understand him and at the same time to save him from inferring 
that you agree with his opinion of the gravity of his disease is not an easy 
task. 

The next step is to make the neurasthenic see himself as a neurasthenic. 
To do this he must be able to stand himself up by the side of others and 
then walk off a few feet and compare. Not an easy task ! 

Once a neurasthenic begins to analyze his own acts and his own opin- 
ions to find the neurasthenia in them a good part of the cure has been 
effected. So long as he keeps that up he will be a much more efficient 
neurasthenic, a neurasthenic much easier to live with. Next to being a cured 
neurasthenic it is desirable to be a neurasthenic who has found him- 
self. 

The next step comes in daily exercise in control of the brain. This is 
the most difficult of all the steps. It is time consuming; it is the step 
which leads to cure. 

Some brains are strong enough to work out a cure alone. A neurasthenic 
may be strong brained, his disorder having arisen because his strong brain 
was untrained and uncontrolled. 

Some brains are strong enough to work out a cure with a little help. 



398 NEURASTHENIA 

Some can get this help from daily study of some such works as those by 
Du Bois, Freud, Sadler, or even Vittoz. 

Vittoz, while not on a plane with Du Bois or Freud, has the advantage of 
setting the subject a daily stunt. Such a stunt is a necessity, whether it be 
Bennett's, Vittoz's, or some devised for the particular case. 

Some must have personal contact and teaching by a physician, psycholo- 
gist, or a teacher of classes of neurasthenics. Some must lean upon faith 
in the supernatural while they are training their brains. 

Some diagnostic skill is required to tell to which group each neurasthenic 
belongs. Another point in which the diagnostic skill is called for is the 
decision as to whether the neurasthenic is to be given rest or work. 

If the nerve exhaustion has resulted from work and worry has been 
but a small factor in it, if the subject has gone about his task level headed, 
well poised, sleeping well, and has broken down because the load was 
too great, beyond question rest is indicated. Prolonged rest, free from every 
sort of work, including the strains of daily friction, is to be followed 
out. 

It is in the nerve exhaustion where the work has been largely worry 
and insomnia that nice diagnosis is required. This group, given more 
release from work, will fill their minds with worry. There is no rule for them. 
The advice must be changed for the individual from time to time. 

The fact is that the question is of secondary importance. The main thing 
is the mental training, the brain control. This having been acquired, rest 
will result from eliminating worry and fear. 

The questions of feeding and giving of medicine belong somewhere 
in the same class as rest. The worry-fear group of neurasthenics will 
be steadied by a bromid-arsenic mixture as they will be by a period of 
rest. 

If they use their drug-caused steadiness as a piece of firm ground on 
which to stand while starting mental training they will be permanent 
gainers. If they use it as an end in itself, they will gain but little. 

There remain the two groups — the inheritance neurasthenics and the 
neurasthenics whose brains are part of poor body machines, the groups whose 
brain cells are exhausted from small loads of work or worry. 

They are in this position: They did not enter the game of wear upon 
the same terms. It will be necessary for them to do all the things the others 
must do and a few things besides. 

The man with poor physique must exercise systematically and persistently 
to develop a better machine. In exercising his muscles and in doing tasks 
requiring large numbers of muscles to work together he will be training all 
parts of his machine. 

The neurasthenic with an inheritance basis must work still harder. 
He can find himself, one kind of a cure, or cure himself, a better kind of a 
cure; but he will have to work harder for it than the man with a good 
inheritance. 

Neurasthenia cannot be cured by coldness or by sympathy. To begin 
with, its cure requires keen analysis of the individual case. Then follows 
patient, persistent, plodding training of the untrained brain. There is no 
royal road. 



TREATMENT OF NEURASTHENIA 399 

Neurasthenia. — S. D. A. writes: "1. For about a year I have felt 
despondent, undecided, changeable, discontented, self-conscious, sensitive, 
and irritable. I crave friendship and feel depressed when left alone. My 
health seems to be good otherwise. I am constantly trying to analyze and 
cure myself as best I know how, but feel discouraged. However, I am 
not hopeless and am willing to try anything that will restore me to my 
former cheerfulness. 2. What is a psychotherapist? 3. Where could I find 
one? Jf. Can you name any boohs on nerves that would help me?" 

Reply. — 1. You are neurasthenic. 2. A psychotherapist is one who 
studies the mental processes and prescribes not medicine but mental exer- 
cises. 3. Every community has many such. 4. ''Physiology of Faith and 
Fear," by Sadler; "Conquest of Nerves," by Courtney; "Psychic Treat- 
ment of Nervous Diseases," by Du Bois. 

First, find out if you have any physical ills. If none is found that 
is in proportion to your symptoms, put yourself in proper hands for a 
course in mental training. Expect, in the main, to work out your own 
salvation. Your psychotherapist can guide, direct, and control you, but 
it is your mind that is to be trained and it cannot be accomplished save as 
you work at it, patiently, optimistically, altruistically, sanely, and per- 
sistently. 

Medicine in Neurasthenia. — Reader writes: "I have been troubled with 
nervousness for almost a year and a half; I believe the doctor calls it 
neurasthenia. I have been examined by several physicians, and all say my 
blood pressure is all right and that I have no physical ailment. It is worry 
and fears that make me so miserable; the fears are things that seem ridicu- 
lous, yet, no matter how hard I try, it seems almost impossible for me to 
overcome them. The medicine I have taken seems to do me no good. Can 
you suggest anything?" 

Reply. — You do not need medicine and you are right that it does you 
no good. Neurasthenia is, in part, inherited. In part, it results from bad 
training. The inheritance part you camt help. The training part you 
can help, although it will require more patience and persistence than if 
you had started right. First, get "Physiology of Faith and Fear" and 
study it carefully and persistently. Second, put yourself in the hands of 
a nerve specialist who will give some time to unraveling your mental state 
and finding you out. Third, go to work on your own mentality, for your 
mental regeneration will, in great part, result from your efforts at self- 
control and training. 

Marriage and Neurasthenia. — H. W. T. writes: "I send you herewith 
a newspaper clipping regarding a proposed change in the English marriage 
law. It seems to me the conditions referred to have been present with me 
for more than twenty years and have become more pronounced within the 
last few years. I find it difficult to center my attention upon any one 
thing. I have no initiative. There is a strange indecision as to the most 
trivial of my affairs. Everything is postponed to the last minute of the 
last day. My memory is poor and mental lapses are frequent. Periods of 
depression come with fears of the future or with regrets over the past. 
My anger is sometimes aroused on the slightest provocation and there is a 
proneness to weep. Please tell me what is the oest thing for me to do." 

Reply. — I have read the clipping referring to the proposed English law 
making marriage with a mental defective a misdemeanor. It is one of 



400 NEURASTHENIA 

those negative eugenic measures that various countries are wrestling with. 
Such laws, though probably different from their present forms, will event- 
ually prevail everywhere. Of course, correspondence diagnoses are guesses, 
but there is an axiom that no man is insane who thinks he is. On the other 
hand, your letter describes a typical neurasthenia. You are in no danger 
of going crazy. You do need medical help. Put yourself in the hands of a 
psychotherapist. Read some of the popular books on nerves. Go to work 
on your mental methods and keep at it. 

Neurasthenic. — W. F. writes: "Can you suggest mode of living and 
treatment for great nervousness, irritability, physical and mental exhaus- 
tion, aches and pain in eyes, head, and all over body, which are perma- 
nent and increase in dull and heavy weather? The condition has repeatedly 
been diagnosed as neurasthenia. Is chlorid of iron beneficial, and for how 
long a period can that be taken?" 

Reply. — If you are in need of iron, chlorid of iron is a good form to 
take. You can take it for a year without detriment. Exercise in the open 
air, training of your muscles, plenty of sleep in fresh air, properly adjusted 
eating, and regular bowel habits are all helpful in neurasthenia. But, 
assuming that you have been correctly diagnosed and are a neurasthenic, 
you must not forget the fact that neurasthenia is a quality of mind. The 
essential is that you train your untrained or wrongly trained mind. It is 
necessary that you forget your ills. You are self-centered. You worry. 
You are afraid. 

First, you must learn sociability. You must learn to play, and with 
others. You must learn courage. You have an idea that the bogey man 
will get you if you don't watch out. That you must overcome. You worry. 
That you must stop. You cannot decide. You wabble between opinions, 
between hopes and fears. That wears you to a frazzle in the day and 
dreams you into waking at night. 

Have I said enough to show you where your salvation lies? 

Mild Neurasthenia. — M . J. K. writes : "I find trouble often in concen- 
trating my mind on any one subject. I often have to read such matter as 
newspaper writeups three and four times before I know what I'm reading. 
In other words, I read the words mechanically, while I am thinking of 
something else. And in my work I find myself dreaming at times. Is 
there anything I can do to train my mind to stay where it is put until I 
get ready to use it for something else?" 

Reply. — This is a mild neurasthenia. Maybe all that you need will be 
to read and apply Freud or Du Bois, or perhaps even Yittoz. 

In the last named are some things which are misleading. Freud is the 
more critical in his analysis of mental states. Du Bois holds the mirror up 
so that a neurasthenic sees himself in a saner light. 

The crux of the neurasthenia situation is, first to find oneself and then 
patiently, ploddingly, and sanely to make good. 

Try Reading These Books. — H. P. P. writes: "I frequently have sensa- 
tions of fear that any breath may be my last, or something sensational. 
My heart is in excellent condition. Please give me your opinion." 

Reply. — You probably have a simple neurasthenia and are in no danger. 
Go to the library and read "Physiology of Faith and Fear" by Sadler, or 
"Mind and Work" by Gulick, or "Making Life Worth While" by Fisher. 



TREATMENT OF NEURASTHENIA 401 

You must be trained or train yourself so that you can control foolish 
fears. 

Better Read Du Bois. — B. L. B. writes: "For a couple of years I have 
been addicted to worry, mental indecision, melancholia, and have often 
wondered if I was not on the verge of insanity, so extreme has been the 
trouble. I doctored for a time, but without permanent benefit, and now am 
inclined to think that there is no medicine that will avail in such a case. 
The only antidote for this anxiety, etc., that I have found is a sense of 
intelligence that comes and goes, but whose coming temporarily allays 
mental stress. What is this mental relief agent, and how may one learn 
to meet every worry with intelligent thought instead of being driven by 
constantly arising perplexities into a state of worry that so reduces one's 
living efficiency f I have found that to associate with healthy minded, 
unselfish people and a habit of reading anything of general interest are of 
great benefit. True humor is a veritable godsend. Work is often a great 
help, but sometimes an added worry. I doubt not that I am but one of 
thousands who are similarly troubled, at least to some extent." 

Reply. — B. L. B. paints a good picture of neurasthenia. Neurasthenics 
seldom become insane, though they usually think they are on the verge 
of it. This disposition to magnify their troubles, to think that their pecu- 
liarities differ from those of thousands of others, constitutes one of the 
manifestations of their self-centered condition. 

B. L. B. has a vein of humor and a sub-stratum of good sense that 
make it plain that he is on good ground. Were he to read Du Bois, he 
would laugh at himself for a week. 

Probably he requires nothing except to read this book. 

Cures Self of Neurasthenia. — C. M. M. writes: "The article which ap- 
peared March 6 on neurasthenia was especially interesting to me, as I 
have been troubled with the same disease or ailment, but have been re- 
stored back to health. I had a severe attack of nervous trouble about 
eighteen months ago. My pulse would beat rapidly and then irregularly. 
Then at times I would have spells of fear, and think I was dying. The 
palm of my hands would be wet with cold perspiration. I had shortness 
of breath sometimes. The blood in my limbs would feel hot and clogged. 
My mind would be almost a blank at times. I slept but little, but when 
I did I would awaken with a sensation of fear. I would lie for hours with 
my hand on my pulse, thinking every beat was the last. I would get weak 
at times. This trouble would generally come after eating. I had some of 
the best physicians. Medicine did me more harm than good. I finally 
took my own case. I got out in the open air. I associated with people of 
strong personality. I kept my mind off what I termed a fatal disease, and 
threw off that fear. I got hold of new life, and said to myself, Til live it 
down.' I succeeded. That was my medicine." 

Reply. — This is published for the help of neurasthenics. However, you 
got off easily. With most people working oneself out of even a mild 
neurasthenia, as was yours, is more difficult and tedious. 

Should Learn Control. — C. writes: "About two years ago I was struck 
at the base of the brain on the left side of my head in an accident and 
practically recovered in about three weeks. I find that I am now suffering 
from fear to such an extent that I am miserable. I am employed as secre- 



402 NEURASTHENIA 

tary and carry heavy responsibilities. Is it the natural spring decline or is 
it due to my nerves? I feel like screaming when at the theater and lay 
wide awake at night, while my body seems exhausted, and finally doze off in 
the morning. Would you advise my taking treatment physically or men- 
tally? I am worried over this affair, as I had wonderful nerve control and 
a happy-go-lucky spirit previously. I sleep restlessly and dream of ugly 
things. While busy I am all right, but when I get home at night, tired and 
hungry and long for rest, I become unhappy, and this state has made me 
worse every evening until now I don't enjoy anything. I tried to fill my 
evenings with entertainment and plesaure, but have a desire to scream and 
picture horrible calamities and vivid suffering. Am I just overworked? 
What mental food do I need? I am 25 years old. I have severe pains in 
my head {where I was struck) almost continually. I gave up all kinds of 
headache powders a long time ago." 

Reply. — So far as your use of headache powders is concerned you are 
wise. Headache powders give temporary relief. If their use is persisted 
in they come, in time, to cause headaches. You are neurasthenic, almost 
hysterical. 

Neurasthenia usually has a physical basis. The characteristic of the 
disease is exaggeration of symptoms, not imaginary, but actually existent 
symptoms. Self-pity, nerves, desire to scream, restlessness, dreams, worry 
are the results of such exaggeration. It is not often as easy +o prove the 
physical base as in your case. But, so far as the injury to your head is 
concerned, you can do nothing. 

The plan is to build up your general health and to learn control. A 
course in a sanitarium where control is taught would benefit you. Psycho- 
therapy given outside an institution would benefit you. 

Case for Psychotherapy. — M. H. writes: "Would you think the follow- 
ing symptoms serious: A skipping pulse, never counting fifty without 
three and sometimes more skips; each time the pulsation is felt in the 
throat; a palpitation in the stomach with the same sensation in the throat; 
a pulsation at times all through the body till the ears pop and the head 
seems full; great exhaustion at times; occasionally acute pain in the chest, 
this, however, not frequent. Some days these symptoms are trying. The 
subject is in good condition every other way. The age is 51." 

Reply. — A lot of subjective symptoms. If a physician finds no organic 
basis for them, and he probably will not, the case is one for psychotherapy. 
Watching the pulse can make it skip one beat in sixteen. 

Temper in the Morning. — T. A. writes: "Why should I, a middle-aged 
man, be so ill tempered in the morning and be quite good natured after 
starting to work? Has the body been manufacturing poisons while I 
slept? Please suggest some simple remedy to overcome this condition." 

Reply. — I should say you have sized the situation up right. Maybe you 
do not sleep enough; maybe you sleep too much. First, regulate your 
sleeping hours; second, improve the ventilation in your sleeping room; 
third, take a cold bath — water or air — and a good rub before breakfast. 
Do not take any medicine for the condition. 

Victim of Neurasthenia. — Mrs. W. N. E. writes: "I am five feet four 
inches tall and weigh 162 pounds. What should I weigh? The doctor says 
my heart is weak. The top of my head hurts and the back of my neck. 



NEURASTHENIA AND HYSTERIA 403 

It is worse at night and often keeps me awake. At times 1 feel so de- 
pressed everything looks dark. I am very nervous. At times I cant keep 
quiet. At other times I am completely exhausted and could lie down for 
hours and never move or wish for anything. When some of my most wel- 
come and loved friends come in to call I get so cold I shake after they are 
gone. I feel warm soon. I have always been among people a great deal. 
What causes such troubles? I am 3Jf years of age." 

Reply. — You are twenty-five to thirty pounds overweight. You are 
neurasthenic. Your physician can show you how ill founded are your 
aches and fears. Read Sadler's "Physiology of Faith and Fear," pub- 
lished by A. C. McClurg & Co., or "Conquest of Nerves," by Courtney, 
published by Macmillan Company. 

Neurotic and Nervous. — R. M. C. writes: "Will you please give the 
definite meaning of neurotic, and how it differs from nervous? Is there 
value for a poorly nourished person in rubbing the flesh with olive oil or 
milk, either fresh or evaporated?" 

Reply. — 1. A neurotic is a person suffering from a nervous disorder. 
As the term is generally used, a neurotic is a person suffering from neuras- 
thenia, or with a tendency toward melancholia, or exaggerating his ills, or 
disposed to be hysterical. A nervous person is one whose nerves are on 
edge, but where there is less disturbance than with a neurotic. A nervous 
person is one easily excited or agitated. 

2. No; neither will be absorbed. 



NEURASTHENIA AND HYSTERIA 

As compared with general paresis, dementia precox and paranoia, 
neurasthenia, hysteria, and melancholia are minor maladies. They produce no 
deaths and no sickness that find their way into morbidity tables. Yet as pro- 
ducers of inefficiency they approach, though they do not equal, hookworm 
and malaria. 

That so large a part of the people are neurasthenics and hysterics is 
the result of several causes. One of them is a faulty educational system. 
Payot in his "Education of the Will" says : 

"It is from this point of view that we should readjust from its very 
foundation our method of undergraduate and higher instruction. It is 
very important to abolish the foolish principle of cultivating the memory 
exclusively, for this is weakening the vital forces of the nation. 

"We shall have to plunge into the inextricable thickets of the curriculums 
of all the schools with a hatchet so that we may cut out the tangle on 
every side to let in the daylight and the air, and we must be willing some- 
times even to sacrifice some beautiful plants which are too crowded and 
which will never grow. 

"Instead of encouraging: feats of memory, we must substitute active 
exercise and work which will develop the power of judgment and intellectual 
initiative and vigorous deductions." 

The schools are for the purpose of training the mental machine. It is a 
part of their duty to prevent the development of the inefficient machines known 
as the neurasthenic and hysteric minds. 



404 NEITKASTHENIA 

Another cause is bad inheritance. In Bridger's "Mind in Distress/' the 
great canse of neurasthenia and hysteria is given as mental isolation. 
This suggests as an increasing cause the isolated life of the only child and this 
leads easily into the next heading. 

Neurasthenia and hysteria are caused by a lack of training in the home. 
Bad heredity, poor home training, poor school training, lack of opportunity 
for play, absence of proper training in one's work — these causes operating 
result in a great mass of neurasthenics and hysterics. 

Why they are here is not the subject of this article. This article is 
written in answer to the question : Can anything be done for those already 
among us? The answer is: Yes. 

At that, there is no royal road. Those who are willing and able to 
work out their salvation can do so. Those who are looking for cure from a 
bottle of medicine or some other form of magic will not be cured. 

The machinery of society for curing neurasthenics is of no consequence. 
If a neurasthenic has it in him to work out his cure he will attain it, but 
not otherwise. If a man has smallpox society will catch him and cure him; 
not so if he has neurasthenia. 

Bridger defines neurasthenia as loss of balance in the masculine type 
of mind; hysteria as the loss of balance in the feminine type of mind. 
Note the statements are "masculine type," not male type; and "feminine 
type," not female type. 

The masculine type is highly practical, demands proof before accepting 
conclusions, and relies only on facts. These are the plodding, steady people 
who achieve financial success or at least stability. Without having studied 
formal logic, they are logical and rely upon the relation of cause and 
effect, considering that to be the one and only criterion of sane judg- 
ment. 

The feminine type is devoted to ideals. It sees the end to be attained, 
but is little concerned with process of attainment. The feminine type 
has the reasoning faculty, but it does not rely on it exclusively. It depends 
largely upon intuition and instinct. 

The feminine type of mind occupies a much greater area of the brain 
than does the masculine and presumably that is the explanation of its 
wider range, its greater capacity, and its relative incomprehensibility. Being 
more complex, it is more unstable. 

Bridger says of the feminine type that, given a good heredity and a 
wise education, it presents the highest type- of mental development, range 
of vision, clearness of faith, conception and love of ideals, rapidity of percep- 
tion, breadth of judgment, love of the beautiful, all under the control of 
a reasoning power not tied to material possessions, never accepting the 
narrow and practical as the only view. 

He divides feminine mind types into three groups, 

1. The pure feminine mind type, occasionally found in men, found 
in a high percentage of women. 

2. The weak feminine mind type. Many men as well as many women 
are in this class. 

3. The mixed type, in which many traits of the masculine type are 
intermingled with feminine traits. 



NEURASTHENIA AND HYSTEEIA 405 

Bridger attempts to reduce these types to mathematical mental formulae 
as follows: 



NORMAL AVERAGE MASCULINE TYPE OF MIND 

Total Distribution Ex- 
Conscious portion— Amount. Inhibited. hibited. 

A — Ideas relating to self 30 15 15 

B — Ideas relating to others 15 10 5 

C — Sensation (impressions) 15 5 10 

Subconscious portion — 

D— Instincts 10 8 2 

E — Impulses 10 8 2 

Unconscious portion — 

G — Reflex muscular and secretory impulses ... 20 8 12 



100 54 46 



NORMAL AVERAGE FEMININE TYPE OF MIND 

Conscious portion — 

A— Ideas relating to self 20 10 10 

B — Ideas relating to others 5 2 3 

C — Sensation (impulses) 10 5 5 

Subconscious portion — 

D— Instincts 30 25 5 

E— Impulses 15 10 5 

Unconscious portion — 

G — Reflex muscular and secretory impulses ... 20 8 12 



100 55 45 

. A frequent division of the mental impulse is into three groups. The 
reflex acts are usually designated as the lowest mind functions. Most 
authorities refer to instincts and intuitions as mental processes of the 
second order. Bergson, however, disagrees with this idea. Bridger says 
that it is not proper to say that the conscious ideas are either superior to 
or inferior to the instincts. 

Environment furnishes stimulation to the mind. Some of this stimula- 
tion is distributed to be stored as inhibited impulses (memory), and some 
is distributed to more active mental acts. It is the will which determines 
the distribution. 

Bridger thinks that whatever tends to produce isolation of mind is the 
one great antecedent condition to neurasthenia. As long as even the most 
unstable of minds keeps itself among the crowd and is in and of the world, 
it is on safe ground. 

In proportion as one fails to keep in contact with humanity the 
tendency to isolate oneself grows, until the mind has become a hermit 
mind. Out of this grows neurasthenia or hysteria, according to whether 
one is of a masculine or feminine type. The men "grand, gloomy, and 
peculiar," are peculiar because they are grand and gloomy. 



406 NEURASTHENIA 

The neurasthenic, having lost his sense of proportion and having 
exaggerated his ego, exaggerates qualities relating to his ego. 

Our general store of knowledge, a register of our conclusions to date, 
constitutes our common sense, and this is one arm of the mental balance. 
This common sense is kept in a state of general average with other minds 
by contact with current opinion. Lose this contact and the balance is dis- 
ordered. Much depends on the soundness and stability of the common 
sense. 

The other arm of the balance is made up of the new impressions coming 
from the internal organs and from the outside as well. A normal individual 
maintains a mental balance between these with ease. 

When this balance is disturbed in the masculine mind, the reason tries to 
reestablish it; the egotism trained in isolation and introspection leads 
wrongly. The person becomes a victim of self-suggestion. This is Bridger's 
idea of neurasthenia. 

The influences predisposing to hysteria fall into two groups — the exalted 
ego or overcultivation of self, and the starved instinct, which includes all 
checks to the proper gratification of normal instincts. These act on the 
feminine type of mind. 

When they act on the pure feminine mind type the result is the or- 
dinary hysteria of the textbooks with the excessive emotional explosions so well 
understood. 

When they act on the weak feminine mind type, the person is always 
ailing and sick, exaggerating and coloring her statements, unreliable and un- 
truthful, excitable, weakly emotional, and selfish. 

Hysterical persons can develop any symptom. They may have any 
form of mental disturbance or nervous symptom. They may develop fever 
or jaundice or slow, fast, or irregular pulse. 

As a means of curing, the first essential is to give time enough to 
find out everything in heredity and environment, even to the smallest detail ; 
then to encourage the mind to show how it works. Bridger closes his 
eyes and allows the patient to talk himself out. Barker lays stress upon allow- 
ing the patient to tell his whole story. 

The next step should be a painstaking physical examination to ex- 
clude organic disease giving symptoms sometimes simulated by neurasthenia 
and hysteria. 

This information being in hand, the next step is to analyze it and 
map out a plan of procedure. The best authorities are of the opinion that 
work is the thing. 

Cabot says: "The sufferer must learn to stand upon his own feet. He 
must get back into life. 'Real life,' as we now begin to see, after all is the 
best teacher and the best doctor. Seclusion in sanitaria or rescue homes is 
being replaced by efforts to get the sufferers back into industrial life, back 
into family life, back to the surroundings which keep ordinary people going, 
back to the best that civilization has to offer to normal people." 

Bridger says: "Work must be insisted on. A man's occupation, if it 
be at all congenial to him, and if it provide means of meeting and con- 
versing with his fellow man, is the best. It should be of a kind that, once 
started, means compulsory regularity and attention. All other measures 



NEURASTHENIA AND HYSTERIA 407 

will fail until you have secured this essential to success. In nine cases 
out of ten it is the only treatment necessary. 

"Seek out the ambition latent in the patient — some ambition is latent 
or active in every man — and stimulate it. All who treat neurasthenics make 
use of some form of suggestion. The variety to be used is to be determined 
by the person and by the psychotherapist/' 

The method of treating hysteria given by Bridger is (1) understand 
and control the patient, (2) alter her surroundings to her benefit, (3) find 
systematic employment for the mind, (4) make a dramatic mental appeal 
and suggestion. 

As a resume, Bridger says the cure of hysteria depends in general 
on the personality of the doctor, on his knowledge, firmness, judicious sym- 
pathy, and above all on the confidence he inspires. 

In neither hysteria nor neurasthenia does he advocate the use of drugs. 
In his opinion they keep the person self -centered ; they further stimulate 
introspection; they appeal to his ego and the little good they do is better 
done by exercise in the open air, while they do harm by twanging the 
string that is most out of tune. 

An essential part of the Bridger system of treating minor mental dis- 
orders, especially neurasthenia, is to discover the bogey and to get around 
it. By the bogey he means the phobia. 

The bogey of a neurasthenic is that person's supreme dread. It may 
be insanity, suicide, injury to self-esteem, loss of good repute. When one 
has had some experience he can guess the patient's bogey long before he tells 
it, as he relates his story. 

Bridger advises that bogey never be charged in the open. Sometimes 
he builds a rival bogey; sometimes he patiently and slowly tears it to pieces; 
sometimes he undermines it. As I understand it, he thinks it advisable 
to deceive the neurasthenic and thus in time show him how he has been 
deceiving himself. 

To do this requires a very great skill. Neurasthenics and hysterics 
especially are exceedingly suspicious. They suspect everybody, and to outwit 
them is not easy. 

On the other hand, Cabot is a strong believer in telling the truth. 
Barker advocates telling the truth discreetly and tactfully. "Reprehensible, 
most will agree, is the practice of permitting the patient to believe that 
his absurd fears are well grounded." 

Most important of all, finally, is the tedious work of reeducation, the 
doing of work that should have been done in childhood; the doing of it 
under circumstances in which the person starts from much worse than an 
even break. The different steps in reeducation are as follows: training of 
the voluntary attention; following this comes the rational reeducation of 
the emotions and the will; then comes training of voluntary activity or 
conduct. To begin with, this may have to be done under outside direction. 
At the end it must be largely self-direction. 

Treatment of Neurasthenia. — R. R. R. writes: "How should neuras- 
thenia he treated when it has been growing worse since childhood? What 
causes neurasthenia in children? A neurasthenic knows no mental disci- 



408 NEURASTHENIA 

pline, so please do not suggest it. I would do almost anything to rid 
myself of that terrible fear which overshadows me, but I cant do it with 
my mind. If you do not care to answer my questions will you kindly sug- 
gest any books on the subject?" 

Reply. — A supposed neurasthenic should be carefully examined to ex- 
clude organic disease. If it be found that there is no organic disease, then 
treatment for neurasthenia should be begun. The neurasthenic should not 
be ridiculed. Such a course is folly. Neither should he be sympathized 
with. That, too, is folly. The only treatment worth while is mental train- 
ing. 

You are right, a neurasthenic knows no mental discipline. But that 
fact is a reason for mentioning mental discipline, not for ignoring. The 
neurasthenic who can train his mind can be cured ; the others cannot. The 
process is necessarily a slow one, but no one can say in advance that it can- 
not be done. Some neurasthenics read such a book as Du Bois or Sadler, rec- 
ognize themselves in the cases stated, and get control of themselves without 
outside help. Some follow the exercises in Walton's "Calm Yourself" or 
Bennett's "Human Machine" or Sadler's "Worry and Nervousness," and 
cure themselves. Some require the services of neurasthenic specialists. 
Some gain control by constant study of Mrs. Eddy's "Science and Health." 
Some prove incapable of mental discipline. Neurasthenia in children may 
be the result of inheritance or lack of training, or both. 



INSOMNIA 

Insomnia is sleeplessness. It does not occur in youth or in those 
who work with their muscle, especially if they work and live in the open 
air. It does not occur much before middle life and then more frequently in 
men than in women. 

Excluding actual disease, pain or delirium it is substantially always 
accompanied by overeating or injudicious eating in those of sedentary in- 
door lives. Granted that worry is the cause it is wise, in offering relief, 
to consider well the digestive apparatus of the sufferer. 

As health editor I receive letters about insomnia every day. Certainly 
many people are not sleeping well. To these letters I sometimes reply 
telling of this or that thing which can be done. Then there follows a 
series of letters from people recommending procedures. Therefore let us 
make our views plain and emphatic. 

Insomnia is a condition of mind. When the brain works too hard, the 
man wakes. He cannot go to sleep again until he has got his trolley off 
the wire. The thinking may be cool, judgmatical weighing of probabilities; 
it may be imagination producing poems, ideas, or inventions. (The best 
thinking can be done in the night hours.) Or it may be worry with its 5 
per cent, of efficiency and 95 per cent, of waste, worse than railroad waste or 
most any other kind, for the most foolish thinking can be done during night 
hours. 

The point is, it is thinking that does it. Whether the thinking is 
good or bad is a detail. 

There is no remedy except mental training. A man must either 



INSOMNIA 409 

train himself to loosen his mental tension before and while he sleeps or pay 
the consequences. 

How he is to train himself is another matter. But it must be done. 
Physical work, hot baths, and things of that character are better than 
sulphonal and bromids. Nevertheless, they are in the same category. 
They do not take care of the root of the difficulty, which is wrong mental 
methods — taking your work or your worry to bed with you. 

A man who has. done hard, muscular labor and who worries will have 
his brain paralyzed by the chemicals of muscular fatigue for, say, six hours, 
but following that brain concentration gets the upper hand, and he wakes 
up. 

In insomnia there is no permanent short cut. You must make your 
brain join the union and keep the working hours of the brain workers' 
union, otherwise you will go on the scrap heap before your time. And 
finally your death certificate may read any one of a dozen ways. 

Insomnia. — L. W. C. writes: "I have for several years teen a great 
sufferer from insomnia, not getting on the average three hours' sleep out 
of twenty-four. For six months I have not averaged more than that, and 
alternate eevry night with bromidia, somnos, and veronal, so that no one 
wears out entirely. But I fear I am endangering myself by this constant 
use of these medicines. I am so heavy every morning it is hard to get up. 
What evil effects can come of constant uses of these medicines? I am a 
traveling man and constantly on the go." 

E. W. S. writes: "I felt that you had found the root of the matter 
when you referred to the primal cause of sleeplessness as being a matter 
of mental control. If you can go just one step further and tell the great 
army of insomniacs just how they can barricade their minds against the 
'imps of thought' that come thronging in the hours that should be given to 
slumber you will be demonstrating a priceless boon to sufferers from wake- 
fulness that 'terror by night/" 

J. 8. T. writes: "To divert the mind from worrying subjects read one 
or more chapters of history before retiring and select a number of topics to 
be remembered, say ten or twenty, or as many as you please. When wake- 
ful recall these topics, counting each topic recalled by holding up a finger 
till the full number is recalled. You generally go to sleep in the effort." 

C. S. S. writes: "I see much written about insomnia. I would be glad 
to relate my experience to those that are troubled that way. I come to 
look upon my experience as a great blessing. I learned to repeat the 
fourteenth and fifteenth chapters of St. John. Then, when awake, I would 
repeat and study these words, words teaching us how to live and how to be 
saved through all eternity." 

Reply. — So many people write me about insomnia that I am sure it is 
a matter of great public interest. I have written about it more than 
once, but I think it advisable to publish the above series of letters and 
to comment on them. 

To L. W. C. we wish to say that no circumstances justify the nightly 
use of bromidia, somnos, and veronal alternating or after any other plan. 
He must take such steps as are necessary to remedy his condition. Pallia- 
tion will get him in trouble. 

E. W. S. recognizes that thought cannot be stopped by willing it. If 
the mind is occupied by thoughts which keep one tense, the remedy is 



410 NEURASTHENIA 

to start a train of thought which is attractive enough to replace the 
harming line and not stimulating enough to develop tenseness. 

To some people J. S. T.'s suggestion is a good one, to others the sug- 
gestion of C. S. S. will be more helpful. Some line of diverting thought 
must be indulged in. 

Let us keep this clearly in mind — insomnia is a state of mind. The 
remedy for it is mental. Physical conditions contribute somewhat. Phys- 
ical treatments of different kinds help somewhat. Drugs for it are not 
to be thought of. If the condition is bad enough to need drugs, or is 
thought bad enough to need them, it needs remedial treatment worse. 

Cause of Sleeplessness. — 8. J. C. writes: "I wish to know what is the 
cause of my restlessness when retiring for the night. It takes hours hefore 
I fall asleep. I am in perfect health, have nothing to worry about or any- 
thing to cause me to keep awake. Kindly tell me what causes it and advise 
me as to the cure for it" 

Reply. — You do not go to bed with a mind at rest. Spend at least two 
hours before retiring in getting rid of all mental tension, and then go to 
bed and sleep. Don't try to sleep or think about not sleeping. Just take 
sleep as it comes, and come it will. 

Sleep Mental Condition. — M. B. writes: "1 am an office man of 65 
years and weigh 11^5 pounds. My health is pretty good, but I am nervous 
and my sleep is not good. I go early to bed. I don't drink nor smoke in 
the evening, and my sleep is disturbed by dreams all night. In the morning 
I feel weak. What could you suggest to obtain a more healthy sleep?" 

Reply. — Sleep is a condition of mind. It is similar to worry, anxiety, 
concentration, equanimity, in that it is a mental state. Therefore the 
treatment for it is mental. Briefly, certain principles are: 

1. Do not try to sleep. Simply turn loose and sleep. 

2. Drop the concentrations of the day a few hours before bedtime. 
Some can accomplish this by physical or mental play after supper. Some 
can only force their minds to turn loose by reading something with grip in 
it for them — novels for some, philosophy for others. 

3. Physical aids, such as baths, proper eating, and proper bedroom 
arrangements, are of service. 

Needs More Sleep. — Anxious Mother writes: "I am not a strong 
woman and not sickly, but I am nervous. If I get eight hours' sleep I feel 
well for the day, but I seldom get it, as I wake up and cannot go to sleep 
again. Is there anything I can do for this, so I can sleep more? I have 
a daughter two years old who is nervous. If the mother is nervous does 
it affect the child, or does she outgrow it?" 

Reply. — 1. You are right; you need more sleep. Eight hours is not 
enough for a nervous woman ; less than eight hours is certainly not enough. 
When you awake, do not get nervous about being awake or over your 
thoughts. Convince yourself that you do not care to sleep. Do not let 
your desire to sleep make you tense — turn loose and sleep or stay awake, 
as it comes. As soon as you get in this frame of mind you will sleep. 
Perhaps intestinal indigestion awakens you a certain number of hours after 
your evening meal. If so, eat a light, simple supper. 

2. Children do not grow out of nervousness, but they may be trained 
out of it. A nervous mother is liable to have a nervous child for two 






iisrsoMNiA 411 

reasons — inheritance and association. Train your child to be quiet and 
calm. 

Cause of Dreams. — H. G. B. writes: "Can you tell me what causes a 
person to dream after retiring at night ?" 

Reply. — Lock the doors to your brain when going to bed. The nerves 
are the doors through which impressions reach the brain and disturb 
sleep. These disturbing impressions may come from outside, such as 
noises, cold, and uncomfortable bed. They may come from within in the 
nature of pains of various kinds, disturbing thoughts, worry, or mental 
excitement. 

If the sleep disturbing impressions are strong enough to unlock the 
doors to your brain against your will, they may be due to some under- 
lying organic disease. 

Often the stomach gets in between the door and will not allow it to 
lock. In such instances it is well to let the stomach go to bed empty, in 
order that the brain may not be rocked and disturbed by dream thoughts. 

Wants More Sleep. — B. M, writes: "I work at night and go to bed 
about 9 a. m. dead tired. But every day I wake up about 2 to 2:30 p. m., 
and, although I lie in bed sometimes until 6 or 7 it is impossible to go back 
to sleep. I wake up without any cause. Can you suggest any way of get- 
ting over this?" 

Reply. — By that hour your fatigue poisons are pretty well used up. In 
consequence, slight influences are sufficient to awaken you. A gripping 
dream will do it, or a noise, or a full bladder, et cetera. 

Make things right as best you can; then lie quietly in bed, free from 
worry and fret, until 5. If you do not sleep you will rest, and that will do 
you nearly as much good. If you sleep, so much the better. When you 
have developed the above frame of mind you will sleep that extra time. 

Insomnia not Disease. — W. B. writes : "In your recent article on insom- 
nia you lay the cause for same to a mental condition. Is it not a fact that 
some cases are due to physical causes, for instance, an overloaded stomach? 
I am given to nervousness and worry, I admit, but I find that after eating 
heavily in the evening, I invariably awake about 3 a. m. and find it hard to 
fall asleep again. Would not a person of good, healthy nerves become a 
victim of insomnia in time through this cause alone? In case both the 
physical and mental conditions have run down and both were good at birth, 
which would you lay the blame to for the state of both, ordinarily — that is, 
is it not usually the bad mental state that brings on the physical ailments?" 

Reply. — A man going to bed with his mind tense would wake up from 
any one of a dozen things, ordinarily of minor consequence. A full stom- 
ach would be one of these ; a little noise, the light turned on, the flapping 
of a curtain, are illustrations of other things, ordinarily of minor impor- 
tance, which would serve to wake up a tense mind about ready to become 
conscious. Do not confuse the issue. Mental tension is the main thing. 
A bad mental state would affect the physical state. A bad physical state 
would affect the mental state. The latter is more of a factor than the 
former, but the relations between these two must be determined for each 
case. Do not forget that insomnia is a state of mind and not a disease. 

Mental Training for Dreams. — Mrs. J. K. P. writes: "What, in your 
opinion, causes dreams? I dream every night, sometimes having as many 



412 NEURASTHENIA 

os five different dreams, waking up dull and untested. Also, what causes 
talking in one's sleep, which consists usually of muttered phrases?" 

Reply. — Dreams are the thoughts of a sleeping mind. There is no rad- 
ical difference between dreams and ordinary thoughts. If yon want to 
study the subject deeper, go to the library and ask to see Brill's 
work on Freudian analysis. You may be able to understand most of it 
and you may not. There is no way to stop dreams short of mental training. 
If you care for your digestion and sleep in a comfortable bed in a cool room 
you will help some, but the real cure is to go to bed always with a mind 
well poised, happy, contented, and free from hate, envy, worry, or fear. If 
you can train yourself to that as a constant frame of mind, your dreams 
will be sweet, peaceful, and restful. 

Afflicted, with Nightmare. — J. E. M. of Canon City, Colo., writes: "I 
am now over 65 years old. I have what is called nightmare and although I 
seem to know enough to make a noise so that my wife comes from another 
room, she often has difficulty in getting me out of them, as I cannot move 
hand or foot. When I do get awake my heart is fluttering as if I had 
exhausted myself by running. I have not found a doctor who can give me 
anything to prevent them. Can you advise a remedy?" 

Reply. — 1. Train yourself to go to bed with your mind at rest. A man 
who suffers from nightmare also surfers from daymare. A man whose mind 
is agitated during his waking hours is certain to have more or less agitation 
during his sleeping hours. 

2. See to it that your sleeping arrangements make for comfort. 

3. Eat very simple evening meals — milk, bread, cheese. 

4. Correct all constipation and intestinal indigestion. 

Causes of Nightmare. — P. R. A. writes: "What is the cause of night- 
mare?" 

Reply. — Mental tension is an important cause. Overeating, especially 
at night, is another. The remedy, when these are the causes, is light sup- 
pers and a mind at peace and resting. 



CHAPTER XXIV 

Insanity 

TO PREVENT INSANITY 

Dr. Bayard Holmes says one person out of each 400 is insane be- 
fore he dies; that there are 150,000 insane in hospitals in the United States, 
and their maintenance costs the different governments $50,000,000 a year. 

When a man stands one chance in four hundred of getting something he 
does not want, it is time for him to sit up and take notice. 

A great deal is known about the causes of insanity and how it can be 
prevented, but those who have this information are off to themselves, and those 
liable to go insane do not know of the means of prevention. The men having 
the information are stuck off in corners running asylums to care for the 
insane. The people who will go crazy unless something can be changed 
are working in offices, factories, and on farms, caring for children or loafing 
in red light districts. The state, which spends millions to care for the 
insane, has much valuable information in the records of its asylums, in the 
knowledge of the asylum officers. Some of the people of the state are losing 
their minds because they do not get and do not apply the information which 
is not "working at its trade." 

Because a man is born of an erratic, neurasthenic or hysteric stock is no 
reason why he should go insane. It is a reason why he should work harder 
to control himself. Because a woman is goiterous is an additional reason 
why she should work out a program of mental poise. Because a man has 
had syphilis, he should not drift helplessly into insanity. It should be the 
reason for shaping a career to avoid it. If a man who takes whisky, mor- 
phin, or cocain goes "batty/' he should find in that a reason for cutting out 
dopes and not a reason for taking more. Many times keeping on one's 
mental keel is a matter of knowing how and then "living it" — two separate 
things. 

How can it be made possible for everyone interested to "know how"? 

ERYSIPELAS IN THE INSANE 

A few years ago it was noticed that there were certain diseases which 
helped the minds of insane people. A woman who had been in a stuporous 
condition from melancholia for weeks would contract erysipelas. As the 
result of the toxins of that disease she would brighten up, take a rosier view 
of things, and occasionally would recover. No other disease exercised 
so favorable an influence as erysipelas, and no other mental state was so 
much helped as melancholia, 

413 



414 INSANITY 

There is not much physical basis for melancholia. It is just a matter of 
tangled ideas. There are people with troubles enough to depress a wooden 
man, but they do not get melancholia. In fact, they are apt to get happy, 
or, at most, resignedly accept the inevitable. The melancholies are those 
who get that way without having any right to do so. They are below 
par in their mental point of view. 

The toxin of erysipelas is a booster. It may boost clean over the fence, 
but it boosts just the same. Therefore it is like an antidote for melancholia. 

Sometimes they are cured by something which gives them a mental 
jolt. When an asylum burns some of the inmates go batty, others develop 
some emergency ability, and some are cured by the experience. 

Even typhoid fever in the insane leaves behind a trail of betterments. 
While an attack of typhoid is becoming more trivial all the time, it disturbs 
all the physical being profoundly. Twenty years ago cases went into a 
profound stupor called the typhoid state. Now a doctor who does not keep 
his patient clear eyed and quick witted through typhoid is a pretty poor 
human engineer. Nevertheless, after typhoid the hair falls out and other 
changes indicate that the process has been profound. Through profound 
changes occasionally a sick brain finds a way back to sanity. 

Insanity. — Sincerely writes: "Some five years ago before I was of age 
I was an inmate of an insane asylum for two months and probably was 
insane for six months. Under such a law as Indiana has would I have been 
unsexed? I am now a fair specimen of physical manhood, ordinarily intel- 
ligent, and of temperate habits. Do you consider me fit for marriage? Do 
you think there is any danger of my children not being normal?" 

Reply. — You probably are not greatly disturbed mentally. Properly 
regulating your habits of mind, your trouble should never return. Answer- 
ing your question as to Indiana, no, emphatically. Answering your ques- 
tion as to marriage, you do not furnish me enough facts as a basis for . 
an opinion. Write to H. H. Laughlin, Eugenics laboratory, Cold Spring 
Harbor, N. Y., for a blank relating to inheritance of insanity. Fill it out 
and submit to him. 

Melancholia. — M. G. writes: "A woman, 45 years old, is afflicted with 
unnecessary melancholy thoughts, such as wrong suspicions and foolish 
imaginations, which cause her to quarrel with her husband and at times 
send her into hysteria. This is a case of seven years' standing, and is grow- 
ing worse every day. Woidd you advise an operation as a possible cure?" 

Reply. — No. Nothing in your letter indicates need of an operation. 
If you have ovariotomy in mind, it will not help matters. 

Mysophobia. — Distressed Woman writes: "I am a sufferer from a dis- 
ease which has been diagnosed as mysophobia by a Chicago specialist. 
What do you know about this disease? Are there many cases of it in Chi- 
cago? Do you consider it curable? I have had it for a number of years. 
Dr. Edward Spitzka of New York told me it could not be cured, but would 
probably wear off or pass away suddenly, and that it was foolish for me to 
waste money on doctors to have them treat me. A few months ago I wrote 
Dr. S. Weir Mitchell explaining the case and he gave me great hopes of its 
being cured. Do you think some new remedy has been discovered for it? 



ERYSIPELAS IN THE INSANE 415 

If so, can you tell me what it is? I am in good health and apparently nor- 
mal. My best friends have no idea I have any such disease, but I suffer 
constantly from it and would do anything to get relief." 

Reply. — Stedman's Medical Dictionary defines mysophobia as a morbid 
fear of defilement from touching familiar objects. The first case I ever saw 
was a young man who, after shaking hands, could not be at ease until he 
had washed his hands. I have known others who were disturbed by hand- 
ling unclean paper. It is impossible to say how much of it there is in the 
community, as few people think of it as being a disorder. Most people who 
have it wonder why anybody will willingly touch an unclean thing. Un- 
questionably the popular public campaign for greater cleanliness is making 
an increasing number of people dread to touch unclean things. Some who 
have this point of view hide it from others as you have done. Evidently 
you are a nearly normal woman with a slight mental slant. It is hardly 
worth doing anything about it at all. A good course in psychotherapy 
should remove this minor mental kink. 

Sign of Nervousness. — E. L. writes: "I am a working boy of 16 years. 
I think I am nervous, as I am always drumming with my hands or feet or 
go through funny motions; sometimes my head and sometimes my whole 
body shakes about one-half inch back and forth. 

"I work in a printing shop and have ink and benzin on my hands all 
day. I have been working at this job for one month and I notice that my 
hands are dried and shriveled up. I use a sand soap and jelly soap mixed 
with a little lye {not enough to hurt my hands), but the dirt sticks in the 
veins and will not come out altogether, which makes my hands look dirty. 
Is it because my skin may not be hard enough?" 

Reply. — Drumming with your hands is a sign of nervousness. Further- 
more, it is a sign of an easily controlled nervousness. If you will make up 
your mind to keep calm and quiet you will succeed in stopping your habit. 
It is natural to sway when standing. Everybody does it. The body pitches 
in one direction and the proper muscles in pulling it back cause it to sway 
in the opposite direction. A man standing still sways like a pendulum. 
You watch yourself too closely. You are too self -centered. You need to be 
with boys and girls your own age. I think you need to play ball on Satur- 
days and Sundays. 

As your skin gets tougher you can clean it better. The ink gets in the 
cracks. Do not use enough lye to make your skin crack. 

Biting the Fingernails. — E. J. P. writes: "Is the biting of fingernails 
injurious? I have been addicted to this habit for ten years. I have broken 
myself of it every now and then for a short period, but found myself biting 
and chewing away again before I even was aware of it. How can I stop 
the practice?" 

Reply. — No. You will infect your nails from time to time, causing 
local suppuration, but otherwise it does you no harm. However, such a 
habit means that you have not good brain control. You need psychotherapy 
or suggestion, not for your nails but for your mental development. 



416 IXSArTITY 

DEMENTIA PRECOX 

PLEA FOR THE CHILD 

Dementia precox is a form of insanity which affects young people. 
That fact is indicated by the last half of the name. One's idea of dementia 
is tied up with the word demented, and demented people, as most of us 
picture them, are dull, listless, mindless, and, ofttimes, in a state of partial 
paralysis. 

This is the condition in the later stages of dementia precox, but the 
conditions found in the earlier stages are so different that they do not fit 
into the mental picture gained from knowledge of the later cases. If any 
good is to be done these cases, it must be through finding them early. 

Again, any amount of sin, and misery, and various types of vice have 
resulted from leaving youths — boys and girls — in the early stages of de- 
mentia free to follow their instincts, when there is almost a certainty 
that those instincts will be determined by their mental twists. 

Any physician with an asylum experience, or any juvenile or criminal 
court officer can tell of more than one juvenile who got into serious trouble 
because his oncoming dementia was not recognized. 

Oettinger says: "The onset of dementia precox is at times so in- 
sidious that its victim continues long in the home, and hence comes under 
occasional care of the general practitioner. 

"A young person, previously normal in his intelligence, in his activi- 
ties and his affections, becomes indifferent, lazy, irritable, no longer amenable 
to home or school discipline. Formerly cheerful and companionable, he 
is now shy, taciturn, introspective, much by himself, yet at intervals domi- 
neering, obstinate, supercilious, or passes suddenly from depression to gayety 
of spirit. 

"His school work lags, his duties are neglected. He ceases to acquire 
new ideas or apply to his acts the lessons of experience. 

"Such a change in character is apt to be attributed to perversity, bad 
temper, or influence of companions ; but loss of appetite and flesh, insomnia, 
or hysteriform symptoms, together with a complaint of headache, vertigo, 
and indefinite malaise gradually result in a visit to the doctor to prescribe for 
'nervousness/ " 

At times the mental condition comes on suddenly with fainting or 
epilepsy, like spasm or mental confusion and excitement, unaccountable 
apprehension or depression, hallucinations, or even by suicidal attempts. 

In the more slowly developing forms, dementia precox could be mistaken 
by the parents for feeblemindedness, retardation, or even mental perversity. 

The army is composed of young men who have passed a fairly rigid 
physical test and a very simple mental test. As the young men in the army 
are under very close observation the results of study of them give us informa- 
tion as to conditions among young men in general. 

One of every five men discharged from the army for disability is dis- 
charged because of insanity. The rate of discharge for insanity is half again 
as great as the number of discharges for consumption — second on the list. 



DEMENTIA PRECOX 417 

These figures do not include those discharged for neurasthenia and hysteria. 
About 60 per cent, of the insanity was dementia precox. 

Captain King of the United States army says : "We are perfectly 
justified in believing that dementia precox is the first condition to be thought 
of when a soldier under 35 years of age is believed to suffer from mental 
disease. The same is, of course, true of civilians." 

In 1672 Willis wrote : "Many young people, in childhood intelligent to a 
degree and extremely teachable so that by their learning and conversation 
they swept everyone with a state of admiration, afterward as they grew 
older turned out stupid and dull, and those who before were very beautiful 
in person afterwards presented no gracefulness nor comeliness in their 
appearance." 

This is a very good description of rather advanced cases of dementia 
precox, as we know it today. You will note that the children started off 
normally bright. Thus the morons, idiots, and imbeciles were ruled out. 
The latter part of the quotation applies to advanced cases. 

About a hundred years ago Esquiral, also quoted by Captain King, 
wrote : "Children are sometimes born in a state of perfect health and grow 
at the same time their understanding develops itself, but possess an unusual 
degree of susceptibility, are lively, irritable, choleric, of a brilliant imagina- 
tion, a well developed understanding, and an active mind. Their under- 
standing remains stationary, making no further advances and the hopes 
recently raised so high are dashed forever." 

Or to put it another way, a child is normally bright up to about puberty. 
He then develops a general "cussedness," has no power of sustained atten- 
tion, is of no account, lazy and shiftless, may run away from home, lacks 
ambition, his personality changes, his ideas are incorrect or bizarre or 
jumbled; later he becomes stupid and hallucinations and delusions develop. 

The boy may be slipping for years before it becomes certain that he is 
insane. The parents notice that he is not as bright as formerly, but they 
do not think it of consequence. They think the boy is sulking or perhaps 
that he is developing some of that antagonism to parents which is not very 
abnormal in the rapid changing of the puberty period. 

It is the natural time for new connections to be made and for the home 
connections to lose some of their dominance. The parent does not differ- 
entiate between these changes and the changes of dementia. 

The school teacher is in a better position than the parent to judge 
of developing dementia precox. Especially is this true of the university, 
college, and high school teacher. The army discovers many dementia precox 
boys. Do the schools? If not, why not? 

That is the object of these two articles : To put before parents and 
teachers the plea that children who are markedly different from other 
children be not allowed to drift on, waiting for something to turn up, but 
that they be carefully studied by someone qualified to advise. 

Dementia Precox. — Mrs. N. W. writes: "What is meant hy 'dementia 
precox'?" 

Reply. — 1. Dementia precox is a form of dementia which develops in 
young people. It is usually first recognized about the beginning of puberty. 



CHAPTER XXV 

Diseases of the Nerves 

CONVULSIVE DISORDERS 

When one looks through medical books he finds little about convul- 
sions. If the mother of a young baby were writing such a book she would 
start with convulsions, and some of the present contents of the books would be 
in the appendices. 

Of course, convulsions are not a disease at all. They constitute only a 
symptom. But of all symptoms, they are most dramatic and terrifying. To 
a mother convulsions carry more meaning than do long Latin names and 
talk about bacteria. 

In babies the character of disorders is profoundly modified by con- 
vulsions. Sometimes they usher in the illness; sometimes they come at 
its height; sometimes they close the baby's lifebook. But at whatever period 
they come, they constitute the bold, outstanding feature of the illness. 

Many baby disorders start with spasms. Such is a case of infection with 
the pneumonia germ and with the ordinary germs of contagion, such as 
measles and scarlet fever. 

Where an infection starts with a convulsion, there is little danger that 
the convulsion will be repeated, the one outburst seems to have used up the 
stock of powder. But an infection which begins with convulsions will be 
of more than average severity. 

We speak of convulsions beginning an attack, but they do not properly 
begin it. A child, peevish and irritable all the morning, will suddenly go into 
convulsions. Had the mother examined closely, she would have found the 
child with fever and suffering from headache, but, at that, nothing in the 
symptoms indicates that so alarming a condition as convulsions is on the 
point of developing. 

Perhaps the child has been left sleeping restlessly, when the mother is 
summoned by a scream from someone who has discovered the baby with 
head drawn back, eyes rolling, limbs jerking, and mouth frothing. When 
the mother catches baby up, she notes that he is unconscious. 

Presently the child sighs, as the convulsion passes off, but from time to 
time a jerking indicates that he is still on the border line. Consciousness 
returns slowly. If the temperature is taken, considerable fever is found. 

When the doctor arrives he finds the baby unconscious, restless, grind- 
ing its teeth, and starting from time to time. The cold head cloths and 
the hot bath have reduced the fever a degree or two, but it is still around 105°. 

As the child is still partly unconscious, he probably will not try to give 
medicine by the mouth, but will give some sedative and something to pull the 

418 



CONVULSIVE DISOEDEES 419 

temperature down by injection under the skin, rectal, or both, giving an 
opiate or emetic under the skin and an antipyretic by rectum. 

Within a few hours the child is conscious; the temperature is down, and 
the infection proceeds on its more usual course. 

Why the convulsions in this group of cases ? The nervous system is pro- 
foundly poisoned. The cells of every sort react. The reaction of the motor 
cells produces the convulsions, and that symptom is so prominent that every- 
thing else is forgotten. 

The common idea that the infection has struck in has a grain of truth 
in it. A hot bath to bring the poison to the skin, sedatives to steady the 
nerve cells, to stupefy and thus protect them — these are the things to do 
approved by custom and essentially right, although, like some of the other 
things that are right, we do not yet know enough to know just why they 
are right. 

When contagion starts with convulsions the mother is more alarmed 
than she need be. The immediate danger is not great. However, as I 
have already said, the attack of the contagion will probably be a severe one. 

When convulsions develop in the course of a disorder, it is a graver mat- 
ter. Here, too, the nerve cells are being overpoisoned. If they are able to 
react they do so. If the baby is thoroughly exhausted the nerve cells cannot 
react. Convulsions imply a fair amount of vitality. 

On the other hand, convulsions twang the cords of life. If the illness 
has been running some time, the twanging of the cords may snap them. 

Children with rickets are prone to have convulsions. Poisoning that 
would not greatly disturb another child will throw a rickety child into 
spasms. 

Not infrequently epilepsy begins in infancy. A mother who has had 
the scare of her life from finding her baby in convulsions cannot under- 
stand how any mother would be willing to trust her baby to outgrow con- 
vulsions, and yet many women follow this policy. 

"Familiarity breeds contempt" for anything. After a mother has seen 
her baby recover from convulsions a few times, she loses her fear. Some 
of the repeated convulsion disorders of infancy may not be of great con- 
sequence, but anyhow the condition should be carefully inquired into. 

It may be that the baby is an epileptic. Epilepsy often shows itself in 
infancy, to stop during childhood and reappear in later life. The question 
blanks of epileptic colonies on which are recorded the personal history of the 
applicant always contain questions about convulsions in infancy and child- 
hood. 

It may be that the convulsions mean nervous instability of some sort 
other than epilepsy. However that may be, two facts of importance stand 
out: Babies and children prone to convulsions should be differently watched 
over, especially as to their mental and nerve habits and their digestions, from 
other children. 

Convulsive nervous disorders in infants and children are more amenable 
to treatment than in older people. Convulsions in older children are gen- 
erally laid to worms. 

No kind of worms produces convulsions. 

Therefore, when a child has convulsions, dig for the cause. To call 



420 DISEASES OF THE NEKVES 

it worms and let it go at that is not fair. It may be the only manifestation 
of a meningitis infection, a scarlet fever, or a pneumonia, or it may be 
the onset of these, or some other infection. Possibly the worms may result 
from errors in eating: whereupon a complete cure will follow free vomiting 
and a big dose of oil. It may be epilepsy. 

Grown people have spasms. The best known of these are the spasms 
of epilepsy. By best known I mean many people know about epilepsy. As 
to the nature of epilepsy and what causes it, little is known. 

However, there is a vast difference between the watched over, the 
controlled epileptic and one that is neglected — which means that much can 
be done for epileptics. 

Grown people have convulsions from the poisoning in the course of these 
diseases in which waste accumulates in the body, such as the convulsions of 
Bright' s disease and a kind of kidney tumor, known as hypernephroma. 

Except in epilepsy, the convulsions of grown people are more serious 
than those of children. The nerve cells are more solid ; they sit more securely 
on their bases; they are not so easily turned over or fussed up. When they 
do fuss up enough to produce a spasm it can be inferred with safety that the 
cause is no matter of minor consequence. 

On the other hand, the grown person has a better hold on life than 
the baby. The twanging of the cords is not liable to break them. Where 
death follows convulsions in Bright' s disease, a period of unconsciousness, usu- 
ally of more than a day's duration, intervenes. 

The element of spasm enters into a great many disorders. I mean here 
local spasm — spasm of a group of muscles. Such spasm is a milder affair than 
the general muscle spasm, known as convulsions. 

Of these partial spasms an important one is St. Vitus' dance. St. 
Vitus' dance is almost a matter of public health; it occurs so frequently in 
school children as the direct result of bad governmental methods — that is to 
say, bad school methods. 

It is true that underlying it is an unstable nervous system, inherited 
usually from parents who are nervous, neurasthenic, hysteric, or worse. But 
the exciting cause is badly ventilated, overhot schoolrooms and school tasks 
that result in fatigue. 

The badly ventilated school rooms mean enlarged lymph glands, enlarged 
tonsils and adenoids, frequent colds and rheumatic pains, called growing 
pains. Another result is pallor. Fatigue causes the break to show itself 
in the nervous system. Pallor, anemia, rheumatism, and St. Vitus' dance 
all form parts of the same picture. 

Why the jerk, the symptom which dominates when the case is one of 
chorea? The fatigued, tired nerve cells explode about every so often, and 
the muscles connected with them jerk. This, on a larger scale, is what hap- 
pens in convulsions. 

In chorea nobody treats the muscular contraction. I once read from 
an old author that the treatment of convulsions was to hold the head still. 
Somewhere about the same time effort was made to restrain the choreic 
movements. 

Now the proper procedure is to do everything possible to divert atten^ 
tion from the movements. For the other children in the schoolroom to notice 



CONVULSIVE DISORDERS 421 

them is bad for all concerned, including those who notice them. When they 
are noticed they get worse. 

The proper plan is to stop the cause. The cause is usually tied up 
with the school. Ergo, stop the school. This is a gross way of stopping the 
two causes in the school doing the harm. 

A better plan would be to find a school where the teaching is by play 
in the open air. The best tonics, by long odds, are play in the open air 
and the features that attend. 

The next best tonic, and the best tonic that comes in a bottle, is arsenic. 

Don't let this escape you. The tonics that come in bottles are never 
in the same class with those that come under the head of personal hy- 
giene. 

Coming to adult life, we find that there are many spasmodic disorders 
that do not involve all of the motor apparatus, and many disorders that have 
spasmodic features engrafted on them. 

As an example of the latter we have asthma. Asthma is an ordinary 
bronchitis on which there has been engrafted the element of spasm. The other 
features of the bronchitis act on the spasm feature, making it worse, and 
the spasm features act on the other features, making them worse. 

In consequence asthma produces distressing symptoms, and tends to 
persist indefinitely. But when the lungs are opened up and the tubes are 
explored, little trouble is found. 

There are cases of heart asthma. In such cases the heart is profoundly 
changed. There are cases of kidney asthma. In those the kidney is found 
profoundly changed. But whether it be heart, kidney, or plain asthma, little 
is found in the lungs and bronchial tubes. 

The element of spasm, besides producing discomfort, abets the bronchitis 
enough to keep it going where otherwise so trivial a bronchitis would be easily 
overcome. 

Another of the partial spasms, disturbing, but of no great importance 
otherwise, is the spasmodic tics. These are the jerks not infrequently 
noted in people looking well otherwise. 

The real physical harm is inconsiderable. Occasionally sleep will be 
disturbed or nutrition will become poor; but, generally speaking, the harm 
done may be classed as social. 

The affliction is noticed and the affected man notes that it is noticed. He 
is kept in a state of uninterrupted self-consciousness. It obtrudes when 
he is discussing a business proposition. He cannot go on with his work on 
the same basis as the ordinary man. Some occupations are entirely closed 
to him by his infirmity. 

If it were possible for him to live a successful, isolated life, he would 
be just as well off as anybody, but that is seldom possible. 

What the affected person wants is that his infirmity should not be noted. 
Sympathy is about as foreign to his wishes as blame. Yet some people 
are not disposed to be fair with these people. 

The jerks usually stop at night. They get worse when they are ob- 
served. From these two facts the conclusion is drawn that the condition is 
due to hysteria, or an exaggerated ego, a liking to be odd, or some similar 
mental perversity. 



422 DISEASES OF THE KEftVES 

In the first place, if this were true, the individual is still a subject for 
help and sympathy rather than censure. 

These perversities, by wise help, can be reached. Censure does not ac- 
complish any good. The victims are variations from the normal. In a 
certain sense they are sick people. 

In the second place, for these jerks and bad muscle habits there is 
usually an organic basis. The matter is beyond the control of the subject. His 
efforts to control it make it worse. The nerve cells or the nerve fibers are 
diseased. 

The cure is to cut the nerve or kill it with an injection of alcohol. 
Sometimes this can be done. Just as often the nerve cannot be reached, 
or it cannot be done for some other reason. 

Thought about this class of disorders suggests this bit of personal 
hygiene : 

It is never wise to permit oneself to develop little muscle movement 
habits — for instance, drumming with the fingers, working around the nails, 
blinking the eyes, drawing down the corners of the mouth. 



ST. VITUS' DANCE 

Soon after the school work begins there is a moderate outbreak of 
St. Vitus' dance. Some children, accustomed to the free life of the summer 
season, chafe at once upon being confined during school hours, and from 
this chafing results the form of nervous breakdown called St. Vitus' dance. 

That is the exceptional course. The rule is that the nervous children 
quiet down after a few days. Then they run an uneventful course for some 
weeks. Then the mothers note that they tire easily; they complain of head- 
aches often; they are flabby. Some of them have night terrors, some are 
restless in their sleep, dream all night about their school work, and wake 
up in the morning unref reshed. Some are irritable, cross, sensitive ; some are 
fidgety. 

A close observing mother will accept these symptoms for what they 
mean — a lack of nervous poise — and, warned by them, will seek to avoid 
trouble. Her child is suffering from overwork. It may be that the work 
would not even be hard work for another child, but for this one it is over- 
work. It may be that it would not be overwork in a cooler, or better ventilated, 
or a clean or quieter schoolroom. Or it would not be overwork if the child's 
sight were better, or the blackboard did not shine, or the light were not 
so bad. 

If the warning is not heeded the child persistently begins to jerk — 
perhaps a hand, shoulder, or head; or there comes a facial twitch. It does 
no good to scold or blame. In fact, it does harm even to notice the 
peculiarity. 

It may be that the mother knows that her child has seen some other 
twitching child and is imitating him. The fact that the spasm is the 
result of imitation does not mean that the imitating child should be whipped 
or even scolded. 

If the condition is left unattended to the jerking may be so violent 









EPILEPSY 423 

as to keep the child in bed. Or the joints may become inflamed, the con- 
dition being then called acute rheumatic chorea. 

In reecnt years we have learned that in rheumatism bacteria are cir- 
culating in the blood as well as resting in the joints. This explains why so 
many girls with rheumatic chorea develop .heart disease and why some of 
them die. 

When the jerking is noticed the parents must get busy to discover 
where the trouble lies. If the school ventilation is bad it must be improved 
or the child must drop out of school. If the eyes or the throat are wrong the 
condition must be remedied. 

Whatever be the cause and however completely it can be removed, the 
probability is that the child should drop out of school for a while; live 
a simple life in the open air; take an iron and arsenic tonic, and eat simple, 
nutritious food. 

EPILEPSY 

One of every five hundred persons is an epileptic. When a subject is 
of immediate personal interest to one-five-hundredth of the people and 
of interest to more than four times as many, it is time to talk about it. 
Even if the majority feel that it does not interest them, and would prefer 
not to hear about it, they should be willing to put their preference aside when 
the interest is so wide and so appealing. 

Epilepsy is so dramatic in its manifestations that it has always been 
known. Even savage minds had no trouble in knowing epilepsy. In the 
first writings that have come down to us the disease is described under 
the name morbus sacer, the sacred disease. One who has seen an epileptic 
in convulsions can readily understand why men at the dawn of civilization 
thought epileptics possessed of spirits. 

We have made but little headway since the first man knew epilepsy. 
No cures have been discovered, no bacteriology or chemistry or other science 
of its cause has been worked out. No Virchow, Cohnheim, or Welch has 
used his scalpel or microscope to demonstrate a pathology. 

In the history of the disease the dates are those of some unusual type 
discovered in one year and some other type in another. But the record 
of accomplishment does not run deeper than symptoms — the surface of 
things — and, at that, the last entry was made nearly a hundred years ago. 

Seventy-five per cent, of epilepsy is the ordinary convulsive type known 
to almost everybody. The other 25 per cent, is divided between petit mal, 
jacksonian epilepsy, psychic epilepsy, and three or four less typical forms. 
No typical epileptic goes long without his condition being recognized. 

However, probably more generalized information about night terrors, 
violent dreams, momentary loss of consciousness, passing clouds that hold 
one speechless for a fraction of a minute, momentary rigidities, sudden 
frenzies, running amuck; more generalized knowledge and more careful 
studies of these will show that many of them are epileptic manifestations. 
When these are added to the list of epileptics the number will pass one- 
five-hundredth of the population, and the more atypical epilepsies will make 
up more than 25 per cent, of the whole. 



424 DISEASES OF THE NERVES 

Spratling quotes Gowers, the great English authority, as saying: 

"Epilepsy is an inherited disease. There are jew diseases in the produc- 
tion of which inheritance has a more marked influence, and the influence 
traceable is always far less than that which exists." 

In a study of 2,523 cases Spratling found that 16 out of every 
100 were due to inheritance. This was similar heredity. By similar heredity 
is meant that some of the antecedents of the epileptic were epileptic. 

There is another type of heredity called dissimilar. For instance, alcoholic 
parents are liable to have epileptic children. Spratling found that 15 per cent, 
of 1,070 epileptics had alcoholic parents — a form of dissimilar heredity. 
Bearing collaterally on this point is the observation that hard drinking, 
middle aged men, leading sedentary lives, are prone to develop epilepsy. 
Of this 1,070 Spratling found that 13 per cent, of the men and 7 per cent, 
of the women had insane parents. 

About half a century ago Bemis of New Orleans came at the question 
from another side. He studied 833 families of whom the parents were 
close cousins. There were 3,942 children, of whom 1.5 per cent, were 
epileptics — over seven times the general average of the community. 

Davenport, in his chapter on epilepsy, says that it follows the same 
law as feeble mindedness. In the inheritance laws, epilepsy and feeble 
mindedness are almost interchangeable. Several family trees showing the 
relation between the conditions are shown in Davenport's book. 

Other writers have discovered that families in which there is an excess 
of chorea, of migraine, or of neurosis also carry an excess of epileptics — 
all illustrations of what is termed dissimilar inheritance. 

Now, Spratling, combining similar and dissimilar inheritance, says 
that 60 per cent, of epilepsy is inherited. Eight per cent, of epilepsy is due 
to brain hemorrhage, and the kinds of brain hemorrhages most frequently 
causing epilepsy are those due to injury at time of birth. Birth acci- 
dents are largely responsible for epilepsy. They are responsible even in some 
cases when the spasms do not start until the child is several years old. 

Fright or shock was found to be the cause in 3 per cent, of the males 
and 8 per cent, of the females in a study made at the Craig colony. However, 
it was found that the people in whom fright had induced epilepsy had un- 
stable nervous systems before the shock. Shock does not seem to be able 
to cause the condition in a good, sound, level headed person. Blows on the 
head, fracture of the skull, and similar injuries are responsible for 7 per cent, 
of the epileptics. 

An idea that eye strain causes epilepsy is fairly widespread. Acting 
on this theory some men have sought to cure, in fact, have advertised cures 
of epilepsy by fitting glasses. 

Ten years ago some careful eye specialists went to the Craig colony 
and studied 900 epileptics from this standpoint. Out of the number they 
found 68 in whom there seemed possibility enough to warrant experiment and 
observation for a year. 

Their conclusion was "that cases of epilepsy due to eye strain are of ex- 
treme rarity, if, indeed, they are ever encountered ; while cases due to this 
cause that can be cured by glasses alone, not counting those whose attacks may 
be suppressed, are more infrequent still." 



EPILEPSY 425 

On the latter point, they say: "It appears that in some cases proper 
glasses — just as the bromids — have the power to hold attacks in abeyance, but 
they do not possess the power to cure." 

Sometimes, under bromids and other forms of treatment, the attacks 
miss for months, and, occasionally, for more than a year. The happy patient 
is liable to conclude that he has been cured. It is this that Spratling refers 
to in speaking of "attacks held in abeyance," "attacks suppressed" but not 
cured. 

A peculiar relation is that ivhich sometimes exists between the attacks 
and sleep. Epilepsy that is characterized by night attacks is most insidious 
and incurable. An individual may have night attacks for years before he 
has any spell during his waking hours. If he changes his sleeping hours, he 
finds that his spells also change. It is sleep and not the night attack which 
"sets off the alarm." In some cases the attacks come just as the sick one drops 
to sleep; in others just as he awakens in the morning; in still others some- 
where in between. 

Just why dropping to sleep should "set off the alarm," it is impossible to 
say. But, for that matter, the sudden development of spasms or a momentary 
catalepsy is a puzzler. Usually, there will be a few hours of a somewhat 
muddy mind, then a sudden, violent explosion. Perhaps the breath is sud- 
denly become offensive, the temperature almost instantly rises; the urine 
is highly colored, scant, and full of indican. 

As soon as the spell has been fully recovered from, the mind is acute, 
and the muscles are sore. But the mind is more alert than for days, and 
the urine is abundant and clear straw color in appearance. It is as though 
a thunder shower had cleared the air. 

We see much the same sequence in migraine. The attack usually begins 
with an aura. Two thousand years ago Pelox wrote that the fit began "as a 
spirituous vapor in the veins of the extremities and ascended to the head, 
when the patient became unconscious." This is a pretty fair description 
of this aura. 

The aura sometimes consists of flashes of light or objects seen suddenly 
to balloon out or shrivel up. Sometimes it is the ears that are disturbed. 
Then there are "roarings" or "voices" or the "sound of sea waves." Or 
sometimes it is the taste — with a bitterness like quinin or a sourness like 
lemon. Or it is a gnawing at the stomach which floats up to the head. 

In practically all cases there is some sort of mental aura — a feeling of 
joy or a sense of doom, or a half-sensed appreciation of the oncoming spell, and 
some kind of an attempt to forfend in some way against accident. Sometimes 
no permanent register of this emotion remains in the brain, but anyone who 
has studied the face of a patient toppling over has seen it written there. 

After the spell, the patient who is indifferent to his condition is in 
good mental shape. Ofttimes, however, the patient has been hoping for 
better things, and his disappointment results in a few days of mild melancholy. 

About 8 to 10 per cent, of the cases can get well, says Spratling. Nobody 
can tell which of the cases are curable and which incurable, except as the 
result of months of careful observation and study. That which is to be 
studied is not the disease [for of that we know, and can know next to noth- 
ing], but the patient. 



426 DISEASES OF THE NERVES 

This serves to introduce the most important part of this article, in 
view of the present shortcomings of our knowledge of the disease. Epileptics 
differ from their fellow men. Things that their fellow men can do with 
safety are too hazardous for them. They do not fit well into crowded streets, 
rushing cars, and automobiles, into elevators, engines, and machinery. Oft- 
times they can do their work, and do it well, but not under the conditions 
safe for you and me. They are not insane; ofttimes they are sensitive - 
and high strung. Some are excellent citizens. Healy says some are "the 
most dangerous criminals," pleasant one day, vicious the next, committing 
heinous crimes. 

They are peculiar people. The liberty of the streets is not liberty for 
them, for the fear of an attack, as well as the hazards of the streets, deprive 
them of liberty. They are misfits in asylums, and asylums are misfits for 
them. Prisons may be the place for a few, but so they are for those not epi- 
leptics. It would be as sensible to confine all men as all epileptics. Poor- 
houses? No. 

The answer? Says Shanahan: 

"A colony can be so arranged as to properly cope with the peculiarities 
of the epileptic. Here a suitable occupation can be provided, such as his 
physical and mental condition will permit. 

"The epileptic is about normal about 95 per cent, of the time. A 
proper plan for him is one in which he can be accomplishing something during 
this normal time, content and happy because he knows that, in his 5 per 
cent, abnormal time he will not be in danger of being run over by a street car, 
or he will not be overcome in some school, church, public gathering, or in 
business or social life, and be thereby horrifying to others and humiliating 
to himself/' 

The Illinois Committee of Fifty quotes the average per capita earning 
at Sonyea, N. Y., as $35 a year. As time goes on and more early stage, 
bright minded epileptics come to regard Sonyea as a refuge and as means 
of individual work, each according to his talents, the per capita earnings 
should increase to a figure materially beyond $35. 

Dr. Peterson describes the employment as being many and varied. 
The schools care for the children, the adults work on dairy farms and in 
vegetable gardens, doing a dozen or more kinds of factory and shop work. 
Nowhere, however, is there a field for the proper use of the capacities of brain 
workers. 

Dr. Flood of Massachusetts says, where, a few years ago, the epileptic 
was stupefied with drugs and made to live a living death under colony regime, 
sedatives are used as little as possible, and an effort is made to find the 
best treatment in each case. 

Strangely enough, the same agents which are beneficial in combating 
tuberculosis are of the greatest benefit in these cases. Work in the fresh air 
and good, wholesome, and carefully chosen foods are more essential than medi- 
cine. In addition, there is the opportunity for prolonged and individual study 
of the case — an absolute necessity, as stated above, for the proper care of a 
case of epilepsy. 

Nor should we forget that in colony life there is a partial solution of the 
problem of inherited epilepsy, not a whole solution, for, as I have written, 



EPILEPSY 427 

a part of the inheritance is dissimilar. Epileptics are born to alcoholic par- 
ents, to migrainous parents, to neurotic parents, to insane parents, to feeble- 
minded parents, to closely related parents, as well as to epileptic parents, 
Therefore, the colony is but a partial solution of the problem of inherited 
epilepsy. 

The Committee of Fifty has issued a pamphlet entitled : "How the Un- 
cared for Epileptic Fares in Illinois— Colony Care the Kemedy." From this 
bulletin we learn that the colony plan originated in Germany in 1867. At the 
present time Germany has fifty colonies; Switzerland, three; Holland, two; 
Australia, one. In this country there are colonies in Massachusetts, Ohio, New 
York, New Jersey, Kansas, Connecticut, Texas, Indiana, and Virginia, and, 
in addition, Michigan and Minnesota provide a modified institutional care. 

Ohio began twenty-three years ago. New York followed suit nineteen 
years ago ; Massachusetts started four years after New York, and New Jersey 
stepped out with the Bay State. Kansas and Texas began in 1902, Indiana 
in 1905; Virginia and Connecticut were the last additions in 1910. 

Amending the methods of airing for epileptics proceeds more slowly 
than amending the constitution of the United States, but it develops a few 
steps every few years. The colony method will presently be general in the 
states. 

Some epileptics can be cured. In most epileptics the frequency of the 
convulsions can be lessened, and the seizures can be made less severe — all of 
this in spite of the mystery of epilepsy, for concerning the cause of epilepsy 
nothing is known. In the history of medicine theory has followed theory in 
the speculation as to the cause of epilepsy. Every science has been made use 
of in its investigation, and still the mystery remains. 

A few inheritance facts are known. It sometimes runs in families. It 
frequently manifests itself in the children of chronic alcoholics. It frequently 
manifests itself in children born of parents or a parent drunk at the moment 
of conception. In a stock it is frequently interchangeable with other neurotic 
manifestations. 

Clinically, it seems somewhat akin to migraine and to hysteria. It can 
sometimes be connected with head injuries. 

A few isolated facts of this nature are about all that is known, and these 
facts do not tell us much about the nature of the disease. But here is one 
observation that every epileptic should know about. It is that most epileptics 
are greatly benefited by a proper regard for personal hygiene. 

Caesar was an epileptic from childhood on. He was most abstemious in 
his eating and drinking, kept his skin in perfect condition, his muscles always 
elastic, and his secretions in good condition. 

Mohammed was an epileptic. Few characters in history have lived more 
simply and kept their bodies in better condition than did Mohammed. 

Byron, whose father was an alcoholic and whose mother was a neurotic, 
was in convulsions when born. For a while in his early manhood he neglected 
himself and grew obese. By most abstemious living he reduced his weight 
from 240 to 160 pounds, and by abstemious living and systematic exercise 
kept his wind good ever afterward. 

When a person learns that he is an epileptic he is prone to grow timid, 
shy, diffident. In time he loses aspiration and ambition, and before long be- 



428 DISEASES OF THE NERVES 

comes slouchy, both mentally and physically. Wood says epilepsy is not in- 
consistent with a life of utility, nor even an important career. 

Besides Byron, Mohammed, and Caesar, many other men of great achieve- 
ments have been epileptics. Perhaps St. Paul was one; many say that Na- 
poleon was an epileptic. 

Many governors, mayors, senators, congressmen, professors, and men of 
learning and letters have won out in spite of epilepsy. 

In spite of the little known of the exact nature of epilepsy, experience 
has taught us that the epileptic who obeys the laws of personal hygiene and 
who refuses to give way mentally and spiritually leads a life of usefulness. 

Treatment for Epilepsy. — Daily Reader writes: "In answer to my in- 
quiry about mild epilepsy, you say: One out of ten can be cured; more are 
often benefited. May I ask, what is the treatment for epilepsy? How can 
this awful malady be cured? May I also know the main cause? You say 
overwork is not the main cause. A person seems to get spells when he 
worries over business. Blood only 66, is this too low? I do not understand 
cubic millimeters. May I also ask how long treatment must be kept up 
after the spells stop?" 

Reply. — 1. [a] When possible, find the cause and remove it. 

[b] Simple life in the open air, such as the inmates of colonies follow. 

[c] An abstemious diet. 

[d] Proper habits, particularly as to excretions. 

[e] Freedom from worry, anger, or other violent emotions. 

[f] Tonics, bromids, and other medicines, as required. 

2. Among other causes are: 

[a] Inheritance. 

[b] Injuries to the head. 

[c] Lack of balance between the secretions of certain ductless glands. 
Attacks are precipitated by : 

[a] Anger, worry, or other emotions. 

[b] Constipation. 

[c] Bad habits. 

3. Sixty-six per cent, hemoglobin is too low. It means a fairly con- 
siderable anemia. Ninety to one hundred is normal. 

4. Blood corpuscle counts are usually expressed in number of cells per 
cubic millimeter. A cubic millimeter is roughly one-six hundredth of a 
drop. Do not try to remember that. Remember 5,000,000 red cells and 
8,000 white cells as normal, and abnormalities in proportions of 5,000,000 
and 8,000 respectively. For example, 4,000,000 red cells constitute 80 per 
cent, of the normal; 16,000 white cells, 200 per cent. 

5. Drug treatment but a few months; the hygienic treatment con- 
tinually. 

Care May Cure Epilepsy. — J. B. K. writes: "A 12 year old girl has had 
epileptic spells for three years. Is there any probability of outgrowing it? 
Is there a Hebrew institution for such afflicted children? If not, which 
are the public or private homes for this ailment?" 

Reply. — 1. Epilepsy will not be outgrown. Sensible care, persistently 
carried out, cures one case in ten. In addition, in many cases not in the 
incurable group, good care greatly reduces the frequency of the attacks. 
To an exceptionable degree in epilepsy is there response to proper care — 



EPILEPSY 429 

greater safety, greater happiness, an increase in general wellbeing, fewer 
attacks, and, sometimes, cures. On the other hand, drifting — leaving the 
patient to outgrow it — makes for harm. 

2. I doubt it. I have not been able to learn of any. 

3. Many states have epileptic colonies. Ohio, Massachusetts, New York, 
New Jersey, Kansas, Connecticut, Texas, Indiana, and Virginia, and Min- 
nesota and Michigan have some provision for care of epileptics. Outside 
of these I know of no public or private homes for the disease. 

Looks Like Epilepsy. — D. A. C. writes: "Are adults as subject to worms 
as children, and how do these parasites become located in the intestinal 
tract? Would a person having an inordinate appetite, especially for 
sweets, being also subject to fits or spasms, in which he falls down, his 
fingers twitching spasmodically and eyes fixed in a vacant stare, possibly 
be troubled with worms? How should a person be treated while in one of 
these spasms? Is it likely that a person would be troubled with worms and 
worm spasms for a period of five years or longer? Would you advise any- 
one so troubled to consult a physician, or is there some reliable medicine 
on the market that will do the work?" 

Eeply. — I suspect the party referred to has epilepsy. Certainly the 
condition is not due to worms. Have a physician pass on the case. Worms 
of the ordinary kind do little or no harm. They do not cause spasms. 
Adults are subject to worms, but are not as frequently infested as children. 

Epilepsy Rarely Curable. — L. M. wants to know if epilepsy is a curable 
disease. What can be done with an epileptic? Are epileptics insane? 

Reply. — As a general statement, epilepsy is incurable. There are some 
exceptions. But many epileptics, by keeping in good physical and mental 
condition, can cause their attacks to come at long intervals and the progress 
of the disease to be slow. 

On the physical side constipation is to be avoided. On the mental side 
paroxysms of emotion, such as anger, grief, and melancholy, are to be re- 
frained from. 

Most epileptics are useful members of society for the first ten years of 
their disorder, but attacks and the conditions which lead up to them are 
very wearing on the brain substance. In time the central nervous tissue is 
worn down and the epileptic becomes of poor judgment from overemotion- 
alism, or insane, or demented, with a brain prematurely old — senile. 

Careful living and, particularly, good control of the mind, decrease the 
frequency of attacks and spare the brain some unnecessary wear. Some 
states have colonies for epileptics. In those states epileptics get on best in 
these colonies. Other states have no provision for them. 

Value not Proved. — G. A. writes: "There has recently been brought to 
my attention the work of Dr. Ralph Spangler of Philadelphia. He treats 
epilepsy with rattlesnake venom, and I have been told has had great suc- 
cess. Could you give readers an opinion on this method of treatment?" 

Reply. — The treatment with snake venom is in the experimental stage. 
The indications are that it is not of much service. 

Mild Epilepsy. — M. L. S. writes: "1. Can mild epilepsy be cured in a 
girl 19 years of age? Never had an attack until she was 19; had three then 
in ten days. 2. Does bromid always affect the brain? 3. Would you 



430 DISEASES OF THE NERVES 

advise discontinuing bromid in this case? What brought on these attacks 
at this time of life?" 

Reply. — Some forms of epilepsy are fairly curable. Most forms are 
controllable; some are hopeless from every point of view. An epileptic 
should remain permanently under good medical control to the end that the 
most useful life possible may be worked out for him. Most states have 
epileptic farms where the patients live under circumstances that give 
them the best chance possible. 

No Epileptic Colony. — H. A. M. writes: "I know of a man who, at the 
age of 1^5, proved to be an epileptic. Will any of his children develop this 
at the same age? Might his grandchildren inherit it? Is there any insti- 
tution in or near Chicago where such people may be taken care of?" 

Reply. — Probably not, especially if the other parent is of good, level- 
headed stock. Illinois has no epileptic colony. Several states have. If the 
man is sane, there is no institution for him. 

One Chance in Ten. — Reader writes: "Can mild epilepsy, brought on 
by overwork and nervous breakdown, be cured? A man SI* years of age has 
had it about one year. What is normal blood count for a man?" 

Reply. — 1. Mild epilepsy can be cured one time out of ten. It can be 
benefited more frequently still. Overwork may be a contributing though 
not a main cause. When overwork is a factor, rest will help. 

2. The normal red blood count is 5,000,000 red cells per cubic milli- 
meter; the normal white blood cell count is 8,000. 

No Institution for Epilepsy. — Anxious writes: "Is there a cure for 
cases of epilepsy? Is there any institution in the State of Illinois de- 
voted entirely to the care of epileptics?" 

Reply. — A small proportion of the epilepsy is curable. Most of the vic- 
tims by properly regulating their lives can be spared many attacks, and the 
progress of mental deterioration will be slow. Illinois has no institution 
devoted entirely to the cure or the care of epileptics. 



PARALYSIS AGITANS 

Some men stand so solidly, so like a stone wall, that tottering, wavering, 
tremors seem wholly out of the question; yet even those most like a solid 
wall are constantly rocking like a ship at sea. They pitch forward a bit 
and the muscles of the back pull them in the other direction, and so it goes 
all day long. There is some tremor about even the most quiet, best con- 
trolled hand, but effort of the will can control most of this. 

Paralysis agitans is a disease in which this tremor is grossly exaggerated 
and wholly beyond the control of the mind. Thinking about it makes it 
worse. When the brain tries to control the trembling hand, the tremor 
redoubles. 

A common test for paralysis agitans is to give a man with a tremor a 
full glass of water and ask him to drink without spilling it. The glass will 
shake so as to spill a good part of the water. 

Many people do things less well when they concentrate their minds on 



PARALYSIS AGITANS 431 

them. In paralysis agitans this rather general propensity is exaggerated out of 
all proportion. 

A more important, though less easily recognized, symptom is a persistent 
muscular rigidity. The muscles, conscious of their weakness, hold the head, 
the body, the arms, and sometimes all in positions and attitudes of rigidity. 

As to the cause very little is known. Some writers think the nerves 
which control the muscles have grown old before their time. There is but 
little basis for this opinion. 

Some think that there are senile changes in the muscles themselves. 
There is not much evidence to support this view, though there is more than 
that behind the first. 

Another group believes that it is due to disease in some of the ductless 
glands. 

Just outside of the thyroid in the neck is a small gland called the para- 
thyroid. It has been noticed that when this gland has been wholly destroyed 
the patient died in the midst of spasms and that when it was partially 
destroyed the patient developed different kinds of jerks. 

In a few cases of paralysis agitans changes have been found in these 
glands. Such changes are not very marked nor very constant. 

Acting on the little evidence of one sort and another, a few physicians 
have given extract of parathyroid in paralysis agitans. In about two-thirds 
of the cases in which it has been tried it has given favorable results. 

That is not very conclusive, out it would seem wise, for early cases at 
least, to give parathyroid an extended trial. Ordinary -drugs are of no 
service, and nothing is lost by not making use of them. Old, long-continued 
cases with advanced changes and settled conditions cannot expect much from 
anything. 

Causes Remain Mystery. — J. E. L. writes: "1. What are the symp- 
toms of paralysis agitans? 2. What are the causes of this affliction?" 

Reply. — 1. Trembling gets worse when one tries to control it. For 
example, when it affects the hands, if the person tries to drink from a full 
glass of water the trembling gets worse. 

2. Nobody knows. 

Marry Him. — Miss M. G. writes: "I am going with a young man and 
he wants me to marry him. His mother is J^5 years old and has shaking 
palsy. Her doctor tells her she cannot get over it. I have noticed the 
young man when he takes a drink of water and his hands do not tremble 
any more than anybody else's. If I marry him will our children have 
shaking palsy? Will he get it when he is ^5?" 

Reply. — There is no evidence that shaking palsy or paralysis agitans is 
inherited. Your children will be in no special danger. Marry him. He is 
no more liable to develop shaking palsy than anybody else. Live within 
your income and otherwise do all you can to keep him from worrying. 
Protect him so far as you can against shock and great nervous strain and 
you will have done your part in shielding him against paralysis agitans. 



432 DISEASES OF THE NERVES 



HUNTINGTON'S CHOREA 



Many years ago a person suffering from a rather strange disorder came 
into the state of Pennsylvania. He located in the country. He was con- 
stantly jerking and twitching. His family grew np around him. In time 
his twitching grew worse, and it was noted that his mind was failing. He 
had the sympathy of the people of the neighborhood. 

The children seemed healthy and well balanced. When he died the 
neighbors went to the funeral, and then helped the widow and children to 
readjust themselves. 

Years passed, and the children, having become of middle age and them- 
selves the parents of children, began to twitch and jerk. 

The older neighbors remembered that the old parent, the first of the 
family known to them, twitched in the same way. Time passed, and they 
remembered that the progressive weakness, insanity, and death constituted 
just the course the infirmity of the parent had followed. 

Still the neighborhood had no emotion, and certainly no thought except 
one of sorrow. For some reason a curse was laid on this man, and it had 
remained to the second generation. 

That right in the simple countryside there was growing up a great 
menace, a great public enemy, or that the occasion called for governmental 
control never occurred to those good-hearted people. 

The disease was Huntington's chorea. It is inherited. It got its foothold 
in a single family in western Pennsylvania, and down this strain it has run 
into the other families to which this stock has contributed. Now it is rather 
widely distributed over the United States. 

But back of the Pennsylvania case there lies some history. On the tip of 
Long Island there lived an isolated community of fisher folk. They lived to 
themselves and married among themselves. Presently it was noticed that 
some of the people began to develop a tremor when they got to middle life. 
Those who developed this trembling in time became feeble minded. 

Among the people of this community was a physician who did not look 
on this nervousness as a part of the day's work. He noticed that it ran in 
families. As it never showed itself until the middle of life had been reached, 
the subjects were married and had families. The name of this doctor was 
George Huntington. He observed all the facts and established the relation 
between them. The disease was given his name. 

During the first forty years of life the patient to be is free from 
trouble. Then a twitching begins. As more or less unsteadiness is to be 
expected in middle life, the disorder is unnoted. It becomes worse. 

For a while the movements can be suppressed by effort of the will. 
The speech gradually becomes slow and difficult. The movements, which at 
first affected the extremities, extend to the face. They reach the stage 
where excitement makes them much worse. 

It is noticed that the mind is not of the former fiber. The mental de- 
generation increases until insanity results. 

For the cure of the disease nothing can be done. The afflicted should have 
the care required. They should have sympathy. The sympathy, instead of 




S3 



433 



434 DISEASES OF THE NEKVES 

being temporary and intermittent, should be continuous. It should be far- 
reaching. It should be so farreaching that it should protect the next genera- 
tion. 

As the disease does not manifest itself until after thirty, the hereditary 
relations may be lost sight of. The sympathy extended should supply the de- 
ficiency. 

The eugenic laws of Huntington's chorea are well understood. Sympathy 
will have no trouble in becoming intelligent. 

My advice to a person contemplating matrimony is: Do not marry a 
middle-aged person with trembling of the hands or head unless you know that 
his disorder is not Huntington's chorea. As the disease does not develop 
until middle life, do not marry any person either of whose parents had 
Huntington's chorea. 






CHAPTEB XXVI 

Stammering and Stuttering 

STUTTERING SCHOOL CHILDREN 

It is a peculiar anachronism that imitation is responsible for some of 
the stuttering, and stutterers stutter most when they are afraid lest their 
stutter and their stuttering be noticed. But then, when you inquire into 
the subject further, it is not so odd. 

Stutterers are above the average in intellectual activity and in mental 
brightness, but they are lacking in mental poise. The same lack of level 
mindedness makes them imitate stutterers, and, having become stutterers, 
makes them sensitive about it. 

In cities stuttering children can be gathered into special classes with 
special instructors. In the country the stuttering child must be taught in the 
same class with other children. Is there anything that can be done ? 

To begin with, stutterers generally are of a nervous or even neurotic 
stock. In their family trees are found a large number of people not of good 
nerve poise. In the next place generally they have been badly brought up. 
As babies they were rocked to sleep or trotted when they cried. As children 
they were allowed too much excitement. 

The statistics show that most children who stammer begin before school 
age. The child learns how to talk properly, but somewhere between two and 
seven years of age picks up the stuttering habit. 

The teacher's problem is to take this child of a nervous stock with an 
acquired habit and to teach him correct speech methods in addition to the 
ordinary tasks of the schoolroom, and at the same time to prevent other chil- 
dren from contracting the habit. 

The first step is to have a frank talk with the subject. The next is to 
have an equally frank talk with the students. The next is to discover the 
fault with that particular child, and the next is to outline a plan of speech 
training and mental training for that child. 

The parents should equip the school library with Dresslar's "School 
Hygiene" and Scripture's "Stuttering and Lisping." The next step is to study 
the books and the next is to study the child. 

Dresslar puts great stress upon studying the child as well as its defect 
and adapting the treatment to the case. In the cure of stuttering in the 
different stuttering schools the personality of the teacher is as much a factor 
as the method employed. 

To the school child the two personalities who rank supreme are mother 
and teacher. No specialist will ever surpass them in personality as the child 
sees them. 

435 



436 STAMMERING AND STUTTERING 

A study of these books will give them enough technical skill. When to 
this their personalities and something of patient effort are added, a mother 
helping the teacher and the teacher helping a mother should make a com- 
bination capable of curing almost any stuttering child. 



STAMMERING 

Much the most comprehensive book on stammering that I know of is 
one recently written by Prof. C. S. Bluemel of the University of Colorado. 
Of stammering by young children he says: 

"Much success has been achieved by a few stammering schools established 
especially for young children. We have already emphasized the fact that 
during childhood, when the secondary causes have not yet supervened, stam- 
mering usually yields readily to rational treatment. But it is not by any 
means necessary, and perhaps by no means desirable, that a young child be in- 
carcerated in an institution. An intelligent mother can usually accomplish all 
that is possible for a stammering child if, instead of supinely waiting for him 
to 'outgrow' the difficulty, she will undertake to combat the impediment. 

"In the first place the child himself must be induced to strive for fluency 
in speech. He must be offered a substantial and much coveted reward for 
ultimate victory, and must then be helped at every stage of the contest. 

"He must be checked quietly and gently each time that he stammers. He 
must be made to wait and reflect upon the words he is about to use — and to 
utter these words slowly and with composure. If he then speaks fluently he 
should be commended and encouraged and should be made to repeat the words 
in order that he may gain assurance. 

"The child should be made to feel that, although it is not reprehensible 
to stammer, it is nevertheless highly commendable to speak with fluency. He 
should never be laughed at, scolded, or punished for his impediment; for, 
with such treatment, fear soon associates itself with speech. He should never 
be mimicked, and for this reason and a hundred others should be kept from 
school till the impediment has been eliminated. 

"If much amnesia appears to be present the child should be told to 
think, during speech, how his words are going to sound. If physical stam- 
mering is in evidence he should be taught to inhale before speaking and to 
speak at all times without effort. 

"The child should be required, by way of practice, to learn and recite 
simple rhymes. He should be told little stories, and should be made to repeat 
each sentence slowly and carefully after the parent. Later, when progress 
has been attained, he should be required to relate these stories by himself. 

"If mothers would adopt these simple measures we should in a few decades 
hear little more of stammering." 

When Bluemel began to study stammering he wrote down certain facts. 
No theory as to the reason for stammering could be acceptable to his mind 
unless it explained all the facts. The facts to be explained were these: 

"The true cause of casualty must explain all the facts. It must explain 
the fact: 

"That the stammerer can usually sing without difficulty. 



STAMMERING 437 

"That the stammerer can often speak well when alone. 

"That the stammerer is usually fluent when speaking in concert with 
other people. 

"That the stammerer can usually repeat fluently the words that are pro- 
nounced for him by another person by way of assistance. 

"That the stammerer can usually repeat a word that he has eventually 
stammered out. 

"That consonants at the end of a word never occasion difficulty. 

"That the stammerer may have difficulty on words that commence with 
vowels. 

"That the speech defect may assume the most diverse forms, being in 
one case passive and in another active and boisterous. 

"That one can stammer in thought as well as in speech. 

"That there are more male than female stammerers. 

"That stammering is rarely acquired after the fifteenth year." 

Starting out with an explanation of these facts as his task, he arrived 
at the conclusion that the trouble was with the mental processes of the stam- 
merer, and that treatment to be lasting must be directed toward the mind. 

Stammerers differ. There are lispers, stutterers, and other types of stam- 
merers. In some the physical side of the impediment is prominent. Various 
habits of tongue, lips, facial muscles, and even of the body as a whole may 
be superimposed on the speech habit in time. The stammerer may have been 
started off with a speech defect in which physical factors are prominent. 

Various modifications of habits, of thought, of demeanor, of temperament, 
develop as a result of speech defects. Therefore, when the cure of a stam- 
merer is undertaken there should be careful study of the individual to deter- 
mine his type and also his peculiarities, his physical, mental, and social 
makeup. 

The simplest, easiest of all propositions is the cure of stammering in 
young children. As indicated above, the problem then is so simple that it can 
be left to intelligent mothers. A little knowledge combined with love, kind- 
ness, tact, and patience is all that is required. 

In fact, without any education except the haphazard education of life, 
about three-fourths of the stammering children are cured of their infirmity. 
Somehow or other they stop. Bluemel thinks that patient, careful, intelligent 
mothers could cure nearly all of the remaining fourth. 

Next easiest of cure are the physical additions present in certain stam- 
merers. The mind having failed to work properly before, the stammerer 
expects it to work improperly this time. He tries to overcome his defect 
by unusual motions with his lips and tongue, thus producing strange sounds, 
or he hesitates and then explodes out a jumble of sound, or he changes his 
facial expression, or jerks his head, or neck, or arm. 

The schools that teach by singing methods, elocutionary methods, most 
any sort of method, are highly successful in relieving this annoying phase 
of stammering. When relieved of this element most people think themselves 
cured. 

When it comes to pure stammering, the opinion of Bluemel is that there 
must be a careful analysis of the mental processes of the stammerer and a 
carefully planned system of mental training founded on it. Training mental 



438 STAMMERING AND STUTTERING 

processes cannot be done in a day. The analysis must be done by the stam- 
merer and a trained man of learning, working together. The plan must be 
laid out by the man of science. The carrying out of the plan must be done 
by the stammerer himself, with occasional supervision by his mentor. 

Bluemel says that, when the quacks are eliminated, there will remain two 
classes of persons treating stammerers — "the good hearted and well mean- 
ing souls that know nothing about the malady and the ingenuous and more 
intelligent students of stammering as a deep and intricate psychological 
problem. Men of the latter class are almost exclusively physicians, and the 
best of them undoubtedly are found in the German empire." 

Bluemel began his study by a careful analysis of the speech of the stam- 
merer. First he determined which sounds were difficult. Then he analyzed 
the physical effort made by the breathing apparatus,- the larynx, the tongue, 
and the lips in producing each of these sounds. Next he analyzed the mental 
and nervous factors responsible for speech; and next, the relation of these 
to the words and sentences which serve as impediments in stammerers. 

Next he analyzed the social factors which have any relation to stammer- 
ing, such as the age and sex of stammerers, station in life, the effects of 
association, school, in social intercourse, the effect of ridicule, of the various 
emotions, of imitation, of embarrassment, timidity, fear, anger. 

With the results of these analyses of stammerers and stammering before 
him, he began a study of the world's literature on the subject. In this study 
he reviewed what had been written on stammering, stuttering, and speech 
defects, and in addition whatever in literature, psychology, sociology, medicine, 
and natural science was calculated to throw light on the subject. 

Having laid the foundation, he studied every important method of treat- 
ing speech defects in use in Europe and America. The results of these 
studies are told in the two volumes. 

It is unfortunate that the scientific study to be found in Volume I is, 
probably of necessity, so technical that the stammerer will not be able to under- 
stand it, unless he makes constant use of the glossary, and even then it will 
be difficult. 

In Volume I Bluemel is the analytical scientist — calm, philosophical, 
unimpassioned, unemotional. In Volume II, a different Bluemel comes to bat. 
He still is analytical, learned, well informed, and keen, but now these qualities 
are made to serve the purpose of a crusader, a satirist, an honest man scourg- 
ing the thieves and money changers from the temple. 

He takes up the schools and methods of cure, group by group. First, he 
analyzes the method to show the underlying principles made use of. He 
found that the hundreds of methods fell into a few groups. 

He then investigated the history of the subject. He found that in 
methods for the cure of stammering there is nothing new under the sun. 
Some part of it goes back a thousand years. Much of it originated with Eras- 
mus Darwin, the grandfather of Charles Darwin, and every important detail 
was in use at least one hundred years ago. Systems advertised as having been 
revealed by God he proves to have been stolen outright. 

Finally he dissects the business methods of the stammering schools, 
showing them to be as bad as the advertising doctors in their palmy days. 

He investigated carefully and found that the schools cured about five per 



STAMMEKING 439 

cent, of their pupils. There is nothing remarkable in this. Seventy-five per 
cent, of the children who stammer get well without treatment. Of course, 
stammering schools do not get many of this group. The percentage of cures 
without treatment among those of the age and station who patronize these 
schools is almost as great as among the students. 

What the best of the schools do is to cure the physical additions which 
develop in stammerers. This helps, but it does not constitute a cure. 

Speaking generally of the systems, he says : "Many of them are entirely 
devoid of merit; they have been recorded (in this study) merely because 
they are the gold bricks that are daily sold to stammerers by an infamous 
fraternity of 'speech specialists/ . . . Progress is hampered by the charlatans 
who rob the stammerer and bring everybody and everything connected with 
the treatment or investigation of stammering into disrepute." 

"The great secret" guarded by speech specialists is the fact that the 
stammerer is being bunkoed. 

"The charges are exorbitant ; but these frock-coated frauds operate chiefly 
among the 'superior' classes. Of recent years a few cheaper schools have 
come into existence. They are apparently no worse than the 'superior' insti- 
tutions." 

"The writer has never known of a worthless institution that was not 
recommended by a body of bishops, colonels, mayors, postmasters, doctors, 
and men that are usually credited with intelligence. The clergy are inveterate 
recommenders. In America recommendations from mayors, former mayors, 
and merchants often are obtained through commercial associations, boosters' 
clubs, and organizations for mutual support among rotten concerns that can- 
not exist on merit. 

"Newspaper puffs in the local press (when not paid for) are usually 
inserted in the interests of 'a greater Mudville.' 

"When the man in the picture points his finger at you and says, 'I guar- 
antee to cure stammering,' he is lying." 

"The writer has an acquaintance that has taken eight courses at English 
stammering schools. He still seems good for eight or a dozen more." 

"The writer could name four principals (of stammering schools) who 
have themselves relapsed. Correspondence schools are few and sporadic. 
They probably do very little good and very little harm; they need not be 
taken seriously." 

Stammering. — B. D. B. writes: "1. What causes stammering and stut- 
tering? 2. Can it he cured? 8. How?" 

Keply. — 1. Stammering and stuttering are the same. The cause may- 
be one of several. 

2. Yes. The case will depend on the type, the cause, the age of the 
subject, and the duration of the condition. 

3. The method will depend on much the same factors as are set forth in 
answer 2. In some children a single lesson suffices. In other cases years 
are required for cure. When a person has been born with an unstable, 
nervous system, has acquired a wrong speech method, and where this 
method has been persisted in for years, it is reasonable to expect that much 
time will be required to retrain the individual. Sometimes it is only the 
speech method that requires attention; sometimes mental methods must 



440 STAMMERING AND STUTTERING 

also be changed. My advice is that you get "Stuttering and Lisping," by 
Scripture [Macmillan] , that you study it with the most caretaking, patient 
physician in your town ; that, in the light of what you learn from the book 
you study your child, and then follow the plan devised by you as a result 
of this study. 

Stammering a Nervous Condition. — B. Y. writes: "I am 27 and I stam- 
mer. Sometimes I talk almost like the best speaker and all at once I can- 
not get one word out, or stammer so badly that nobody can understand me. 
I am perfectly healthy and don't think I am nervous at all. I have stam- 
mered since I was a little girl." 

Reply. — Stammering is purely a nervous condition. There is nothing 
wrong except in the mind. While most stammerers are neurasthenics, some 
are not. The remedy is by psychotherapy. 

The different systems of cure are about equally good. Whenever the 
patient has faith that the system is going to cure, the cure is half accom- 
plished. After that it just means patience and grit. 

Generally stammerers do not try for a cure until the habit has been on 
them for years. A ten year habit cannot be cured in ten days. Go to any 
one of the schools, pick the one where the teacher makes the best impression 
on you, have faith and stick. 

To Prevent Stuttering. — N. V. writes: "I have a little girl about 8 
years of age. She is perfectly healthy and bright. She has been talking as 
plainly as any child, but lately, say for the last month, I notice an inclina- 
tion to stutter at the beginning of a sentence. Kindly advise me what to 
do." 

Reply. — Admonish her to speak slowly. 

Children are prone to imitate. Speak slowly and deliberately when in 
her presence. Do everything you can to cultivate poise in her. Keep her 
away from everyone with a speech defect or a bad speech habit. 

Cure Matter of Training. — La Grange writes: "There is a boy of my 
acquaintance, Ik years old, who is afflicted with stammering. What can 
be done in his case? Should he have medical treatment, or is there some 
kind of a school or institution where he can be sent to be cured of his 
trouble?" 

Reply. — The Chicago public schools have a school for children with 
speech defects. There are private schools, each teaching some one method. 
Scripture, in his book on "Stuttering and Lisping," says the trouble with 
these institutions is that the fundamental trouble differs in nearly every 
case, and, therefore, the method must be changed for each case, or nearly 
so. Medical treatment gains nothing. Cure is a matter of training. 

How to Cure Stuttering. — A. W. writes: "Will you please let me know 
whether stuttering or stammering is curable, and whether a surgical opera- 
tion is necessary? I have stammered and stuttered badly for some time. 
Now I at times find it difficult only to commence certain words. Some- 
times I can speak almost without any difficulty. What would you advise 
in my case?" 

Reply. — I cannot see how a surgical operation would help you. Stutter- 
ing is curable. A careful study of the individual case and persistence in 
carrying out the cure bring success. Read Scripture on "Stuttering and 



PHRENOLOGY 441 

Lisping," decide on a method, and patiently follow the method you have 
selected. 

May Help Yourself. — F. C. P. writes: "I am IJf and I stammer. I have 
attended schools of stammering and have tried nearly everything. Nothing 
seems to help. Would you please give me some advice?" 

Reply. — No two stammerers can be treated exactly alike. Go to your 
nearest library and get Scripture's "Stuttering and Lisping." Read it care- 
fully. Through it you may be able to help yourself. 

Suggestion for Stammerers. — J. A. E. writes: "I wish to state that a 
number of years ago I stuttered on every word. I started to whistle as I 
started to talk, and found I had no trouble talking. If you will watch the 
faces of the majority of stutterers when they talk you will see that they 
breathe in instead of breathing out. If they will only stop and whistle 
they will be able to talk without stuttering. I stutter little at the present 
time. I have been to stutterers'' schools, but found the whistling helped me 
more than any other treatment." 

Child Stammers. — A teacher writes: "Will you kindly advise how to 
control stammering in a child of 5f" 

Reply. — I would suggest that you get Scripture's "Stammering and 
Lisping." It is a small and inexpensive book. There are many cures for 
stammering. Scripture writes that each subject must be carefully studied 
and then a plan outlined for that individual. Each cure is adapted to a 
group of cases, but ineffective for others. Whatever the cure, it is a matter 
of training and patient persistence is essential. 



PHRENOLOGY 

Not long ago I picked up a daily paper published in a city of some im- 
portance. I was astonished to read of a combination for mutual advantage 
between this newspaper and an archaic type of faker — a phrenologist. The 
"professor" was writing daily character studies of prominent people, based 
on bumps, for the newspaper. The newspaper was running editorials and 
editorial notes about the "professor" and his bumpology, and everybody was 
happy except the poor "suckers" who were being done out of their coin by the 
Bump and Hump twins. 

The quality of brain, to say nothing of the brain capacity, is in no way 
related to the bumps on the head. The soft, brainy substance cannot push 
knobs on the hard, bony skull, and, for that matter, the hard, bony skull 
cannot change the type of brain inclosed therein. 

No group of scientists, psychologists, anatomists, histologists, or physiolo- 
gists has ever been able to find any evidence of relation between skull humps 
and bumps and types of mind or mental capacity. This information is more 
or less generally diffused, and yet these fakers still catch fair crops of suckers. 

Don't waste your time watching for bumps, hoping thereby to estimate 
character. If you have time to spare, however, put in some of it watching 
children for mouth breathers and thumb suckers. Sometimes it will prove 
as interesting as reading a "best seller/'' 



442 STAMMERING AND STUTTERING 



HEAD NOISES 

One of the most frequent calls for help coming to me is the call for relief 
from head noises. Searching far and near, I have not been able to find a 
suggestion simple of application and offering hope of relief for many sufferers, 
and these are the reasons : 

The ear is divided into three parts — the external ear, the middle ear and 
the internal ear. The external ear opens to the outside and, at its inner end, 
is closed by the drum. The middle ear opens into the throat, and, at its outer 
end, is closed by the same drum. Then the purpose of the external and middle 
ear is to receive the sound waves and convert them from air waves into bone 
waves. The internal ear converts these bone waves into nerve impulses which 
the brain interprets as sounds. 

Incidentally, a part of the internal ear keeps the body in proper equili- 
brium. The simple way to put the last point is to say that, when that part of 
the internal ear is disturbed there is vertigo, swimming in the head, and 
sometimes fainting. 

When one is hit in the eye or so as to jar the eye, one sees stars; when 
the bronchial tubes are irritated, there is cough. When the nerves of the in- 
ternal ear are irritated, the irritation expresses itself not by stars, or cough, 
or sense of heat or cold, or pain, but by "noise." 

In the case of head noise the external ear should he examined. Wax 
may he irritating the drum. If so, and it is cleaned out and the canal is kept 
clean, the trouble will end in this group of cases. 

Occasionally the ears are too keen. In this case, cotton in the ears will 
bring relief. In some cases the throat man will find that adenoids or tonsils 
are interfering with the canal from the nose to the ears. 

These are the unusual causes of head noise. The usual cause is trouble 
in the internal ear or the bones that surround it. Any inflammation or disease 
of any sort in the internal ear such as would cause pain in another part of 
the body causes head noise. 

Head noise merely means that the internal ear is being pained and is 
responding to the irritation in the only way known to it. Doctors try to find 
out something more about the trouble by inquiring into the nature of the 
sound. For instance, some say that a sharp, metallic, striking sound like that 
of a hammer striking an anvil is due to disease in the bones. 

Furthermore, they try to sound conduction of the bones. Bones get 
denser and under other circumstances more porus, and the ear test is a fair 
test for bone density. 

One with head noise due to internal ear disease can do something by 
keeping his bowels right and living a hygienic life. Ear specialists can cure 
some of the cases. But the average man with head noises must make up 
his mind patiently to endure, to calm himself, to train himself to forget the 
noise. 

Nor is this as difficult as we imagine. A street noise must be out of the 
ordinary to attract attention. We forget, or never hear, or, better, never 
notice — nine-tenths of the sounds we hear. We have so trained ourselves. We 
could easily hear our hearts if we encouraged ourselves to listen for them. 



CHAPTEK XXVil 

Headaches 

The most helpful statement about headaches that I can make is that 
one should not take coal tar headache cures. They are effective in just two 
varieties of headaches. They give relief in bilious headaches — headaches due 
to overeating or improper eating, and headaches due to constipation. But for 
this variety of headache there is a better remedy. A full dose of purgative 
taken on an empty stomach will act more quickly and better. 

The source of poisoning having been removed, a short period of mental 
rest will restore mental balance. The disadvantage of using headache powders 
in this group of headaches is twofold. It begets the headache habit. Coal 
tar headache remedies change the blood so as to produce headache. By fre- 
quently taking headache medicine one can easily double the number of his 
headaches in a month. 

The second disadvantage is that the use of coal tar headache remedies 
makes one forget that the essential thing to do is to eat less, exercise more, 
and attend to his elimination. 

The other group of headaches relieved by coal tar remedies are those 
due to fever, sore throat, and infections generally. It is not safe to allow 
headache from that source to run long without medical attention. The 
danger is that the infection may be with an organism capable of doing great 
harm. Certain quite serious disorders begin with headache. 

Another reason why headache powders should not be used habitually is 
that the habit leads people to overlook important causes. Bright' s disease and 
arteriosclerosis are grave but subtle conditions. It is important to know 
of them early; yet when they knock at our doors they do not bang. There 
is no brass hammer business. They tap very, very gently, and, half awake, we 
dream the sound to be of another nature, or we miss it entirely. 

A persistent or frequently recurring headache may be the form taken 
by the gentle tapping. Anything which makes us overlook the cause of the 
tapping may harm us. 

The habit may cause us to overlook the condition of the eyes. Of all the 
causes of headache, eye strain is said to be the most frequent. I do not think 
so. I think that if we could get a headache census we should find that bilious- 
ness-overeating-constipation was the most frequent cause. Nevertheless eye 
strain is a very important cause of headache. People who dismiss their 
headaches from consideration by swallowing a tablet or a powder are liable to 
suffer their neglect of their eyes to continue. 

There are other causes which may be overlooked when the custom 
is to take one or more doses of headache medicine and to let it go at that. 
That the pain does not get better after the medicine has been taken makes 
no great difference. 

443 



444 HEADACHES 

The two thoughts which should stand out are these: When one has the 
headache habit he should know the reason why; and the use of headache 
medicine does harm in several ways, among others by multiplying the spells. 



FOUR KINDS OF HEADACHES 

Any sensation of any sort anywhere inside or outside the skull or within 
a few inches of the skull is liable to be called a headache. Worse still, not 
content to throw all disagreeable sensations of the head into one bag labeled 
headache, we have one remedy for headache — a coal tar headache cure. And 
worse still, though this remedy may give temporary ease, it causes more head- 
aches than it cures. Though this coal tar cure be called anti-this or anti- 
that, or by one or another copyrighted name, essentially the medicine is the 
same. 

There are a dozen kinds of headaches, and what is proper for one is not 
proper for another. Then where is the sense in having one headache remedy 
for everybody that has headache and for every kind of a headache ? 

In an annual address before the Iowa Medical Society Dr. Patrick told 
his audience of some things that he had observed about four kinds of head- 
aches. 

If a headache be due to rheumatism, it is necessary, first, that it be 
recognized as such. The cause of rheumatism is pus infection from some 
source of infection. As in all other forms of rheumatism, the source of 
infection must be found and remedied. For relief, nothing is better than 
massage, heat locally, and aspirin internally. 

The second form of headache discussed by Dr. Patrick was that from 
sinus trouble. The pain from sinus headache is not especially liable to be 
located near the sinus. In cases of sinus headache there is very apt to be a 
little fever — a half a degree or so at some time during the day. A good 
nose specialist can locate sinus trouble, and a blood examination shows some 
increase in the white cells during the spell. 

Sinus headache is helped by steaming the nose or soaking the face in 
hot water. When the offending sinus is cleaned out, the headache gets well. 

The third variety discussed is the neurasthenic headache. The headache 
of neurasthenia is not a pain; it is an unpleasant feeling of pressure. This 
sensation is liable to be geometric — a band, a circle, a point, a streak, a square, 
or a parallelogram. When the pain is described in this way or emotion is a 
factor, Dr. Patrick told the physicians that the headache is neurasthenic and 
must be treated on that basis. 

Much the most important of the four varieties of headache discussed was 
migraine. This form of headache runs in families. It attacks women more 
often than it does men. It begins in childhood, increases in frequency and 
severity until the age of forty-five or fifty, and then lessens. 

Migraine headaches go by a dozen names — sick headache, constipation 
headache, menstruation headache, neuralgic headache, nervous headache, gouty 
headache — all forms of migraine. 

The prime necessity of treatment is to search out and remove every custom 
which can be classed as wrong living; to change the eating habits, especially 



HEADACHE PREVENTION METHOD 445 

if there is a tendency to overeat; to exercise vigorously in the open air; to 
correct constipation; to search out and remove all sources of ill health such 
as "pelvic pathology and pressure from a deflected septum, enteroptosis and 
eye strain, constipation and overwork, excessive menstruation and loss of 
sleep, excess of alcohol or tobacco, insufficient food, anemia and domestic 
discord." 

While proper attention to such of the above as may need attention in a 
given case may not entirely prevent attacks of migraine, the attacks will be 
less frequent and lighter. It is just in these headaches that coal tar headache 
powders and tablets are most used. The great objection to their use is that 
they increase the frequency of the headaches. 



HEADACHE PREVENTION METHOD 

In many people great activity in the large intestine, particularly in the 
colon above the rectum, is accompanied by irritation of the nose. To be more 
specific, for a short time preceding a copious bowel movement, particularly 
if there is some griping and pain, sneezing will be frequent, and the nose 
will discharge water freely. 

This is especially noted, as stated above, when there is considerable ab- 
dominal discomfort. It has been suggested that a pinch of snuff or a whiff 
of ammonia be used 'as a laxative in lieu of salts and oil by the stomach. 

It has been noted that women who suffer from painful menstruation 
and monthly headaches are benefited and ofttimes cured by burning the nose. 

Separating the nostrils from each other is a partition called the septum. 
On the outer wall of each nostril are three bony ridges called the turbinate 
bones. It has been found that there is a nerve connection between the uterus, 
the breast, the brain, and the nose. 

At the time of menstruation physicians have noted a swelling of the 
membrane over this septum and over the lowest one of these ridges, called the 
inferior turbinate. 

They have gone farther than that. They have prevented monthly 
headaches and painful menstruation by burning these areas two or three times 
during the month with trichloracetic acid. 

In the Journal of the American Medical Association there is a report 
of 93 cases, and in Surgery, Gynecology, and Obstetrics there is a further 
report of cases treated in this way. Most of the reports on the subject come 
from Germany. 

An able German authority, E dinger, says that the most frequent form 
of headache is one where there is tenderness at certain points on the scalp. 
An important part of this theory is that massage of the scalp over the tender 
points relieves this pain. 

The areas of soreness are as follows: An area one inch square one 
inch above the inner end of the eyebrow; an area one-half an inch wide 
and beginning one inch above the outer end of the eyebrow and running to a 
point one inch above and just behind the ear; the top of the head directly 
above the ears; the back of the head directly behind the ears, beginning two 
inches back, where the back of the neck joins the back of the head; along 



446 HEADACHES 

the sides of the backbone in the neck; along the spines of the backbone in 
the neck. 



HEADACHE MEDICINES 

The powders, tablets, and capsules so frequently taken for headache induce 
drug habits. He who takes them is a drug fiend. He may not relish the 
association, but he belongs with the "coke" fiend, the morphin "dope" and 
the whisky "soak." 

When, in the '80's, this group of remedies began to appear, the medical 
profession quickly saw their usefulness in relieving aches and pains. Before 
many years it was seen that they led to habits, whereupon the medical pro- 
fession became much more careful in using them. 

However, in the meanwhile the people had learned by experience that 
they would relieve headaches and the aches of colds and fevers. In consequence 
the use of them at least holds its own, and possibly increases. 

Occasionally a large dose of "headache" medicine kills suddenly by over- 
whelming vital nerve centers, but these cases are so infrequent as not to be 
the principal reason for not using the drugs. 

The main reason for not using them is that they harm the blood cells 
in such a way that they cannot properly carry oxygen to the cells of the body, 
nor can they carry away body wastes — just as if a man were marooned in a 
house with the grocery wagon only able to get to him twice a week, and the 
garbage wagon twice a month. 

The result is that his tissues are poisoned and starved — but more poisoned 
than starved. He gets flabby and soft — suboxidized — physically and mentally. 
Instead of a head-ache once a month he now has one a week. Instead of being 
cured by a small dose of "headache" medicine, he now needs a large dose. 

The more he takes the more "stippled" are his red blood cells, the more 
his nerve cells cry out in pain. 

This is the kind of habit and the reason for the habit known as the head- 
ache medicine habit. It differs in many ways from the "coke" or "dope" 
habit. It is a habit which affects the individual solely. It has no social 
relations. 

The alcohol fiend may shoot up the town, and the morphin fiend may 
steal to get his drug. The headache medicine fiend has no disposition to bother 
anybody. 

A man is frequently justified in taking a dose of such medicine for the 
relief of a headache, but the circumstances must be exceptional. Whenever 
they become regular the man had better by far go after the underlying cause, 
or rely on purges, or bear his suffering, or all combined. 

He must fight it out some time, and he had better fight it out while the 
water is shallow. To take headache medicine and let it go at that is con- 
stantly drifting him toward water over his head. 

Sick Headache. — W. A. B. writes: "What is the cause of chronic sick 
headache? I have an attach of sick headache on an average of once a week, 
at which times I suffer excruciating pain through the eyes, temples, and 
back of the head and neck. These attacks are accompanied by violent 



HEADACHE MEDICINES 447 

vomiting and usually last from five to eight hours. They are sometimes 
brought on by an extra effort in the way of physical exercise or manual 
labor and I have suffered with the ailment since* childhood" 

Reply. — Such headaches, termed migraine, are closely related to gout. 
To eat less and exercise in the open air more increases the interval be- 
tween them. They are many times more abundant among inside people 
than among out of doors workers. A good cleaning out brings relief. An 
attack comes when clogging has recurred. With these facts in mind know- 
ing what to do is easy. Doing it. is hard. One of the advantages of old 
age is that gouty headaches have quit. Somewhere about fifty they 
seem to say to themselves : "I cannot teach this fellow to live in the open 
and eat less. I think I shall quit trying." Whereupon the man becomes 
less and less subject to sick headache. 

Cause of Sick Headache. — M. S. M. writes: "What causes sick head- 
ache and what is the best remedy?" 
Reply. — Sick headache is due to : 

1. Nerve tire. 

2. Condition of poisoning from chemical substances manufactured 
by the body or manufactured in the body. 

3. Eye strain. 

Some cases are due to one of these alone. Most of them are due to sev- 
eral combined. 

Remedy : 

For those cases due to nerve tire — rest. 

For those due to eye strain — eye rest, including proper glasses. 

For those due to what is called intoxications, gout, biliousness, and the 
like — a laxative and, sometimes, some of the coal tar headache medicines. 
It has been demonstrated that the promiscuous use of these increases the 
frequency of gouty headaches, though they give temporary relief. 

Headaches from Stomach. — J. C. F. writes: "I am 50, and at 30 got 

my first headache. Headaches come once or twice every month. I took 
great care of my stomach and for years warded off the headaches. Five 
years ago I got it daily. My sight is good, my meals regular, also my sleep. 
What course should J adopt?" 

Reply. — The important causes of headaches are: 

1. Eye strain. 

2. Migraine. 

3. Mental strain. 

If your eyes have been competently examined, your case is limited to 
one of two groups of causes, in all probability. You may be working your 
brain or worrying too much. In that event you should have more mental 
rest. Probably you have migraine. If so, as you get older your head- 
aches will get less. 

Have your eyes examined again. Cut down the quantity of your eat- 
ing; fletcherize; double your physical exercise; do less brain work. This 
is as much as I can suggest. 

Migraine. — K. C. H. writes: "What is migraine and how can it be 
cured? Is it not a new disease and is it not on the increase?" 

Reply. — Migraine is a gouty headache. Inheritance is a large factor. 
It runs in families. After forty attacks come with less frequency and 



448 HEADACHES 

they usually stop soon after fifty. Attacks can be relieved by purges, 
and mental and physical rest. Headache medicine gives some relief, but 
the average woman is better off without it, particularly if she has to "lie 
up" with it. It is not a new disease; people have always suffered with it. 

Suffers from Migraine. — J. T. N. writes: "What is the cause of sick 
headache? I have an attack of sick headache about twice a month. I have 
pain through the eyes, temples, and back of the head and neck. These at- 
tacks are accompanied by violent vomiting. What are the symptoms of 
gouty headache? Will inflammatory rheumatism cause headaches?" 

Reply. — You have what is commonly known as migraine. By keeping 
your bowels regular, eating lightly, exercising in the open air, and avoiding 
worry, you will reduce your spells somewhat. You will get some relief 
during spells from purges. However, migraine gets to be a habit. It 
usually lasts until past middle life, getting better as age comes on. It runs 
in families. 

Treatment for Migraine. — D. W. writes: "What is migraine? How 
can it be cured or relieved?" 

Reply. — Migraine is the name given to sick headache. It is one of the 
features of what is sometimes called biliousness. Commonly, there is a 
period of heavy logishness out of which a headache gradually develops. 
The headache may be attended by nausea and dizziness. Following it the 
mind is bright. It is something like the air after a storm. 

A migraine tendency is inherited. The periodical attacks generally stop 
coming after the sufferer has reached fifty. 

To give relief nothing equals purgatives, particularly salines, rest in 
bed, and, in some cases, headache remedies. To prevent attacks the free use 
of water, temperance in eating, and a simple life in the open air constitute 
about all that can be done. 

Not a Headache Preventive. — N. L. writes: "Will the juice of a whole 
lemon and one-half a spoonful of table salt in a glass of hot or cold water 
ward off a headache if drunk before breakfast?" 

Reply. — No. The salt will act as a mild saline laxative. There is the 
same objection to it that there is to any other saline laxative as a daily 
dose. A lemon, lime, or orange each morning is almost a necessity until 
the spring fruits and vegetables come in. 

Has Harmful Effect. — M. B. writes: "Will you please tell me what 
effect a continued use of a coal tar product for headaches, etc., will have 
on the heart if it is used in small quantities?" 

Reply. — Such use is moderately harmful to the heart. It is much more 
harmful in that it produces changes in the blood. Among other effects 
produced by these blood changes are headaches. Headache medicines, long 
continued, produce headaches. 

Forbidden by Law. — Inquirer writes that a headache remedy is being 
distributed on premises and sometimes is placed in mail boxes. Is the 
remedy liable to do harm? Is it against the law to distribute medicine in 
this way? 

Reply. — Headache remedies are generally composed of coal tar deriva- 
tives. They are moderately poisonous. A full dose for a grown person is 
a highly poisonous dose for a small child. 



HEADACHE MEDICINES 449 

The Legal Friend of the People in the Tribune informs us that to 
distribute such medicine is against the law in Chicago. The fine is from 
$5 to $50. The ordinance violated is found in Ch. 22, Art. IV, No. 811. 

Where many mail boxes are found supplied with original packages, 
there is a fair chance that the courts would hold that the company is 
responsible, even if the distributor was not apprehended. 

Dizziness. — J. B. writes: "What is it that causes one to become dizzy 
directly after taking the first mouthful of food at dinner, the dizziness dis- 
appearing at the second or third mouthful?" 

Reply. — Dizziness always calls for investigation and change in one's 
habits somewhere. There are many causes of dizziness, but no one who 
gets dizzy frequently is normal. Find out, as the result of proper tests 
and examinations by your physician, why you are dizzy frequently, and 
change whatever it is necessary for you to change, since to allow frequent 
dizziness to continue is unwise. The relation to the first mouthful of food 
as compared with other mouthfuls is of no consequence. 

Paraffin and Headache. — A. R. C. writes: "Can you explain the use of 
paraffin oil? Also the benefits derived from it? Is there any danger if it 
is bought from a reliable druggist? Would you advise the use of it for 
headache? What is self-infection, and its cure? Is it similar to auto- 
intoxication?" 

Reply. — 1. Paraffin oil is not absorbed from the intestines. The theory 
is that it acts as a lubricant. In crude oil there are substances which ab- 
sorb, and some cases of harm have been reported. 

2. So much depends on who is using the word reliable. So much has 
been written on the subject of pure and impure paraffin oil that every 
druggist has had it brought to his attention. The high grade ones should 
have gone to some trouble to get a properly refined article. Buy from the 
most dependable known to you. 

3. If the headache were due to constipation, yes. 

4. I do not know just what you mean by self-infection. I presume auto- 
intoxication is synonymous. However, the answer would depend upon the 
connection in which the term was used. 

Too Much Aspirin Harmful. — J. R. S. writes : "A friend of mine uses 
aspirin tablets. At first she used them for headaches; now she uses them 
whenever she thinks she is going to have one. I have known her to take 
a dozen in one day. The question is: Aren't they dangerous when one 
takes as many as that? Does not a person acquire a Haste' for them the 
same as one would morphin? Doesn't the constant use of them endanger 
health?'* 

Reply. — Aspirin as a habit producer is not in the class with morphin; 
but you can be certain that anybody who takes a dozen aspirin tablets a 
day is being harmed by them. Anybody who takes any headache medicine 
systematically and regularly is being harmed by it. 



CHAPTER XXVIII 

Foods 

Foods are divided into two classes — organic and inorganic. Organic 
foods are divided into proteids, fats, and carbohydrates. Proteids are the tissue 
formers and are found in both animal and vegetable food substances. Fats 
are the heat producers and are also found in the animal and vegetable foods. 
Carbohydrates are the energy or work producers and are almost entirely ob- 
tained from the vegetable world. 

The common forms of the first class — the proteids — are lean meat, eggs, 
milk, cheese, peas, beans, and cereals; of the second class — the fats — butter, 
fat meat, bacon, lard, olive oil, cream, chocolate, and certain nuts ; of the third 
class — the carbohydrates — potatoes, rice, cornstarch, arrowroot, many grains 
like wheat and oats, the sugars (cane, beet, and milk), maple syrup, molasses, 
honey. 

The main inorganic foods are water and common salt. 

It is a common belief, borne out by results of a large amount of experi- 
mental investigation, that Americans use more food than people of Europe 
of the same class. The dietary of the working people of America contains more 
meat than that of the toilers of European and Asiatic countries. 

The reason is that meat is more expensive in those lands than in America. 
Fats occur in smaller, and carbohydrates in larger, quantities in European 
dietaries than in American. 

Cold storage has changed the dietary habits in some parts of this country. 
Formerly, in the north, people were limited to cabbage, potatoes, onions and 
a few other root crops in the winter and to eggs and salt meats during the 
summer. 

Circumstances determine the food of an individual or family to a great 
extent. Statistics show that we Americans are on the whole overfed rather 
than underfed. 

Langworthy says : "Animal and vegetable foods are about equal as sources 
of protein, some 48 per cent, of the total being supplied by animal foods and 
some 52 per cent, by vegetable foods, of which 43 per cent, is contributed by 
the cereals. Little fat is furnished by vegetable foods, the group as a whole 
supplying only 11 per cent, of the total amount in the diet. 

"Animal foods and dairy products are the most important sources of 
fat, milk and cream furnishing 26 per cent, of the total fat of the diet and 
meat as a whole furnishing a little over twice as much as is supplied by all 
other animal foods. Of the different meats, pork is the most important 
source of fat. 

"Meats and poultry together furnish about twice as much protein as the 
other animal foods, and of the different meats, beef and veal together furnish 
about half of the total amount supplied by the entire group." 

450 



BEEAD 



451 



. .. Com position. Functions. And Uses Of Food 



U.S. Department of Apiculture Prepared by 

Office of Experiment Stations C. F LANGWORTHY 

A.C.True, Director Expert in charge of Nutrition Invesiigatiofls 

FUNCTIONS AND USES OF FOOD. 
CONSTITUENTS OF FOOD. 



FOOD AS PUR- 
CHASED CONTAINS 



Water 



EDIBLE PORTION 
Flesh of meat, yolk Nutrients 
and white of eggs, 
wheat flour, etc. 
REFUSE 
Bones, entrails, 
shells, bran, etc. 

USE OF FOOD IN THE BODY. 



PROTEIN Builds and repairs tissue 

White (albumen) of eggs, 

curd (casein) of milk, 

lean meat.gluten of wheat.etc, 



Protein 
Fats 

Carbohydrates 
Mineral Matter Or Ash 



FATS Are stored as fat 

Fat of meat, butter, 

olive oil. oils of corn 

and wheat.etc. 
CARBOHYDRATES— -Are transformed into fat 

Sugar, starch, etc. 
MINERAL MATTER OR ASH— Share in forming bone. 

Phosphates of lime. assists in digestion, etc. 

potash, soda. etc 



All serve as fuel to 
yield energy inthe forms 
of heat and muscular 
power 



Food is that which, taken into the body, builds tissue or yields energy. 



Fig. 163. 



BREAD 



That bread is "the staff of life" is an old saying hardly subject to contra- 
diction. Everybody eats bread. It is more abundantly used than any other 
article of food. 

Bread is made of flour ground either from wheat, buckwheat, barley, rye, 



452 



FOODS 



Bread and other Cereal Foods. 



U.SDepartment of Agriculture 

Office cf Experiment Stations 

A.C.True: Director 



FVepared by 

CrTLANGWOFrmY 

Expert in Charge of Nutrition Investigations 

COMPOSITION OF FOOD MATERIALS. 

WHOLE WHEAT BREAD 



amn 

Proton Fat 

WHITE BREAD 



Carbohydrates 



Ash 



Fat: 1.3 



Askil 



mmxm 




m 



Carbo- 
•':S : .v>'-T-V';:^V.;-v h^drjtgs: 53.1 



Wat^n 35.3 
Protein : 9.2 



Ssg5snaSmmSB«/ ' 



Fuel value- 



OAT 
BREAKFAST FOOD 




1215 calories Water- rU 
PER POUND WJKSL. 



TOASTED BREAD 



Fuel value- 

■ 

1 1 40 CALORIES 
PER POUND 

hydrates: 11.5 
CORN BREAD 



FAfU 




Fig. 164. 

or corn. Enough water is added to the flour to make a uniform dough, after 
which it is kneaded, either by hand or machinery. A pound of bread is com- 
posed of three-quarters of a pound of flour and one-quarter of a pound of water. 
To this is added enough yeast to excite a fermentative process. 

As a result of the fermentative process starch is converted into alcohol, 
carbonic acid, and water. Just enough salt is added to the bread to give it a 
pleasant, wholesome taste. 



BEEAD 



453 



Cereal drains. 



ULSOepartment of Agriculture 

Office of Experiment Stations 

A.C.Truej Director 



Rrepared by 

C.rTLANGWORTHY 

Expert in Charge of Nutrition Investigations 



COMPOSITION OF FOOD MATERIALS. 

rmrn 



Fat 



CORN 



Fat: 4. 



Ash:! 




mm ^s mm 

Water 

Water: 10. 
FVotein:12 



Carbohydrate* Ash 

ater:10.8 
in: 10.0 



Fuel Value 

i- Sain. Equals 

1000 Cajories 



WHEAT 



rates: 73A Carbohydrates: 




at: 1.7 



sh:1.8 



BUCKWHEAT 

1800 calories r^tein.-10.0^D£-Water: 12.6 1750 calories 

pcr pound •Carb J D^-~W?vXFat:2.2 p^ pound 

hydrates: 73.2 ^^Ush: 2.0 

F uel valu e 

OAT RICK 

ater: 11.0 1 600 calories Water: 12J 



Fat: 5, 



Ash; 3 




otein.H.8 



PER POUND 



Carbo- 
hydrates: 69.2 



Fuel 



Fat:1. 



VALUE 



Carbo- W<& 

hydrates:73.9 W-Ash: 1.9 

1720 CALORIES F UEL VALUE: 

PER POUND ^mu> 



1750 CALORIES 
PER POUND 




at:2£> 



sh:1.0 



1720 CALORIES 
PER POUND 



Fig. 165. 

The object of baking is to kill the yeast germ and arrest fermentation. 
The art of baking bread is all important, since it has much to do with 
whether the bread is heavy or soggy and whether it is sour. When the baking 
process leaves the bread in this state it has not been scientifically done, as the 
germ of fermentation is still active. 

Where bread is made from wheat flour it is usually referred to as white, 
gluten, graham, whole wheat, and bran bread, the name being derived from 
the particular kind of flour from which the bread is made. 



454 FOODS 

Of these, the white is higher in nutritive value, hut it may not he- so 
wholesome, as it is less bulky, contains less roughening, and hence is more 
constipating. 

Graham and whole wheat breads are supposed to be made from flour 
which contains all of the constituents of the original grain in their same 
proportions. In many cases, however, the graham and whole wheat flours have 
been but partially bolted. 

Bread is a mixed food, containing many classes of ingredients — fat, salts, 
sugar, protein, and starch. While it contains fat, it does not contain enough 
to make it a perfect food, which probably explains in part the reason why 
people eat butter with their bread. 

Bread does not seem to tire the appetite. No hetter explanation, perhaps, 
could he given for its common consumption than this fact. 

The free use of hot hread is usually tabooed by hygienists for several 
reasons. Hot rolls, for instance, are not thoroughly chewed before swallowing, 
and are, therefore, not properly mixed with the digestive juices. There may 
be too great a quantity eaten, because of greater palatahility. Accordingly, 
the habit of eating stale bread instead of fresh should be encouraged. 

White bread usually is purer than the brown breads, because it is easier 
to adulterate the brown breads than the white. White bread, however, may 
be adulterated with chalk, gypsum, pipe clay, and similar articles. 

The addition of a mineral acid to bread containing these adulterants 
produces an effervescence when it comes in contact with the carbonates used 
as such adulterants. 

A man cannot keep in condition on a diet of bread alone. At the same 
time he would come nearer succeeding than on a diet of only meat, olive oil, 
milk or any other food article. It comes nearer meeting all the requirements 
than any of them. Some have the idea that milk is a complete diet. It is for 
a baby under six months of age, but after that, no. On the other hand, 
every race and, for that matter, every individual, builds the menu around 
bread. 

Bread is out of balance in that the percentage of starch is too high. 
Protein, fats and salts are too low. There is not enough roughage to prevent 
constipation. Bread which contains a high percentage of bran comes nearer 
being balanced than one that is freer. Second-day bread is somewhat more 
nutritious than fresh bread. Bread crust is more easily digested than the 
center of the loaf. 

Fat people should eat little bread. Diabetics should eat still less. 

Let us end by changing the quotation with which the first paragraph 
began. Let it read — Bread is a staff of life. To make it the staff of life 
causes ill health. 

Sanitation in Bakeries. — Two reasons for sanitation in bakeries exist. 
The first is that the bread may be wholesome ; the second, that the bakers may 
keep in good health. 

People buy bread because it is a wholesome, nutritious, easily digested, 
economic food. They are willing to use bread made outside their own kitchens 
when they are satisfied that the process of making is carried on under condi- 
tions about as good as those prevailing in their own kitchens under their own 
eyes. The cordwood way of distributing bread — stacked up in a fly-abounding 



MEAT 455 

salesroom, stacked up in an open wagon, stacked up on the arm of a delivery 
boy, stacked up on the floor of the back porch until someone takes it in — 
prevents many a woman from buying bakery bread. 

Miss Howell, one of Professor Jordan's students at the University of 
Chicago, made a study of bread purchased from shops in different parts of 
Chicago. She found wrapped bread much cleaner than unwrapped. Of the 
unwrapped specimens 39 per cent were classed as dirty (bacterial average 
14,000, maximum 120,000) ; 39 per cent as fair (bacterial average 4,000, 
maximum 20,000) ; 22 per cent clean (bacterial average 2,500, maximum 
14,000). 

Of the wrapped bread 45 per cent was fair (bacterial average 848, 
maximum 3,000), 55 per cent clean (bacterial average 371, maximum 2,200). 
She found that a few of these bacteria, though but few, were possible disease 
producers. A larger number, while not capable of producing disease, indi- 
cated practices that the consumer does not like to think about in the midst 
of his meal. 

She thinks there is some possibility that the germs of consumption 
and typhoid, when present in the dough, can survive the baking temperature 
and exist in the bread capable of causing disease. The proof of this point 
is not satisfying. The proof that germs, and especially tubercle and typhoid 
bacilli, get on bread after it has been cooked and can spread disease is good. 

The principal reason for bakery sanitation, however, is conservation of 
the health of the bakers. Bakeries in operation are always too warm. It is 
not possible to ventilate them perfectly. The bakery air usually contains a 
good deal of dust. It is difficult to keep the premises clean. Much of the 
work is done at night. The work is uneven. The mixing and doughing time 
is one of fast, hard work. Then come several hours with little to do — when 
the sponge is rising. This is followed by the hot, trying work of baking. 
This distribution of work is responsible for much use of the bakery as a 
sleeping place. 

All in all, the work of baking puts such a strain on the vitality of the 
baker that he cannot keep in health unless the bakeshop conforms to sensible 
requirements as to light, ventilation, temperature, humidity, cleanliness, and 
toilet facilities. 

MEAT 

We are great meat eaters in this part of the world. In spite of everything 
that will be said, in spite of the prices that will prevail, we shall continue 
to be heavy meat eaters. However, we should take the trouble to be dis- 
criminating meat eaters, and that we are not now. 

About one-third of the cost of food for an American family is spent for 
meat, and yet we blindly order one of a small number of cuts and leave the 
balance of the animal in little demand. 

Hall and Emmett of the University of Illinois (Illinois State Bulletin 
No. 158) say that one-quarter of the weight of the carcass (loins and ribs) 
sells for one-half of the total selling price of the carcass. In other words, 
the failure of the people to buy other parts just about doubles the price of 
porterhouse and sirloin. 



456 



FOODS 



Meat Fresh and Cured. 



U.SDepartment of Agriculture 

Office of Experiment Stations 

A.C.True: Director 



Prepared by 

C.rTLANGWOR"mY 

Expert in Charge of Nutrition investigations 



COMPOSITION OF FOOD MATERIALS. 



(rrrm 

Protein 



Fat 



C art) o h yd rate* 



Ash 



umiD 

Water 



Fuel Value 

iMSah.Equab 

1000 Calories 



LAMB CHOP 

EDIBLE PORTION 



PORK CHOP 

PORTION 




154-0'CALORIES 

PER POUND 



BEEF STEAK 

EDIBLE PORTION 



1940 CALORICS 

PER POUND 



DRIED BEEr 

EDIBLE PORTION 

Pr-otein:3P.O 




Fuel I 1 1130 calories 
value! per pound 



Fuel 
value. 



84-0 calorics 

per pound 



Fig. 166. 



The "tastier" portions of the meat are those in the neighborhood of bones. 
The great health need is for greater consumption of fiber, skin, and tendon, 
and yet the premium is put upon muscle fiber — the portion which does not 
become "tasty" and individual in flavor until a skillful cook seasons it with 
substances to give it savor. 

Hall and Emmett had a set of animals slaughtered under their eyes. 
They then cut the carcasses according to the approved lines of division. They 



MEAT 



457 



ftftu* 




L Neck. 

2. Chuck. 

3. Ribs. 

4. Shoulder clod. 

5. Fore shank. 
Brisket. 
Cross ribs. 
Plate. 
Navel. 

10. Loin. 
Flank. 

12. Rump. 

13. Round. 

14. Second cut round 

15. Hind shank. 



Farmers' Bulletin, 34, U. S. Dept. of Agriculture. 

Fig. 167. — Diagram of Cuts of Beef. 

next determined the amount of lean, fat, and waste per pound in every eut. 
From this, using the retail market price of the different cuts, they esti- 
mated the cost per pound of nutritious elements in each cut. They found 
that when a woman buys porterhouse hip bone at 25 cents she pays 29 cents 
for the usable food purchased. At the other end of the line was hind shank, 
middle cut (soup bone), selling at 5 cents and worth 6.3 cents. In between 
came porterhouse, regular price 25 cents, cost 27.2 cents; sirloin (round 



458 



FOODS 



bone), 20 cents, cost 21.1 cents; round steak (first cut), 15 cents, cost 15.3 
cents; roast beef (rump), 12 cents, cost 12.8 cents, and round pot roast, 10 
cents, cost 10.1 cents. 

On the whole, the data clearly show that the cheaper cuts of beef are by 
far the most economical sources both of lean and of fat. Not only did they 
find that the food value is not in relation to price, but that there is no rela- 
tion between flavor and cost. Furthermore, cooking tests showed that waste 
and shrinkage are not necessarily greater in the cheaper cuts. 

In buying for the lean, the neck, shanks, and clods head the list, and 
rump, rib, and loin bring up in the rear from the standpoint of fuel value. 
The flank, plate, neck, and shank are cheapest at the price, and rib, loin, and 




1. Head. 

2. Shoulder. 

3. Back. 

4. Middle cut. 
6. Belly. 

6. Ham. 

7. Ribs. 

8. Loin. 



Farmers' Bulletin, 34, U. S. Dept. of Agriculture. 

Fig. 168. — Diagram of Cuts of Pork. 



roast are the most expensive. From the standpoint of all combined, clod, 
chuck, and plate hold the head of the list. 

Too Much Meat. — In von Noorden's interesting paper before the Inter- 
national Congress on Hygiene he had much to say about the use of meat. 
In gouty people he did not think dieting was of the importance held by most 
people. He agrees with Chittenden that brain workers do not need the large 
amounts of meat taken by the average office man and that the excess throws 
a strain on his organs. 

In gout if the disease is well developed the person should go on a vege- 
tarian diet until he is better. He should at all times keep away from foods 
rich in purin bodies. 

A meat that has much flavor, speaking generally, contains a good deal 
of purin bodies. The fat tasting proteids, such as milk, eggs, and boiled beef, 
are good. The extremely juicy steaks, the chops, roasts, ribs, backbone, and 



MEAT 



459 



the rich soups are bad. Other foods rich in purin bodies are coffee, choco- 
late, tea, halibut, and salmon. Beef extract and beef tea lead the list of the 
bad foods. 

In fevers, meats are poorly borne. It is not so much the digestion 
in fevers, for digestion of meat may be highly satisfactory, but it makes 
the fever higher. 

In goiter, meat is badly borne, especially in those who are losing flesh. 
There is a very close connection between digestive trouble and goiter. Some 




1. Neck. 

2. Chuck. 

3. Shoulder. 

4. Flank. 

5. Loin. 

6. Leg. 



Farmers' Bulletin, 34, U. S. Dept. of Agriculture. 

Fig. 169. — Diagram of Cuts of Lamb and Mutton. 




people with enlarged thyroids do well when their digestion is good and do 
poorly when it is bad. 

In addition to that von Noorden finds meat eating to be bad for the goiter 
itself and bad for the general nervous system of the subject. This means 
that the person with a goiter who is nervous thereby, who is losing flesh, and 
whose pulse is rapid and irritable should eat some meat but not much. 

In certain cases of chronic constipation the subject complains of pains 
in certain nerve areas. These pains are so troublesome that the doctors often 
call it gout or rheumatism. Hot baths, electricity, and drugs do no good. 

Von Noorden says the condition is a toxic neuritis. This means that 
the sore nerves are poisoned. The poison is generated in the large intestine. 
"The neuritis disappears with astonishing rapidity when the abnormal 
intestinal decompositions are stopped." 

In certain of these cases he has got cures by stopping all meats for weeks 
and giving large quantities of milk, and, better still, soured milk or yogurt. 

At first there is a great deal of indican in the urine. After a while 



460 



FOODS 



this disappears from the urine. After some weeks or months these patients 
can begin eating meat if they wish. 

The old Mosaic law prohibited people from eating meat and milk to- 
gether. Yon Noorden thinks the discoveries of the last few years justify 
the prohibition. 




1. Neck. 


6. Ribs. 


2. Chuck. 


7. Loin. 


3. Shoulder. 


8. Flank. 


4, Fore shank. 


9. Leg. 


6. Breast. 


10. Hind shank. 




Farmers 1 Bulletin, 34, U. S. Dept. of Agriculture. 

Fig. 170. — Diagram of Cuts of Veal. 



In fact, he believes generally in eating one kind of a food at a time. 



He cannot see anything in favor of a heavy feed of mixed food from 
to nuts." 

FROZEN CHICKENS 



soup 



Ellis says those people who have nightmares about what will happen 
when socialism comes forget that socialism has been here a long, long time. 
He asks who would be an individualist as to his water supply. 

The chicken industry is only partly brought under socialism. Some 
people raise their own chickens. Such can and should eat fresh chicken, but, 
unless a man can see the killing and cleaning, he had better stick to frozen 
chicken. 

But the balance of us are under socialism or collectivism so far as the 
chicken industry is concerned. The city man who is not in a position to 
see the killing and cleaning of the chickens offered him should insist upon 
getting not only a chicken which has been frozen but one that is frozen at 
the time" of purchase. 

Dr. Pennington has been studying market chicken for the Department 
of Agriculture. She knows more about chickens than anybody else. She 
says city people get their chickens in very poor condition. The reason is 
that the housewife goes to market and demands a fresh chicken "and she 
gets the thawed companion of the frozen bird which may have deteriorated in 



FISH AS FOOD 461 

the hands of the retailer, and will deteriorate every hour that it is in her 
possession. As usual, ignorance and prejudice conduce to the disadvantage of 
all concerned." 

This particular part of Dr. Pennington's report is in support of her 
advice to housewives in the city to buy no chicken that is not frozen at the 
time of purchase. 

A dry-picked chicken, undrawn and frozen, and kept between 30° and 40° 
for twenty-four hours after killing, and so carried to the kitchen and there 
thawed in the refrigerator, is the only city chicken that should be eaten. 
The chickens killed by chicken killers in the city constitute no exception. 
Without exception, so far as I have seen — and I have seen a great many 
chicken killing establishments — the places are filthy. 

The chickens are wet picked in hot dirty water. They are cleaned by 
unclean methods. They are thrown into wet, soggy barrels with loose ice. 
Then, ice packed, they are put on sale. 

Dr. Pennington's researches show that wet picked, ice packed, soggy 
chickens deteriorate rapidly. They may look good and they may taste good 
at the end of twenty-four hours, but they will not keep good much longer 
than that. From coop to stove in the. city is generally longer than twenty- 
four hours. When Thursday is killing day, and the kill will be on sale until 
the next Thursday, for instance, the consumer takes unwarranted chances. 
The chicken which has been killed in the country, scalded, picked, cleaned, 
packed with loose ice in barrels and thus shipped to market is still 
worse. 

Dr. Pennington studied two chickens bacteriologically. One (A) was 
dry picked, then frozen and shipped. The other (B) was wet picked, ice 
packed, and shipped. At the end of twenty-four hours A had, roughly, 
100 bacteria, B, 300; at the end of seven days, A, 300, B, 11,800; twelve days, 
A, 8,200, B, 102,000; sixteen days, A, 72,000, B, 307,000; nineteen days, A, 
328,000, B, 1,083,000. 

Demand that your market man send you an undrawn frozen chicken. Do 
not receive it unless it is frozen. Thaw it out in your own icebox. 



FISH AS FOOD 

The man who catches his fish, cleans and eats them within six hours after 
they leave the water gets a freshness and flavor that no possible treatment can 
preserve for the city man. Whether or not he has any advantage after twelve 
to twenty-four hours depends upon how well he has kept his catch from drying 
out, and what were his facilities for keeping them cold. The city man must 
eat fish that are days out of the water at the least. For him to try to get 
fresh fish, in the sense that the brookside fish eater uses the word, is, of 
course, rank folly. 

The authorities have studied the keeping of fish along the same lines as 
the keeping of poultry has been studied. One conclusion is that much of the 
trouble arises because the housewife insists on buying thaived fish believing 
that she thereby gets fresh fish. This is unfortunate, for what is sold for 
fresh fish in a city has progressed far enough in deterioration to have lost 



462 



FOODS 



the savor of freshness, and sometimes to have gained harmful or dangerous 
qualities. 

When fish are thawed out, put on sale, and then not sold, they are 

.. Fish, Fish Products, art d Oysters. 



U.S. Department of Agriculture 

Office of Experiment Stations 

A.C.True: Director 



FVepared by 

C.rTLANGWORTHY 

Expert in Charge of Nutrition Investigations 



COMPOSITION OF FOOD MATERIALS* 



HMD 

Protein 

COD 

Lean Fish 



Fert 



Carbohydrates 



ESS 

Ash 



Water 



Fuel Value 
\i. Sain. Equals 
I 1000 Calories 

SALT COD 




Fuel value. 
ater:82.6 I~""l 

325 CALORIES PER POUND 

FVotein:15.8 



Fue l val uei 

1 I Waten 53.; 

4-10 CALORIES PER POUND 

Protein:2l.5-J 



OYSTER 



at: ft Water:86. 
Carbohydrates = 3- 7 J 
Ash:12 



SMOKED HERRING 




Fat-.. 3 
Ash,£4-. 



Proteln:6.2 
Fat:1.2 
sh:2.0 




MACKEREL 

Fat Rsh 




Fuel value 



c 



Water: 34.6 235 calor.es per found Water:73. 

otein:36A FVotein:l8. 



Fuel 



Fuel value: 



m 



1355 CALORIES PER POUND 6^5 CALORIES PER POUND 




Fig. 171. 



refrozen, to be rethawed next fish day. How often this happens no one knows. 
Experiments like this are harmful to the flesh of the fish. The consumer 
reaps the result. 

How well fish will keep depends much upon how they are cleaned. Fish 



OYSTEES 463 

from cold water keep better than fish from warmer water. Fish taken while 
feeding do not keep so well as others. Fish that have been bled and drained 
keep better than others. Fish that have been handled in an insanitary place 
and in an insanitary way spoil rapidly. 

Fish that have been frozen hard keep better than fish mildly frozen — 
refrigerated fish. Mild freezing merely prevents the multiplication of the 
bacteria already in the flesh. Hard freezing crystallizes the water out of the 
flesh, and in that way dries it. Hard, frozen meat, therefore, is both too cold 
and too dry for bacterial growth, and therefore keeps extra well. 

Every fisherman — and everybody is at times a fisherman — knows how 
easily fish spoil. All sorts of fish strings, fish buckets, and fish baskets have 
been devised to keep fish the few hours between catching and camp. The 
need of having everything clean everyone knows. The hygienic standards of 
commercial fish places must come up to kitchen standards. 

Under all circumstances the consumer should demand a fish that has 
been frozen hard. He should demand that it reach the kitchen frozen. It 
should be thawed out in the kitchen refrigerator. 



OYSTERS 

Is it safe to eat oysters ? Can oysters be eaten with safety in the months 
the names of which are without E? If it is safe to eat oysters at all, can 
they be made safe enough to eat the year round? 

When oysters do harm it is because they are infected with typhoid or 
because they are spoiled. From time to time an epidemic of oyster-borne 
typhoid is reported. 

Typhoid fever is reported to health departments. Upon receiving a 
report of a case of typhoid the source of the trouble is investigated by the 
department. Sometimes the cause is found to be the drinking water, some- 
times milk, sometimes people, sometimes flies and sometimes oysters. 

The reports of oyster-borne typhoid, especially those of recent years, 
have been closely investigated. It might appear that the danger of typhoid 
from eating oysters is increasing. If so, it is because of the closer study of 
the causes of the cases of typhoid fever. Actually, the danger of oyster-borne 
typhoid is decreasing. 

Why is there any danger? Oysters grow in shallow water. They feed 
on the organic matter of the water. They feed most actively in warm weather. 
It has been the practice to float oysters, that is, to remove them from the 
growing beds and to leave them for a short time prior to marketing them in 
water different from the sea water of the beds. Floating was often done in 
badly sewage-polluted waters. The oysters were marketed in liquor, some 
part of which was raw water. The methods of icing and shipping were 
objectionable. 

The digestive apparatus of the oyster is eaten. Oysters are eaten raw. 
These are the reasons oysters convey typhoid. 

Oyster typhoid is growing less rapidly because some states are super- 
vising the oyster beds in their waters. They are not allowing sewage to be 
discharged into oyster waters. They are not permitting oyster beds within 



464 FOODS 

a certain distance of sewer outfalls nor in the course of currents of sewage. 
They are controlling the practice of floating. Shipping is now done with 
some regard to sanitary law. 

A careful purchaser can now eat raw oysters without danger of typhoid. 
The question arises : Has not the time come when it is safe or it can be made 
safe to eat oysters at all seasons of the year — in summer as well as in winter ? 
It has been found that oysters are safer from typhoid in winter than in sum- 
mer. Perhaps this is because typhoid bacilli which get into the water near 
oyster beds die off more rapidly in cold weather. Possibly it is because when 
the water is very cold the oyster closes his shell and feeds but little. 

But the difference in the typhoid content of oysters in the summer and 
winter does not equal the difference between clean oysters from clean beds and 
oysters that have been grown on polluted beds and floated in dilute sewage. 
Therefore, improvement in practices should make oysters from the typhoid 
standpoint safer in summer than they were in winter in the past. 

The fear of oysters in summer time was due to the danger from spoiled 
oysters. The methods of handling have improved so much that I can see no 
reason why the eating of oysters in summer time can not be made safe. It is 
easy to foresee the oyster industry developed on the basis of a twelve months' 
supply and demand. 

That there may be safety in eating oysters, demand as well as supply 
must have sanitary standards. The purchaser — demand — must refuse to 
purchase oysters unless they come from supervised waters, have been shipped 
in cold, clean containers, are on sale in cold, clean packages and are in good 
condition. 

EGGS 

It is not due to accident or chance or freakish fancy that eggs are in such 
general use as food. They have great food value; they are convenient; they 
are neutral in taste. When combined with fruit and bread they make a well 
balanced morning meal. Nothing else fits so well into the dress-eat-and-run 
policy so often necessary in the morning. 

Aside from the nutritive qualities that can be analyzed, there are chem- 
ical substances in eggs, the uses of which the test tube cannot tell us much 
about — certain delicate phosphorus compounds whose work seems to be to 
stimulate other substances to help. 

In order to get this effect from eggs, the consumer wants them fresh, 
with a certain delicate quality that is as baffling to analysis as are the organic 
chemical compounds. 

The physicians even go so far in their quest of this fresh effect as to 
order sick people to eat their eggs raw — a procedure that is much safer with 
eggs than with milk. 

However, to the city dweller fresh eggs seem to have disappeared. If we 
believe the advertisements, and try to make them fit the facts, we cannot escape 
the conclusion that hens are now laying eggs that are weeks old. 

Several years ago the Department of Agriculture came to the res- 
cue. It has issued three bulletins on eggs — circular 140, bulletins 141 and 
160. Its investigators have found ample reasons for the prevailing conditions. 



EGGS 



465 



The complaint of the consumer is justified. Eggs are neither as good 
nor as cheap as they ought to be. 

The complaint of the farmer and egg merchant is justified. There is 
not the money in eggs that there ought to be. 



Eggs and Cheese. 



U.S. Department of Agriculture 

Office of Experiment Stations 

A.C.Trua: Director 



R-epared by 

C.FLANGWORTHY 

Expert in Charge of Nutrition Investigations 

COMPOSITION OF FOOD MATERIALS. 

lllllll B3S8c33 tov*vl 1\\\\\\1 ITT ■ .Fuel Value 

Protein 



fat Carbohydrates 

WHOLE EGG 



Ash 



tuna 

Water 



i Sq. In. Equals 
1000 Calories 



EGG 

WHITE AND YOLK 




Water.4-9.5 
Protein.- 16.1 



FVo tein:14-.8 

Fat:10.5 
AsM.C 

FuEL VALUE OF 

WHOLE EGG: 




Water:862 



700 CALORIES 
PER POUND 



CREAM CHEE<SE 

Water.34,2 



Fuel value or yolk« 



1608 CALDRIEF 

PER pound 



Protein.- 13.0 
at: 0.2 

Sh:0.6 

Fuel value of white: 



c 



265 CALDRIES 
PER POUND 



COTTAGE CHEESE 

Water: 72.0 




Frotein:20.9 



Fuel value -. 
1950 calories per pound 



Fuel value- 

E 

510 CALORIES PER POUND 



Fig. 172. 



The reasons are several. The consumer has been shying away from cold 
storage eggs, when there is no way of marketing eggs in cities except by stor- 
age. The farmer and merchant have been losing because they have had no 
system in their business. 



±66 FOODS 

Nobody had ever studied the keeping qualities of eggs. There was no 
accurate information on the subject, and the old rule of thumb practices 
mixed a lot of foolishness in with some facts. 

The five basic principles for the producer set forth by the bulletins are: 
Give the hens clean nests; gather eggs at least once daily; keep eggs in a cool, 
dry place; market eggs at least twice a week; kill or sell all mature male birds 
as soon as the hatching season closes. Of these the last is the most important. 

The investigators found that an unheated room in a dwelling house is 
not conducive to good quality in eggs. The farmer should keep his eggs on 
ice or in a cyclone cellar. 

The storekeeper should keep his eggs in the refrigerator, or at least in 
the cellar. 

The railroad should transport eggs in a cold car. Refrigeration, at least 
partial, from the hen to the consumer is advisable with infertile eggs and 
absolutely necessary with fertile eggs. 

Fertile eggs were found to spoil almost as readily as milk. The investi- 
gators found that washing eggs does not help much. While getting rid of the 
dirt is a gain, the washing removes a protective mucilaginous coat from the 
shell and is about an equal offset. 

During the latter part of the month of March, all through the month of 
April, and until the middle of May is the natural time for hens to lay. At 
this season everybody can buy new laid eggs, for a very good reason — there 
are no other eggs to be had. The surplus of the previous year has been dis- 
posed of and all storage places are cleaned out and prepared for the new 
supply. 

The eggs are produced so fast in the spring that farmers rush them to 
market to get them out of the way and for the further reasons that they have 
more time, and in some localities there is danger that the eggs may freeze. 
The spring eggs are firmer and of better flavor than at any other season, 
because it is the natural season for laying and the hens are then grain fed. 

During the rest of the year only a limited number of newly laid eggs 
reach the general market. Some of the better groceries receive a small quan- 
tity of eggs within a day or two after they are laid, and some, indeed, have 
the date upon which they were laid stamped on the shell; but they cannot 
depend upon the shipments all the year through. 

Aside from the limited number, the fresh eggs that are offered in the 
market during most of the year are three weeks old. The farmer is at least 
a week gathering a sufficient number to make it worth while to take them to 
market. The country dealer takes another week to get enough to make a 
shipment to the city, and another week is consumed before the eggs are placed 
on sale. 

Market Classification. — In the public market eggs are divided into 
eleven different classes by the trade, and sometimes more than eleven. The 
best the market affords is called "extras," 80 per cent fresh; the second is 
called "prime firsts," 65 per cent fresh; then follow "firsts," 45 per cent 
fresh; "ordinary firsts," 30 per cent fresh. In all the grades that follow the 
word "fresh" is not used; presumably they are just eggs. They are "No. 1 
dirties," "No. 2 dirties," "seconds," "checks," "broken," and "spots." 

One would think there was nothing in the egg line worth less than a 



EGGS 467 

broken egg, but the trade has given eggs that show a decayed spot before the 
candle light the name of "spots." Lower down in the scale of infamy it is 
not possible for an egg to go and still find a place in the market 
reports. 

Flavor of Eggs. — Eggs, like milk, readily absorb odors about them. 
They should never be packed in musty straw nor in bad smelling boxes. They 
should never be allowed to get wet. Such treatment will be noticed in the 
-flavor within a few hours. 

The seasons also have an influence upon the flavor and keeping quality 
of eggs. The March and April eggs are the best and can be kept the longest. 
The October and November eggs are the next best. 

The green grass and other things that hens eat while running at large 
in the summer injure the flavor, while the summer heat debilitates the hen 
and robs the eggs of firmness and keeping quality. 

Storage. — Eggs are put into cold storage whenever there is a surplus. 
The month of April produces more eggs than any other month, hence April 
leads all other months in storage. As the April eggs are of better keeping 
quality than those of any other month, they are the best for storage purposes. 
An April storage egg is better at Christinas than an August storage egg, 
because it is of better quality to start with. Taking the market as a whole 
there are more eggs in storage about May 1 than at any other season. The 
quantity grows less each month and is exhausted in February as the spring 
supply begins to arrive. 

Less than 10 per cent of all the eggs produced go into cold storage, and 
it may be said that cold storage offers the only good way to keep eggs. 

Great care is required in storing eggs. The lofts where they are kept 
must be scrupulously clean and kept clean as well as ventilated. There must 
be no other article capable of giving off an odor stored in the same room. 

A whole roomful of eggs has been known to be tainted by the odor of 
lemons stored in an adjoining room and separated from the eggs by a brick 
wall. Eggs in cold storage will give up an odor acquired in storage when 
the source of the odor is removed. 

The temperature required is about 32° F. Under proper conditions eggs 
can be stored for ten months and come out in remarkably good condition. 
The less an egg is handled and the sooner it can go into storage after it is 
laid the better. Little change takes place in eggs in ten months of storage. 

The eggs that come out of storage wrong were wrong before they were 
put in, or perhaps an accident may have occurred in storage and an even 
temperature not been maintained. 

The popular notion that eggs are stored for two years at a time or even 
longer is an error. It is not done for the reason that the eggs would not 
keep, and it would not pay if they did keep. Cold storage of eggs has been 
blamed in other ways for sins it did not commit. The best stored eggs to be 
had in seasons of scarcity are those of cold storage. 

Country Held Eggs. — A large part of the stale eggs that find their way 
to the market are what is known to the trade as country held stock. They 
are held on the farms or at the country stores where the facilities are bad. 

There is no regular way of keeping eggs on the farm. Sometimes they 
are kept in a receptacle in a damp cellar with cabbages, onions, and other 



468 FOODS 

produce. Sometimes they are kept behind the kitchen stove or other unsuit- 
able places. In such circumstances the eggs are off in flavor in two or three 
days, and in two weeks they are stale. 

In the summer time hens steal their nests away and they are not found 
until some or all the eggs are faulty. These go to market in due season. 
These eggs, if kept in country stores in the same room with all sorts of goods, 
are still further injured. It is from such sources that a large part of the 
stale eggs come that are found in city markets. The cold storage eggs 
are good by comparison. 

There is real need for some plan that will place the new laid eggs at once 
in the cool temperature that is necessary for their preservation. There also 
is need for a campaign of education that will reach the farmers and inform 
them how eggs should be cared for and the necessity of rushing them to the 
cooler at once. Perhaps the butter and cheese factories that are scattered 
over the country could be made agencies for egg collection as well as milk 
collection. It would at least have the merit of taking the eggs away from 
the farmer every day, and as a cool room is necessary for butter, a moderate 
extension would do for the cold storage of eggs until shipped to the large 
warehouses. 

Retailing Eggs. — After eggs come out of storage and before they are 
placed in the retail market they are usually candled and graded. Candling 
is done by holding each egg before a candle or other bright light in a space 
where the diffused light of the room is excluded. Expert candlers can detect 
the changes in the eggs and grade them with wonderful accuracy. 

By this process several grades of eggs are sometimes obtained, each 
grade worth less than the other. In the retail markets two of these differ- 
ent grades may appear side by side. The patron is permitted to believe 
the best grade are new laid eggs and that the others are cold storage eggs. 
Indeed, the better grades are sometimes labeled fresh eggs, and the joke 
of it is that usually the buyer does not know the difference when the eggs 
are used. 

The average palate cannot tell the difference between a newly laid egg 
and one that may be called near fresh. This is especially true of eggs that 
are taken from the shell before they are cooked. Those who prefer to eat 
their eggs from the shell must have them newly laid, as whatever flavors the 
egg contains are all retained. Even stale eggs may be used for cooking as a 
part ingredient of a dish and give little or no offense to the taste. 

Season of Greatest Scarcity. — When hens are moulting they will not 
lay eggs, and the moulting season is in the fall. The only newly laid eggs to 
be had at this time are the products of the early spring chickens. Well con- 
ditioned pullets will lay at the age of nine months. Chickens that are hatched 
February 1 will begin laying November 1, and sometimes earlier. These are 
practically the only new laid eggs to be had in November, hence the limita- 
tions of the supply. 

In very cold weather hens do not lay, and this accounts for the short- 
age of newly laid eggs during the winter. During the season of shortage 
housekeepers should avoid eggs that have been held in the country. All 
labels on eggs in the grocery, such as "fresh country eggs," are deceptive. 
The eggs may be fresh arrivals from the country but may have been held 



CHEESE 469 

in the country for weeks and even months. Such signs should be regarded 
with suspicion. 

The best stored eggs are those of cold storage. In the lean egg season 
the buyer should ask for fresh tasting cold storage eggs. By knowing the 
history of the eggs he has for sale and after careful candling the dealer can or 
should be able to know which eggs are fresh tasting and which grade are stale 
to the taste. It may be laid down as a rule that all eggs that are held by any 
other process than cold storage will be stale to the taste. 

Cold storage eggs should be used the same day they are taken from 
storage, especially if they are to be eaten from the shell. If the eggs are 
taken from storage and allowed to lie around the grocery a few days, and a 
few days more at home, they all will taste stale. Here again the patron should 
inquire of the dealer and learn when the eggs left the cold storage. It is the 
duty of the housekeeper to know and to take advantage of all these points. 
When that is done there will be no more trouble with bad eggs in the 
market. 

The future is full of promise of better things for dwellers in cities in 
the way of food products from both farm and garden. The parcel post, if 
rightly used, is an agency that will bring newly laid eggs directly from the pro- 
ducer to the consumer. In addition to the shortening of the time between 
the producer and the consumer it should make better prices for the farmer, 
and, by cutting out express or freight charges and the miscellaneous profit, it 
should reduce the cost to the consumer. 

As the business of the parcel post increases in volume new means of 
transportation doubtless will be established and probably be publicly owned 
and operated. The new lines will be run by electric power and will have 
branches extended into the country around so that the perishable food products 
that are gleaned in the country today may be brought to the city tonight and 
served on the tables tomorrow. 

CHEESE 

Milk in the form of cheese is wholesome. The type of cheese called 
American is liable to produce constipation for the same reason that milk 
produces it — because it is so concentrated, so free from ivaste. The more 
highly flavored cheeses have enough of bacterial products in them to overcome 
this objection. 

Eaten slowly, well masticated, and well mixed with other food, cheese is 
highly digestible. The rarebit fiend develops nightmare, not because of the 
cheese, but because he eats a heavy meal while in a condition of mental ex- 
citement, and then goes to bed. The fault is not with the cheese. 

Cheese is good, nutritious food. Cheese is man-made. It follows that 
some cheese is well made, made in a cleanly fashion, and properly protected 
against dirt and contagion. It also follows that some cheese belongs in the 
other group. 

Probably most cheese, when stored, is, like most natural ice when stored, 
sca'rcely to be called safe food. But before the green is out, the contagion is 
out. This, however, is not true of tuberculosis. Galtier Harrison in Canada, 
and Mohler at Washington have proved that tubercle bacilli can stay alive in 



470 FOODS 

Cheddar cheese for more than four months; in Emmenthaler they die 
more quickly. 

The flavors of cheese are due to bacteria. Cheese makers have been try- 
ing for years to grow the bacteria of the different cheeses so that the milk 
could be first sterilized and then the culture added. In this way they could 
get a more uniform product, a better product, and one that would never 
contain live consumption germs. 

These efforts began more than ten years ago, but Sammis tells us 
that when the Chicago ordinance requiring that cheese be made only from 
pasteurized milk was passed in 1908 no practical way of making American 
cheese in this manner had been found. 

However, the experimenters got busy. Soon signs advertising cheese 
from pasteurized milk appeared, and now the agricultural department is 
out with a bulletin in which it tells of two years' practical experience with 
the new method of cheese making. 

The cheese was made at the University of Wisconsin. It was put out as a 
regular market commodity without letting the purchaser know that it was 
out of the ordinary. 

Samples were submitted to cheese graders. The cheese was graded higher 
than ordinary market cheese. It was much more uniform. It kept better. 

From the market standpoint it was more economical to make, it went 
away less frequently, and the trade liked it. 

It was all right in practical use as well as in theory. And it was free 
from live tubercle bacilli. 

MUSHROOMS 

Mushrooms have considerable food value; they appeal to the taste; 
they can be had for the searching; and as a search for mushrooms adds 
zest to an outing, many people go to the woods basket in hand. 

Before writing this I asked a librarian how to tell harmful mushrooms. 
He told me that the eating test is about the only one of value. Unfortunately 
this test will never become popular and the "before taking" tests are mostly 
worthless. Certainly the silver spoon test is no good. 

The government bulletins give testing points that, in a general way, 
are of some value. They say mushrooms are fairly safe if they come from a 
clean looking place, show firm white flesh when broken, and smell like freshly 
ground meal ; that they are dangerous if, on pressure, a milky fluid exudes, if 
the flesh is soft and spongy or hard and "corky," if it turns green or blue, 
if the odor is bad, or the taste is acrid or unpleasant. 

As a matter of fact the mushroom hunter generally knows one or two 
edible varieties and he sticks to what he knows, rejecting all others. If 
he applies the spoon test or any other he does not pay much attention to 
the results. He is not guided by them. Following this plan, he rejects many 
kinds of edible mushrooms, but, at that, he is wise. He searches farther to 
fill his basket and lives to search another day. The wise man is he who leaves 
wild mushrooms to themselves and cultivates the mushrooms he eats. 

Mushrooms are not so nutritious as meat, bread, corn, peas, tomatoes, or 
any of the ordinary foods. A pound of round steak is nearly five times 



FEUIT AS FOOD 471 

and a pint of milk nearly twice as nutritious as a pound of mushrooms. 
They are not as wholesome a summer food as are fresh vegetables and fruit. 
Where their value comes in is that they can be grown fresh for midwinter 
use, at which time the human system does not get all the fresh vegetables 
needed. There is no other vegetable that can be grown in a crowded city 
in winter and that, therefore, can come on the table but a few hours after 
coming out of the soil. This gives mushrooms distinctly a health phase. 
They can be preserved in summer and Icept for winter use, but, as a canned 
vegetable they are less wholesome than peas, tomatoes, corn, peaches, or pears. 

Perhaps half the people in a large city and practically all of those in 
small cities and towns are so situated as to make mushroom growing possible. 
The spawn can be had in any seed store, bulletins telling how to prepare 
the soil and how to care for the crop can be had from the Department of 
Agriculture and a basement space eight feet square is within easy Teach. Pre- 
paring the soil is an art; but the rudiments of it can be learned from these 
bulletins, or probably there are expert mushroom soil preparers who furnish 
soil ready to use. 

Many fungus growths are edible when they first come through the ground. 
All are dangerous when they are old or begin to shrink. Even the familiar 
mushrooms should be rejected when old. They are only prime when fresh. 



FRUIT AS FOOD 

The eating of fruit, like working on water colors, is considered a refined 
indulgence. Those who would consider it improper to launch into a slice 
of buttered bread outside of home or a regular eating place, will gravely 
and with dignified viciousness hack into an apple in the office or even in the 
street. 

Fruit probably was the first food of man. It still is universally recom- 
mended and eaten. There are those who use it sensibly as a part of their diet; 
there are others who would make a meal of it. 

Many growing children are given an apple for their lunch at school. 
We have seen young women in office and factory who take little else than an 
apple or two for their noonday lunch. 

Cheating the body by the esthetic holes and savory flavor of fruit is no 
better than cheating it in any other way. 

The nutritive value of fruits is very small. About 80 per cent of 
the bulk of fresh fruits is water. The tissue building substances, the pro- 
teids, are present in less than 1 per cent. Sugars and starches are present 
in considerable quantities — from 6 to 15 per cent in fresh fruit. Wood 
fiber, a very important element, averages about 5 per cent. Acids vary from 1 
to 3 per cent. Of salts and extracts, there is about J per cent of each. 

Plums are richest in water and acids, grapes and cherries in sugar, cher- 
ries and peaches in fiber, apricots in salts. Bananas are the lazy man's 
food in all tropical countries. They contain 20 per cent, of sugar, 2 per 
cent of proteid, and some starch and fat. Dried fruits have greater nutritive 
value, containing less water and considerably more sugar, proteids, and salts. 

The value of fruit as a food is in the following order : 



472 FOODS 

Fruit and Fruit Products. 



USDepartment of Agriculture 

Office of Experiment Stations 

A.C.True: Director 



FVepared by 

C.rTLANGWORTHY 

Expert in Charge of Nutrition Investigations 



COMPOSITION OF FOOD MATERIALS. 

Carbohydrate* A 9 h Water ■ 1000 Calories 



FVotein 



Fat 

CRAPES 

EOBLE PORTION 



RAISINS 

EDIBLE PORTION 




Carbo- 

rates:19.2 



GRAPE JUICE 

UNFERMENTED 




4-50 CALORIES 
PCR POUND 



CANNED 

FRUIT 



Water:92.2 





Fuel value-- 



1,605 CALORIES 
PER POUND 



R-otein.-0.2 



Carbo- 
hydrates:7.4- 

Ash: 0.2 



FRUIT 
JELLY 

Water: 21.0 



150 CALORIES 
PER POUND 



Carbq 




AshT0.5 

Fuel value 



hydrates:78.3 IffijaaSSa 

N^hiO.7 



E 



Carbo- 
hydrates: 21.1 



415 CALORIES 
PER POUND 



Fuel value: 



1,455 CALORIES 
PER POUND 






Fig. 173. 



1. Because it is appetizing and palatable. 

2. Because it is refreshing and thirst quenching. 

3. Because of its nutritive properties. 

4. On account of its salts and acids. 

5. On account of its action on the kidneys. 

6. Because of its laxative properties. 

For its appetizing value, fruit should be eaten before meals. Fruit 



FRUIT AS FOOD 



473 



Nuts and Nut Products. 



U.S. Department of Agriculture 

Office of Experiment Stations 

A.C.Tr ue: Director 



R-epared by 

C.rTLANGWORTNY 

Expert in Charge of Nutrition Investigations 



Protein 



COMPOSITION OF FOOD MATERIALS, 

nnm ^ mm ^ num. ■/a , l v *» I 

Water ■&%££ 

CHESTNUT 

'ater:5.9 
: at:7.0 



Ash:2i 




3285 CALORIES 
PER POUND 



Protein.^o.O FalT38.6 

Fuel value: 



Ash:2.0 1875 CALDRIE5 



PEANUT BUTTER 

JJJJJJJJJ. ' JJ 

-Protein:29.3 



2500 CALORIES 
PER POUND 



Ash: 5.0 i^VAVAV^ 




PER POUND 



COCOANUT 

DESICCATED 

Water: 3.5 



Carbo- 
hydrates: 17.1 




Fuel 



VALUE: 



2825 



CALORIES PER POUND 



3125 



Fuel value: 



CALORIES PER POUND 



Fig. 174. 

soup, a dish extensively used in Germany but little known in this country, 
would serve the purpose very nicely. 

For its nutritive value, fruit is best taken as dessert at the end of the 
meal. 

As a laxative, it should be taken on an empty stomach, preferably soon 
after rising in the morning, instead of before bedtime, as many people 
are in the habit of taking it. An apple can stay in the stomach for three 



474 



FOODS 



Roots and Succulent Vegetables. 



U.S. Department of Agriculture 

Office of Experiment Stations 

A.p.Troe: Director 



B-epored by 

C.fTLANGWOR"mY 

Expert in Charge of Nutrition Investigations 

COMPOSITION OF FOOD MATERIALS* 

anni ^ an ^ unra WM&Fi** 

Proian Fat Carbohydrate, A,h ^ater HittoVSaK 



F>t:0.3 

!fSA3h:0.6 

Fuel value: 

£25 calories 
per pound 



Fuel 



VALUE 



C 



230 CALORIES 
=ER POUND 



Carbohydrates: 1o. 




POTATO 

Protein.- 2.2 




Water: 78.3 



Fuel value 
385 calories per pound 



Carbohydrates: 3. 
Ash7T.( 



UEL VALUE: 



85 CALORIES 
PER POUND 



Fig. 175. 

hours, and, if taken just before bedtime, often will disturb sleep. Laxative 
fruits are figs, raisins, prunes, apples, grapes, gooseberries, plums, and 
currants. 

Fruit should not be eaten to excess, is best eaten at mealtime, and 
should not be eaten when unripe or overripe. Persons suffering from sour 
stomach should eat fruit guardedly. Fruits and grains make a good combina- 
tion at meals; sour fruits and milk do not go together. 



FRUIT AS FOOD 



475 



Fresh and Dried Fruit. 



US Department of Agriculture 

Office of Experiment Stations 

A.C.True: Director 



R-epared by 

C.FLANGWORTHY 

Expert in Charge of Nutrition Investigations 



COBffiPOSITION OF FOOD MATERIALS. 



nxnD 

Protein 



Fat 

APPLE 

EDIBLE PORTION 



Carbohydrate* 



Ash 



cnLTro 

Water 



.Fuel Value 
4. Sa In. Equal: 
1000 Calori* 



DRIED F1C 

PORTION 




>in.-0.4 



F¥otein:4, 



'at: 0.5 



Carbohydrates: 14; 



Fuel 
value 



AshtO.3 

290 CALORIES 
PER POUND 



STRAWBERRY 

EDIBLE PORTION 



90.4 



Carboh 




Dl OU CALORIES 
PER POUND 



Fuel 



180 



Carbo 




Fuel 
valued 



H75 CALORIES 
PER POUND 



BANANA 

EDIBLE PORTION 



CarboijN 




D 



Fuel I ] 460 calories 

VALUE: II | PER POUND 



Fig. 176. 



Fruit always should be thoroughly washed before eating. Dirt and 
filth are not more esthetic nor less harmful because they perch themselves 
on the glowing cheek of an apple or the graceful lines of a pear. Cooked or 
stewed fruit is easier to digest but not so nutritious. 

The "grape cure," practiced in Germany for obesity, consists of an ex- 
clusive grape diet. Nothing else is allowed. From one to eight pounds 
are gradually allowed daily. The significant fact is that the patients are re- 



476 



FOODS 



Legumes and Corn. 



US Department of Agriculture 

Office of Experiment Stations 

A C.True: Director 



Prepared by 

C.rTLANGWORTHY 

Expert in Charge of Nutrition Investigations 



COMPOSITION OF FOOD MATERIALS. 

nmn mm mm ^ mnni ■usffe* 

Carbohydrate* Ash Water ■lOO^CalorS 

NAVY BEAN, DRY. 

teten1£.6 



Fat Carbohydrates Ash 

SHELLED BEAN FRESH. 

-Water*58.9 
Carbohydrates: 29 .1 

-Ash:2.0 





Carbohyarates:59.6 \&S 



at:1.8 
Sh:3.5 



740 CALORIES PER POUND 1600 CALORIES PCR POUND 

STRING BEAN. GREEN. 

^Sh:0.8 



Carbohydrates: 7. 



Water: 89.2- 




CALORIE5 PER POUND 



CORN, GREEN 

EDIBLE PORTION 




Carbo hydrates:1 9.7 
Ash:0.7 



at:1.1 



Fig. 177. 

quired to pick all the grapes themselves, thus securing the advantages of open 
air exercise. 

Use fruit as an adjunct to your diet. Use it to prevent scurvy, to over- 
come constipation, to prevent overeating. Do not use it to replace meat and 
bread ; to build up the body, to repair waste. Eat it because you need it but do 
not eat it with the idea that it is cheap food. And finally clean it before 
eating it. 



COTTONSEED FOOD 



477 



COTTONSEED FOOD 



The Public Health Service is telling the people that they need not 
have pellagra. It says that pellagra is preventable. There is no doubt but 
that the people are afraid of pellagra. Their attitude about it is different 
from their attitude toward malaria. They are not indifferent about malaria. 

There is a fair chance that people will listen to what these authorities 

Butter and other Part -Yielding Foods, 



FVepared by 

OFLANGWORTUY 

Expert in Charge of Nutrition Investigations 

COMPOSITION OF FOOD BIATERIALSo 



U.S. Department of Agriculture 

Officeer" Experiment Stations 

A.C.Trues Director 



mnD 

Protein 

OLIVE OIL 



Fat 



Carbohydrate* 



Ash 



nun 

Water 



, Fuel Value 
iSa In. Equals 
1000 Cdariee 



R-otein.- 



BACON 



Water:l8.8 




U87A 




3030 CALDRIE5 PER FOUND 

ater.13.2 
otein:^-./ 



Aoh:0.3 



BUTTER 

Fat:85 




3510 CALORIES PER POUND 

r.11.0 



LARD 




3410 



EALDRIE5 PER POUND 



4080 CALDRIE5 PER POUND 



Fig. 178. 



478 FOODS 

say. They say that pellagra results from prolonged eating of an ill balanced 
ration — too much corn bread, too much sow belly, too much molasses, too 
much plum pie, and too many blackberries in summer, too little lean meat, 
fresh vegetables, fruit and milk. 

They advise especially that the farmers plant peas and beans and that 
these become very staple articles of diet. There is no tastier vegetable than 
cornfield peas. They grow well in every part of the country where pellagra 
abounds. They contain just the ingredients which the public health people 
say are needed to prevent pellagra. Cornfield peas should be growing 
in the rows of every cornfield in the South. 

I do not know that the Public Health Service men have experimented 
with cottonseed meal cakes and cottonseed flour biscuits, but they might 
profitably do so. Anyone might try them. Cottonseed meal and flour are 
rich in protein. Dr. Goldberger says many of the Southern people do not eat 
enough protein and that pellagra develops as the result of the short- 
comings. 

The Texas Experiment Station Bulletin No. 163 gives the result of feeding 
tests with cottonseed baking goods. One part cottonseed meal or flour to four 
parts of cornmeal or wheat flour were mixed for cakes, biscuits, and muffins, 
using the same recipes as for cornmeal or wheat flour. For instance the 
recipe for cottonseed corn cakes was as follows : 

Cottonseed meal or flour 1-3 cup 

Cornmeal 1 1-3 cups 

Eggs 2 

Lard 1^ teaspoonf uls 

The cottonseed meal used was a fresh meal from fresh seed. It was 
free from lint and hulls. It was sifted through a twenty mesh sieve. It 
was a fine yellow powder made by roller process. 

Professor Eather says that cottonseed meal bread is a substitute for 
meat. It should be eaten instead of meat or by people who do not eat 
enough meat. It is very digestible. It is cheap. A pound of protein in 
cottonseed meal costs one-twentieth as much as a pound of protein in eggs 
or one-fifteenth as much as a pound of protein in meat. 

It is so rich that people are disposed to eat too much without know- 
ing it. Eather says that a man does not need and should not eat more 
than two ounces of the meal a day. 



PASTEURIZED BUTTER 

One of the striking exhibits at the International Tuberculosis Congress 
at Washington showed that butter made from tubercular milk could cause 
tuberculosis. The proof is overwhelming and it comes from every part 
of the world. Whether the butter was salted or unsalted, fresh or stored, 
the results were the same. 

Some will remember the Asheville story of an epidemic of typhoid along 
a certain butter route, back of which was a woman nursing her child sick 



PASTEURIZED BUTTER 479 

with typhoid and making fresh country butter for a discriminating group 
of city people. 

Schroeder, in "Milk and Its Relation to the Public Health/' says : 

"Tuberculosis among dairy cows is so common and widespread that we 
cannot hope to clean all dairy herds for some time to come ; hence it is neces- 
sary for the protection of health to avail ourselves of the one expedient which 
is immediately at hand, and that is pasteurization, and pasteurization should 
not be restricted to milk, but must be extended to all dairy products." 

Acting upon this opinion (an opinion so general in the Agricultural De- 
partment that it may be interpreted as the official opinion), the federal govern- 
ment has been testing out the different pasteurizing methods as applied 
to butter. 

Butter was made of raw milk and of milk pasteurized at temperatures 
ranging from 140° to almost 200 °, almost up to boiling. The butter was tested 
in many different ways. Some of it was submitted to butter experts, one of 
whom was Mr. Newman, assistant food commissioner of Illinois. 

The opinion of these experts was that butter made from pasteurized 
milk, in addition to being safe, was the better butter. The temperatures which 
gave the best butter were 155° to 180°. Over 180°, the butter tasted scorched. 
Under 155°, the scores were not quite so good. 

One reason was that the ferments of the milk were not destroyed and 
these caused the butter to go off a little after forty days of storage. The 
ordinary ferments of milk are peroxidase, catalase, galactose and lipase. 
There are those who think that milk should not be heated enough to destroy 
these. These butter tests showed that the butter is better if the milk has been 
heated enough to destroy them. 

Peroxidase is killed at about 170°, catalase at 168°, galactose is weak- 
ened materially at 160°, but is still present at 200° ; lipase disappears at 
about 160°. 

The conclusion of Dr. Rogers is that held pasteurization, 140° for thirty 
minutes, does not make as good butter as flash pasteurization or retarded 
pasteurization at 165° or over. This is the first time that flash pasteurizers 
have had an inning. The commissioners studying fresh milk favor the other 
method. 

Incidentally, the men working on ferments found the scientific reason for 
throwing away the rusty cans. Butter and cheese made from milk kept 
in rusty cans will not score up to grade. 

Half the butter is now made from pasteurized millc. It is the safest 
butter now on the market. 

The Milk Standards Commission voted unanimously that all butter should 
be made from pasteurized milk. The danger that raw butter will carry 
infection they regard as considerable enough to warrant this precaution. With 
butter it is safety first. Flavor is less important. Then, too, tastes differ. 
Some of the speakers at the Commission hearing on butter thought the flavor 
of butter from raw milk was better. As noted above some authorities hold 
the flavor of pasteurized butter to be better. 



480 FOODS 



MILK 



Skim Milk and Buttermilk. — Milk contains about eighty-eight parts 
water and twelve parts solids. Of these twelve parts, four are fats. The use of 
the fat is to make heat. As it is burned up in the body it has no power 
to repair waste and only moderate power of furnishing energy. 

Recognizing it as a heat maker, why pay good money for it when you 
are paying other good money for things to keep you cool? You buy ice 
to put in your glass of milk to keep you cool, and you buy cream with your 
milk to keep you hot. 

Skim milk contains every particle of the milk except the fat. At that, 
about one-tenth of the fat is left behind, if the milk is creamery skimmed, 
and even more if hand skimmed. 

A pint of skim milk will repair more tissue, furnish a little more 
energy and make about half as much heat as a pint of whole milk — and it will 
cost less. Five pints of skim milk will furnish as much food value as a 
pound of round steak, and cost a quarter as much. A glass of skim milk 
and a half pound of bread will furnish one-third enough nutriment for an 
entire day, and will cost five cents. And skim milk is good for babies in ex- 
tremely hot weather. 

Another advantage is that the cream always contains three times as 
many bacteria as whole milk. Therefore, where cream is skimmed from 
milk a large proportion of the bacteria is carried with it, and the skim 
is left with but few bacteria. 

However, a better form of milk for hot weather is buttermilk. It, too, 
is skim milk. If the butter man has been after results he has left but 
Y 2 of 1 per cent of fat in the buttermilk. 

Buttermilk has still another advantage. Its albumin is more easily 
digested than the albumin of sweet milk. The albumin of sweet milk is 
mildly alkaline. When it is swallowed it always curdles in the stomach. The 
stomach and intestinal juices must get into and the stomach muscles must 
break up these curds. Occasionally they are leathery and tough. 

The albumins of buttermilk are acid. They do not form leathery curds. 
They are more easily digested. When babies are fed buttermilk they do not 
pass the so-called curds composed of masses of fat. 

Buttermilk is always a better hot weather food than whole milk for 
grown people, and sometimes it is for babies. On a hot day it is better to 
drink buttermilk than beer over a bar. 

If the saloonkeepers want to do the right thing let them keep butter- 
milk on tap. 

Sour Milk as Pood. — Men have always eaten sour milk. Cottage cheese, 
curd, whey, and buttermilk as foods are used all over the world and always 
have been. Sweet milk furnishes a baby about what it needs and in an 
easily digested form. For the human baby, human milk contains ingredients 
in about the proper proportions. The proportions of the ingredients in 
cows' milk is not right for babies and, as a further consideration, when babies 
have grown into youths and adults, sweet milk is do longer a perfect 
food. 



MILK 



481 



Milk and Milk. Products. 



Prepared by 

C.r7UNGW0R"mY 

Expert in Charge of Nutrition Investigations 

COMPOSITION OF FOOD MATERIALS. 



U.S Department of Agriculture 

Office of Experiment Stations 

AC.Iroe: Director 



mum 

Protein 



Fat 



Carbohydrates 



Ash 



nTTTTfl 

Water 



.Fuel Value 

U. So. In. Equals 
^CK>0 Caloriee 



WHOLE MILK 



SKIM MILK 




^— Water: 87.0 
< — FVotein:3.3 



Carbohydrates: 5.0 

c 

FuEL VALUE:310 calories per pound 




-Waten90.5 



JPrMn:3/t 
Carbohydrates-.5.1 

D 

Fuel value:165 calories per pound 



BUTTERMILK 



CREAM 




<— Water* 91.0 



Protein: 3.0 Fat:18.i 



H-Water:74-.( 



Carbohycirates:4-.8 Asht0 * 

Fuel value:160 calories per pound 




83§S§§§8 



'ater:74-.0 
in; 2.5 



Carbohydrates: 4-.5 

D 

Fuel value: 8 65 calories per poind 



Fig. 179. 

When milk is taken into the stomach, it is at once converted from a 
liquid to a solid food. One-eighth of it is made use of as food and the 
other seven-eighths as water. The albumin, normally present in milk as alkali 
albumin, is converted into acid albumin, whereupon digestion begins. 

Men have always anticipated these two preparatory steps of digestion 
by drinking soured milk, sometimes with the albumin in large, solid masses 
as in clabber and sometimes in small mixed particles, solid particles and 
albumin in solution as in buttermilk. 



482 FOODS 

But the people who have made most use of soured milk are the Bulgarians 
and their neighbors. Almost ten years ago a Swiss scientist studied Bul- 
garian milk-souring cultures, for in that country every housewife has her 
culture just as with us every housewife has her yeast. Among the three 
germs always found present was a long, heavy bacillus, which had a pro- 
digious capacity to make acid and a remarkable capacity to live in the acid 
produced, for it is a universal law of nature that what we make kills 
us. 

This bacillus is what people expect, and occasionally get, when they buy 
lactic acid tablets, cultures in tubes or bottles of culture. It is impossible 
to say which is best, since there has been no effort made to standardize any of 
them. A few laboratory workers have tested the different kinds on the 
market, but nobody has gone far enough with it to help the situation prac- 
tically. Certainly it has not reached the standardization of the bread yeast 
and beer ferment industries. 

If the tablet kinds are to be used, one to three tablets are to be put 
into a glass of sweetened water (several lumps to the glass), which is allowed 
to stand until they are broken up. Then the mixture, sediment especially, is 
to be swallowed, preferably during the meal. If the culture in sealed tubes 
is used, the culture should be diluted with sweetened water and used in the 
same way. If the culture in bottles is used, the prescribed dose can be 
taken straight or in sweetened charged water. 

Other things being equal, the dried cultures in tablets are best. It is 
better that the bacillus awaiting use should be dry and inactive as they are 
in tablets. 

Three days after the use of bacillus has been begun, it can be proved 
that it has passed through the intestinal tract. It then takes about eight 
days for it to become fairly well acclimated and that acclimatization having 
been effected the bacilli will remain in the intestine about twelve days over 
the last dose taken. To make it live longer in the intestine is the end sought 
by Metchnikoff in his recommendations that patients eat sugars and starches 
in abundance and take this second bacillus recently recommended. 

Condensed, Evaporated, and Desiccated Milk. — These milk products 
have advantages over fresh milk. They likewise have disadvantages. The less 
milk is tampered with the better, which means that a baby at the breast is 
the only arrangement that meets with full approval. 

His milk cannot be tampered with. All other forms of baby milk 
have been tampered with. When a milk has been drawn from a cow into a 
can, manhandled on the farm, hauled for miles to a railroad station, shipped 
on a milk train, hauled to a dairy, clarified, pasteurized, bottled and de- 
livered, it has been tampered with. The only question is which tampering 
is best for the baby — that to which fluid milk is subjected or that undergone 
by evaporated, condensed and desiccated milks. 

Evaporated milk has been put through the following process: Good 
milk is taken. Some of the fat is taken from it. The milk is heated almost to 
the boiling point. It is evaporated about one hour at a temperature of 140° in 
a vacuum pan. The temperature is then raised almost to the boiling point 
and the product is canned. It contains 68 parts of water instead of 88 as 
in the case of fresh milk. The solids are about 2% times those of fresh milk. 







Drow- b a - KATnCRINC FIELD WHITE - 1914 



Tie &EMEE ©EMlIMM wfa® BlSTMDBIDTES 

'MiLKj^©™ & Wmn ©fBwkt w Wimcjki^ G&se 

«DF CdDNTAGJKDUS DISEASE Em§T& Is ^^^ 



Vi.±/*>0/S 3T«« BOAK.D or HEALTH 



ILLINOIS STATE BOARD OF HEALTH. CARTOON NO. 10 



Fig. 180. 



484 FOODS 

It is sterile. A can when opened contains neither disease-producing bacteria 
nor bacteria of decomposition. 

By condensed milk is meant what is often spoken of as sweetened con- 
densed milk. The process is the same as for evaporated milk except that 
the temperature is not raised at the end of the evaporating process. Enough 
cane sugar is added to make the mixture 40 per cent sugar. It is then 
canned and sealed. Sweetened condensed milk does not contain any disease- 
producing bacteria when the can is opened but there is nearly always a con- 
siderable number of other bacteria. 

Desiccated milk is milk evaporated down to dryness. 

And now for the advantages and disadvantages of the different milks 
as compared with fresh milk. The great advantage is that they do not 
contain tubercle bacilli or typhoid or any other bacteria of that group. They 
do not contain bacteria of decomposition. Those are great advantages. The 
disadvantage is that the food ingredients are in different proportions from 
those of fresh milk. The sugar is too high in all kinds and especially in 
sweetened condensed milk. The fats are too low. And they are all cooked 
milks. 

Babies fed on condensed milk are liable to be overfat, soft and flabby. 
Some of them get scurvy and others get rickets. Babies fed on these milks 
must be closely watched for these conditions. Almost every one of them 
will need fruit juice, meat juice and strained vegetable soups at times. 

If a mother cannot have an icebox or if she cannot get cold, clean, fresh' 
milk she had better feed her baby on the canned milks. For her the 
advantages are greater than the disadvantages. 

Two other groups of people should use canned milk by preference — 
travelers, including picnickers, and soldiers. 

When the cow has taken the woman's place and when, in between 
the cow and the baby, cow trains and wagons, pails, cans, and many hands 
have been run, it is late in the game to introduce objections to tampering. 

If there is no ice to keep the milk, and if it is reasonably certain that the 
milk is not typhoid free, then evaporated, condensed, or desiccated milk should 
take the place of fresh milk. This about means that three groups of people 
should use these milks — babies in homes where there is no ice, travelers, in- 
cluding picnickers, and soldiers. 

Evaporated milk is milk from which some of the water has been driven. 
Instead of being 88 parts water, as is whole milk, it has 68 parts water. The 
solids are about twice and a half the proportions found in whole milk. 

Grown persons can use it for years without special precautions. Babies 
fed on concentrated milks for a long time may develop scurvy or rickets, 
or may get too fat. Therefore, when concentrated milk is being used as a 
baby food it is necessary to watch the baby with unusual care. If somebody 
will stay on guard the danger of scurvy, rickets, and obesity will be of no 
importance. 

On the other hand, concentrated milks are sterile when they go to the 
consumer. They are sterile when the consumer opens the package. The 
consumer can be certain that there is no tuberculosis, typhoid, scarlet fever, 
diphtheria, or septic sore throat in the can. Furthermore, after being opened 
the milk will keep twice as long as will ordinary milk. 






FOOD ECONOMICS 485 

Sweetened condensed milk is evaporated milk to which sugar has been 
added. It was evaporated at a lower temperature than evaporated milk, 
and, in consequence, it is not so much cooked. But, on the other hand, the 
excess of sugar goes to make fat rather than health and resistance. 

The desiccated milks, or powdered milks, are those from which still more 
water has been driven. They have not come into general use for baby feeding, 
but grown people find them convenient as well as wholesome and nutritious. 

The federal government is beginning to control the condensed milk busi- 
ness, which means that the product will be more uniform, truer to label, and 
generally more meritorious. 



FOOD ECONOMICS 

In the purchase of food for a family allowance must be made for waste. 
The average waste in an American household is 10 to 20 per cent, accord- 
ing to the way the kitchen is run. Another, say 5 per cent, should be 
allowed for the loss in cooking. 

Take milk. Ninety-seven per cent is digested and absorbed. Figured on 
the basis of usable calories it is a good purchase. 

It takes food forty-eight hours to pass through the alimentary tract. 
Five hours are required for the passage through the stomach and small 
intestine; forty-three hours for the large intestine. What happens to the 
large intestine must not be left out of the calculation. The three per cent 
wastage from milk is not enough for the work of the large intestine. 

After the food has been eaten the digestive apparatus fails to digest 
and absorb all of the food values. There is about 9 per cent loss on this 
score. Therefore, a very learned housewife will calculate the number of 
calories needed to nourish her family and then she will increase the figures 
by about 35 per cent to allow for these elements of waste. 

If she is wise she will figure which foods furnish her the calories 
estimated to be necessary at the lowest cost. But if she has more common 
sense in addition to her knowledge and her wisdom, she will buy some articles 
of diet not because they show up well in the calculation but because the 
system needs them for one reason or another. 

Some foods should be used for reasons that do not show on a balance 
sheet. Fruits on analysis do not show well, yet the freest use of them 
is to be recommended. A food, the use of which cannot be justified on a food 
value basis, may be a good "buy," because it furnishes bulk to the intestinal 
contents. 

To illustrate, let us use milk. Of milk 97 per cent is absorbed 
and so little bulk is left that constipation results. Of the forty-eight hours 
which food takes in its passage through the body five is taken in passing 
through the stomach, five in passing through the small intestines, and forty- 
three in passing through the eight feet of large intestines. 

And for another reason, rough foods must not be lost sight of. A man 
needs about 300 grains of minerals a day — mostly common salt and phos- 
phates, small amounts of lime and iron, and a trace of sand. These are 
not of much service when physically mixed with food — they must be in 



486 FOODS 

chemical combination. For instance, salt sprinkled on food passes through 
the system without being stored, while salt which is a chemical part of 
food, which has been grown into it by the cabbage plant or the beef steer, 
phosphorus which has been mixed in the milk by the cow or formed into the 
egg by the hen, is that which counts. 

Therefore bran, peelings, shreds, fibers, skin, crusts, husks — all have 
values which do not show on the balance sheets. 



DIGESTIBILITY OF FOODS 

There is no doubt but that the preparation of food influences its diges- 
tion. Foods having a pleasant odor and an attractive appearance stimulate 
the appetite. Pawlow got a world-wide reputation for discovering these facts 
— facts known always and by all men. 

Atwater says: "Generally speaking, the most readily digested animal 
foods were materials of soft consistency. White meats, for example, chicken, 
leave the stomach more quickly than red meats or dark meats, for in- 
stance, duck. 

"The method of cooking also exerts a very marked influence on stomach 
digestion. Fresh fish was found to be more readily digested than meats. 

"As regards vegetable foods in general, the consistency and the amounts 
of solid material were again principal factors affecting the time required for 
digestion in the stomach. Mealy potatoes, for instance, were more easily 
digested than waxy potatoes, and mashed potatoes more readily than potatoes 
cut up in pieces. Fine bread was more quickly digested than coarse bread." 

Experiments have shown that the addition of butter to bread and vege- 
tables lengthens the time the food remains in the stomach and upper in- 
testines. Sugar, bread, and potatoes remain only a short time in the 
stomach and upper intestines, and make the least demand on the digestive 
secretions. Flour gruels, cream, and beef are completely assimilated. Cooked 
fruit digests more easily than raw. Potato with fat pork remains in the 
stomach longer than potato mixed with butter or cream. Experiments have 
shown that mutton, like beef, is almost completely assimilated. 

Generally speaking, dried vegetables are much harder to digest than when 
fresh. A large part of the vegetables contain tough cellulose or fiber which 
is not digested. The laxative vegetables are spinach, tomatoes, and most 
green vegetables when fresh and well cooked. As a general rule, the vegetables 
which grow above ground are more digestible when fresh and young (with the 
exception of celery), and those which grow below ground are starchy and 
more indigestible. 

The digestibility of fruits depends largely upon the ripeness and fresh- 
ness. Some people have an idiosyncrasy against fruits, such as strawberries, 
pineapples, and so forth, and cannot, therefore, digest them properly. 

The more digestible fruits are grapes, oranges, grapefruit, lemons, cooked 
apples, figs, peaches, cantaloupes, blackberries, strawberries, and raspberries. 



PEESEEVE FEUITS FOE WINTEE USE 487 



PRESERVE FRUITS FOR WINTER USE 

During his service in the United States Senate reporters told us that 
Senator Stephenson, of Wisconsin, was "doctoring" the senate. It ap- 
pears that, nearly a half century ago, Senator Stephenson got an aloes 
prescription from one of Chicago's great physicians of that day — Dr. E. N. 
Isham. That prescription, containing aloes, he has since used and is now 
using to prolong the lives of senators beyond the Biblical limitation. 

Now, the use of aloes for this purpose is good, but the discovery that 
constipation makes for senility cannot be patented by Senator Stephen- 
son. 

One variety of aloes is known as the Socratine aloes. Whether Socrates 
used it I do not know, but we do know that the drug has been used on 
the Socratine island since the time of Alexander the Great. 

A few years ago Metchnikoff gave the relation of constipation to old age 
careful and scientific study and suggested a plan which he thought an im- 
provement over the Stephenson plan. While these scientists, Professor Metch- 
nikoff at the Pasteur Institute in Paris, and Senator Stephenson and his lieu- 
tenant, Tillman, in Washington, are contending there is something which the 
housewife can be doing in July and August about which there is no room for 
argument. 

Constipation contributes to senility. Deficiency of fruits and vegetables 
in the daily diet contributes to constipation. Many more people suffer 
from constipation in winter than in summer — at least four times as many. 
Why? Winter foods are more concentrated. In saving for the winter, 
we store the kernel and throw away the hull. When winter comes, we live 
on meat and white bread. In case we buy fruit and vegetables, we eat 
sparingly of them since their use, in winter, runs into money. The way out 
of this is to pick up fruit and vegetable bargains when they are plentiful 
and cheap and can, can, can. Then next winter the mother will feel that 
the family can afford to eat fruits and vegetables lavishly and better health 
will result. 

The object of cooking and preserving is to sterilize. If sugar is not used, 
the vegetables canned must be sterile else they will not keep. If the peaches 
and other fruits are mixed with an equal quantity of sugar, they need not 
be completely sterile since sugar prevents some bacterial growth. Canned 
fruits and vegetables are clean and sterile. As winter foods, preserves, jellies, 
pickles, and canned vegetables are better than medicine. 

The housewife, though she has not known it, has been a working 
bacteriologist all along. Professor Koch had nothing on her. What he 
discovered in the late seventies, she had been doing for a century. Had 
the laboratory scientists gone into the kitchen or the housewives into the 
laboratory the science of bacteriology might have gotten under way in 
1779 instead of 1879. 

Constipation leads to ill health and induces premature senility. The 
Stephenson aloes plan for preventing the effects of constipation is better 
than nothing. 

The Metchnikoff plan along the same general line to prevent the forma- 



488 



FOODS 



tion of senility-inducing chemicals in the large intestine is better than the 
Stephenson aloes plan. 



Sugar and Similar Foods. 



U.S. Department of Agriculture 

Office of Experiment Stations 

A.C.True: Director 



R-epared by 

C.FXANGWORTHY 

Expert in Change of Nutrition Investigations 

COMPOSITION OF FOOD MATERIALS. 

(mm sm hip ess] cnnn WMHslE&L* 

Protean Fat Carbohydrates A 3 h Water MM fooVcalcries 

MOLASSES 



:p&£%? Carbohydrates: 100.0 




FVefein.-£A- 



.|^7^Wat9r^5.1 





fUEL VALUE" 



1860 calories 
per pound 



STICK CANDY 

Carbohydrates: 96.5 



1290 calories 
per pound 



WSter: 3.0 r Ash:0.5 

rUEL VALUE: 



MAPLE SUGAR 



1785 CALORIES 
PER POUND 



HONEY 



Ash:0. 



1540 




Watent 
Frotein:0, 



^Water:16.3 



Carbo- Carbo- 

hydrates :8£.8 hydfSes:81.2 




CALORJE5 PER POUND 



1520 



Fuel valueT^ 3 ^-* 



CALORIES PER POUND 



Fig. 181. 



The plan of eating fruit, especially in winter, is still nearer to nature. 
Canning fruit and vegetables in August is better than taking aloes in 
December, 



TOXINS IN FOODS 489 



TOXINS IN FOODS 

Scientists have extracted toxins from many different plants. From 
the castor bean, the source of castor oil, ricin, a violent irritant, has been 
obtained. But for this, castor oil would be a bland food like olive oil 
rather than the purgative it is. From Croton oil, crotin is had; from mush- 
rooms, phallin. Furthermore, scientists, proceeding as they do in making 
tetanus and diphtheria antitoxins, have made an antitoxin to cure castor 
oil poisoning, and another to cure mushroom poisoning. 

To those who decry antitoxins, saying that they are fantastic conceptions 
since, as bacteria are the products of overheated imaginations, and toxins 
are the imaginary products of imaginary bacteria, antitoxins are the 
imaginary products of the stimulation of imaginary toxins produced 
by imaginary bacteria, it will be a poser to be told that such vege- 
tables as potatoes, mushrooms, peaches, and castor beans produce toxins, 
and that, for some of these toxins, antitoxins have been discovered. For 
example, snake venom is a toxin and for it antivenoms, or antitoxins, are in 
practical use. 

In fact, toxins and antitoxins are found everywhere in nature, and 
bacterial toxins and antitoxins, far from being peculiar, are a part of a great 
nature-wide scheme. 

Diphtheria antitoxin is not a new fangled conception. The old way 
of saying it was that we got used to a thing and, therefore, it did not 
affect us any longer — the same statement, but said differently. 

The evidence is strong that beriberi is due to an exclusive diet of rice — 
probably of polished rice. We have not much beriberi in the United 
States, but there formerly was a good deal around Panama. Now comes a 
physician with an account of beriberi among the people on certain Cana- 
dian Atlantic islands — a people who are forced to live on oatmeal alone for 
months on a stretch. The conclusion is that beriberi comes from long 
continuance of a single article of vegetable diet, usually rice, occasionally oat- 
meal. 

One of the most violent of poisons, ergot, is due to a mold or smut 
growing on grains of corn. 

The question whether food is wholesome often depends more upon 
how clean, how fresh, and how well kept it is than upon commercial fabri- 
cations. Food inspectors have usually overlooked this. 

The object of the above is not to cause distrust of food. Most of the 
safety rules for foods are known. In fact intelligent people apply them 
so universally that in spite of the wide separation between consumer and 
producer and the many things that happen in between cases of food poison- 
ing are very infrequent. 

The object of the article is to call attention to the fact that the principles 
underlying the use of toxins and antitoxins are not man-made. In learn- 
ing to make antitoxins man has merely discovered how to do something 
that nature has always done. And so it is with toxins. 

It would seem reasonable, therefore, to decide whether or not to use anti- 
toxins on the merits of the case. The charges that men are serum mad, 



490 



FOODS 



Dietary Standards. 



U.S. Department of Agriculture 

Office of Experiment Stations 

A.CTrue. Director. 



Prepared by 

C.F.LANGWORTHY 
Expert in charge of Nutrition Investicjations 

DIETARY STANDARDS. 



DIETARY STANDARD FOR MAN IN FULL VIGOR 
AT MODERATE MUSCULAR WORK. 



Condition considered 


Protein 


Energy 




Grams 


Calories 


Food as purchased 


115 


3,800 


Food eaten 


100 


3.500 


Food digested 


95 


3,200 



ESTIMATED AMOUNT OF MINERAL MATTER 
REQUIRED PER MAN PER DAY. 

Grams Grams 

Phosphoric acid (F£0 5 ) 3to4 Calcium oxid 0.7 to 1.0 

Sulphuric acid (50 3 ) Eto35 Magnesium oxid 0.3 0.5 

Potassium oxid 2to3 Iron 0.006 to 01Z 



Sodium oxid 



4to6 Chlorin 



6 to 8 



Fig. 182. 

toxin mad and germ mad is tommyrot. Nature points the way. They are 
really nature cures. 

QUANTITY OF FOOD 

There is a great deal of misinformation about what to eat and wliat 
not to eat from the standpoint of food values. It is true that lean meat is 



OVEREATING AT DINNER 491 

rich in protein and is good for building up tissue. Starches and sugars are 
rich in carbohydrates and are good in furnishing energy. Vegetables, as 
compared with meats, are rich in carbohydrates and sugars and low in 
protein. Fats are rich in hydrocarbons and are especially useful in making 
heat. Salts are needed for nourishment, and water is needed for digestion 
and assimilation. 

Meats are not, however, all protein, and vegetables contain a good 
deal of protein. It is not possible to draw a hard and fast line between 
the use of foods since tissue building protein can make heat, and vice versa. 

A few variations have been exaggerated into all sorts of absurdities. 
We hear of fish as brain food, and so forth. 

The fact is, it does not make much difference what food you eat. It 
does make a great deal of difference how much you eat. While there is some- 
thing in quality, the very important point is quantity. 

Almost any man can eat almost anything if he will eat it slowly and chew 
it very well, and then, having swallowed it, will forget about it. A period of 
quietude after eating will increase his latitude in things which can be eaten. 

The harm which is done by eating is in the main from eating too 
much. Children over two years of age and men doing hard physical labor 
seldom eat too much. 

The advice to cut down the volume of food applies to office workers, clerks, 
and other men and women who do not get much muscle work. 

More food is required during the winter than during the summer. As 
the weather gets colder it is advisable to increase the quantity of food. 
More heat is needed and that calls for food. The colder weather stimulates 
one to take more exercise, and that demands more tissue building. 

The advice to go on a tropical diet when the weather is tropical indicates 
that when the weather ceases to be tropical the proper thing to do is to change 
the volume and, in some measure, the kind of food to match, especially to 
increase the amount of fats and meat. 



OVEREATING AT DINNER 

The dinner meal is that in which there are most sinners. The day's 
work is done, and the succeeding hours are to be spent at physical ease and 
in a warm, comfortable room. At breakfast the man has held his appetite 
in check. Knowing he had work before him, that he was going out into 
the cold air, he has eaten lightly. He sits down to his dinner with different 
prospects in mind. He usually eats until his stomach is uncomfortably dis- 
tended. Therefore he should know something of the food values of his 
evening meal. 

One portion of soup — 

Soup, one pint, equals 200 calories and 180 grains protein. 
Chowder, one pint, equals 360 calories and 480 grains protein. 

Fish, game, chicken, beef, turkey, lamb, goose, lean ham — Ordinary help- 
ing, about one-quarter pound, equals 125 to 250 calories, according to 
how much fat it contains, and 300 grains protein. 



492 FOODS 

Butter — One pat, one-third ounce, equals 80 calories; practically no protein. 

Butter beans — One-quarter pound equals 160 calories and 150 grains protein. 

Green corn — Four ounces equals 100 calories and 45 grains protein. 

Green peas — Four ounces equals 100 calories and 105 grains protein. 

Turnips — Four ounces equals 50 calories and 30 grains protein. 

Fodder vegetables and their juices, having but little food value, are aspar- 
agus, string beans, brussels sprouts, cabbage, cauliflower, celery, cucum- 
bers, greens, spinach, lettuce, pumpkin, radish, rhubarb, tomatoes. 

Apples — One-quarter pound equals 60 calories. 

Raisins — One-quarter pound equals 350 calories. 

Figs and prunes — One-quarter pound equals 80 calories. 

Pineapple — One-quarter pound equals 40 calories. 

Almonds — One-quarter pound equals 650 calories and 300 grains protein. 

Pecans — One-quarter pound equals 750 calories and 150 grains protein. 

Bread or rice pudding — One-quarter pound equals 175 calories and 60 grains 
protein. 

Custard — Large cupful [8 ounces] equals 240 calories and 180 grains pro- 
tein. 

Cake — Large slice [one ounce] equals 85 calories and 20 grains protein. 

A man needs about 2,500 calories and 800 grains protein. Take the 
list given below (Food Values) and figure your breakfast. Add about an equal 
amount for your lunch, and then figure your dinner from the above list. If 
you have eaten some article not given figure it in terms of that food most like 
it. Add the three together and see whether you should be getting fat or 
thin. 

Thanksgiving Dinner. — The custom of overeating on Thanksgiving is 
well established. Overturning a custom is no easy matter. The comfortable 
thing to do is to abide by it. Maybe we can say something to lessen the bur- 
den. It may not seem a burden now, but it will about four o'clock in the 
afternoon of Thanksgiving day. 

Drink no wine, beer, nor whisky with the meal. The stomach 
juice will be loaded up. Do not decrease its efficiency by diluting it with 
alcohol. No chemist has ever been able to mice alcohol and pepsin so as to 
make an efficient dig est ant. 

Eat slowly and chew your food well. Your stomach muscle will be carry- 
ing an overload. The more work your teeth do, the less your stomach 
muscle will have to do. 

Eat lightly of the earlier courses. By the time the meal is about half 
through you can form a good idea of how your stomach space is holding out, 
and, if you conclude you can stand more, you can make up on later courses. 

Do not eat the dressing. It taxes the digestion all out of proportion to 
the excellence of its taste or its nutritive properties. 

Drink a good deal of water during the meal. All of that food must go 
into solution, and water u needed. 

After the dinner is over get plenty of air in the room. You will 
make a lot of heat in digesting that food, and you will need fresh air 
to get rid of that surplus heat. 

An hour after dinner you will get thirsty. Drink plenty of water. It 
will help your stomach to digest that food and move it on into the small 
intestine. 



FOOD VALUES 493 

Be sure to have some chewing gum on hand. I am opposed to chew- 
ing gum on the grounds that it is not esthetic and that it is not the most 
worth while means of whiling away the time. It should not replace gos- 
siping, novel reading or the picture snow. But it has a place on Thanks- 
giving day. 

When you have overeaten so that you feel heavy and sleepy, when 
you gape and sneeze, when your stomach feels full and you unbutton your vest, 
then comes the time for gum. It beats pepsin a mile. In spite of what 
you have been told you have overfilled your stomach. For several hours 
the stomach muscle has labored. Overworked it shows a disposition to lag. 
If you will drink some water and then chew gum your discomfort will 
lessen. The explanation is as follows: The stomach contents were too dry, 
hence the help from drinking water. The stomach muscle needs stimulation; 
this gum-chewing supplies. 

About two hours after eating go for a walk in the open air. Walk 
slowly for a while. After you have got well under way, begin to move 
faster. Do not come in until you have burned up the surplus. 

If you begin to sneeze, be certain to get out into the fresh air. 

Finally, if you wish to escape a bilious spell the next day, take a dose of 
castor oil before retiring. 

FOOD VALUES 

For the benefit of those who desire to regulate their diet for some one 
of many reasons a list of the more common foods, with their heat unit, or 
calorie, value is given. Much of the information is taken from Atwater's 
"Principles of Nutrition and Nutritive Value of Food" (Farmers' Bulletin 
142, Department of Agriculture). 

Calories. 

Bread, one ounce (one slice) 80 

Lean bacon (one slice) 65 

Small lamb chop, broiled (about one-eighth of a pound) 92 

Medium size pork chop (about one-sixth of a pound) 150 

Beef, one pound (five helpings) 1,000 

Potato of medium size 240 

Milk, one-half a pint 140 

Buttermilk, one-half a pint 100 

Butter, one inch cube 140 

One lump of sugar (heaping teaspoonful) 40 

One inch cube of American cheese 100 

One teacup of mashed potato 180 

One teaspoonful of cream 20 

One egg 70 

Peas, heaping teaspoonful (fresh or canned) 25 

Beans, heaping teaspoonful (dried) 90 

Apple, medium sized 60 

Orange, medium sized 50 

Banana 50 

Dried fruit, saucerful 150 

One rice croquette 150 



494 FOODS 

Calories. 

One teacup bread pudding 150 

Combination salad, oil dressing (one helping) 75 

Vegetable soup, one portion 150 

Chicken soup, one cup 60 

Oyster (large), one 10 

One Parker house roll 110 

Cocoa (powder) , 40 

Chocolate (powder) 90 

The average man working at moderately hard labor requires about four 
ounces of proteids, three ounces of fats, and eighteen ounces of carbohydrates. 
In the selection of a diet in order to maintain a proper food balance this re- 
lation should be approximately maintained. 

Graham Lusk tells us that "it is evident that a hard working, laboring 
man requires 3,500 calories daily in his diet in order that he shall have 
fuel for the maintenance of his life and for furnishing power to accomplish 
his daily tasks." Those doing light, muscular work require about 2,500 
calories. 

Lusk gives a table of the number of calories for a family of five : 

Calories. 

Father, a clerk 2,500 

Mother 2,500 

Son, nine years 1,250 

Daughter, six years 1,000 

Baby, one month , 500 

7,750 

Economical Dishes. — We are again told that the baby death rate de- 
pends upon the earnings of the family. This time the telling is based 
upon an investigation made at Montclair, New Jersey. The same story has 
come from so many sources that we are safe in accepting it as a fact that the 
largest single factor in baby death rate is the family earnings. 

Money buys other things needed by a baby, but a considerable part of 
the baby death rate among the poor is because not enough money is spent 
directly and indirectly for the babies' food. But the relation between 
food and health embraces much more than baby food. The leading health 
departments in every portion of the world know that there is a. relation 
between the food, its cost, its quantity and its quality, and health. 

When it comes to personal hygiene, thousands are interested. The in- 
comes of many are so small that, they must be careful in their expenditures 
for food. They want to know what foods furnish ample nutrition for a small 
sum. 

Taken as a class, pastries and desserts furnish the largest amount 
of energy for five cents. Analyzing forty-seven pastry orders bought at well- 
known moderate priced restaurants, Mr. Kephart found that five cents bought 
an average of 233 calories. The most economical was Napoleon — 453.6 
calories. The least economical was strawberry shortcake — 91.8 calories. Nutri- 



FOOD VALUES 495 

tion as shortcake was five times as expensive as that of Napoleon. Other 
classifications were as follows : 

Average calories in 24 orders of beans 204.5 

Average calories in 56 orders of sandwiches 180.3 

Average calories in 12 orders of dairy dishes 174.4 

Average calories in 87 orders of meats • 174.1 

Average calories in 44 orders of miscellaneous 164.7 

Average calories in 6 orders of oysters 149.4 

Average calories in 33 orders of eggs 140.7 

Average calories in 4 orders of salads 135.9 

Average calories in 17 orders of soups 116.0 

Average calories in 14 orders of fruits 88.8 

The most economical pastries and desserts were Napoleons, crullers, and 
cabinet pudding with vanilla sauce. The most expensive were strawberry 
shortcake, strawberry ice cream, strawberry corn starch with whipped cream, 
cup custard, and pineapple fruit jelly with whipped cream. 

The most economical bean dishes were Boston baked beans and Boston 
pork and beans. The most uneconomical were Boston beans on the side 
and New York pork and beans. 

The most economical sandwiches were roast beaf sandwich with a roll, 
minced ham sandwich with bread and butter, and ham sandwich with a 
roll. The most uneconomical were chicken sandwich, club sandwich, and 
hot roast beef sandwich. 

The most economical dairy dishes were milk crackers and Graham 
crackers. The most uneconomical were the various forms of breakfast 
cereals. 

The most economical meats were lamb croquettes with mashed^ potatoes, 
German meat cakes with French fried potatoes, and Vienna roast with 
French fried potatoes. The most uneconomical were deviled crabs, sirloin 
steak with onions, and tenderloin steak. 

The most economical forms of egg dishes were plain omelet and tomato 
omelet. The most uneconomical were two poached eggs and chicken omelet. 
The omelet orders included bread and butter. 

The most economical salad was potato salad. The least economical salads 
were crabmeat, tuna fish, and egg. 

The most economical soups were beef stew and lamb stew. The least 
economical were tomato soup with rice, bean soup, and vegetable soup 
with bread and butter. 

Eaw oysters were very uneconomical; fried oysters and oyster pie made 
a better showing on account of the flour and grease added to them. 

The most economical vegetables were stewed corn and creamed asparagus 
on toast. The least economical were sliced tomatoes and tomatoes and lettuce 
with dressing. The most economical fruit was baked apple with or without 
cream. The least economical fruits were sliced pineapple and cantaloupe. 

The pastry in :'rawberry shortcake and other fruit and pastry dishes 
consists of cooked starch, a little raw starch, sugar, a fat and albumin. The 
berries consist of some raw starch, sugar, and two fruit acids, malic and 
citric. The percentage of starch in berries is about 7. Thompson gives the 



496 FOODS 

proportion of sugar to acid as 4.4 to 1. The milk contains fat, sugar, and 
albumin. Sugar contains sugar only. 

On account of the large proportion of pastry to berries the mixture 
is but slightly acid. The acidity is due to weak organic acids. The point I 
wish to make is that the acidity is not great enough nor the acids power- 
ful enough to interfere materially with the digestion of starch. As 
sugars are absorbed -unchanged just as they are, they do not need to be con- 
sidered. 

The starches must be converted into sugars before they can be absorbed. 
An out and out starch is called a polysaccharid. A starch halfway to sugar 
is called a disaccharid. The straight sugars are called monosaccharids. 
When starch is eaten it is first converted into a disaccharid and then into 
a monosaccharid, whereupon it is absorbed. Sugars, being monosaccharids, 
are absorbed without change. 

The juices which bring about the changes in the polysaccharid starches 
are the saliva, the pancreatic juice, the intestinal juice, and a ferment in the 
interior of the cells of the intestinal wall. 

The known ferments which do the work are the amylose and maltose. 
Amylose converts the polysaccharid into disaccharid, and the maltose changes 
the disaccharid into a monosaccharid. 

Starches are best digested by ferments in mixtures that are weakly 
acid. When the acid becomes too strong starch digestion stops. When pastry 
is chewed saliva is mixed with it. The amylose and maltose begin to convert 
the starch first into maltose and then into glucose. 

In the mouth little digestion occurs, as the time is too short. Digestion 
proceeds in the stomach until the percentage of free acid surpasses 1-10 of 1 
per cent. When it reaches 2/10 of 1 per cent digestion stops. 

From 5 to 25 per cent of the starch eaten is digested in the stomach, 
the percentage occurring in the mouth being too small to be estimated. 

The work of the stomach having been finished, the food passes into 
the intestines. Here the starch digestion is resumed by the pancreatic and 
intestinal juices. These juices as starch digesters are much more powerful 
than is the saliva. In addition, the food is kept in contact with these ferments 
for several hours instead of minutes, as is the case with the saliva. 

Now how do the people who hold that strawberry shortcake cannot 
be digested go wrong? They assume that because a strong mineral acid, 
muriatic, when as strong as 2/10 of 1 per cent, stops starch digestion, 
the weak acid of strawberries will also stop it. We make a mistake when 
we conclude that because muriatic acid will cause a certain effect, malic acid 
will do likewise; also that because a high acidity (2 per cent) will cause a 
certain effect, a low acidity will do likewise. 

All the salivary digestion that occurs takes place in the stomach where 
the contents are always more acid than strawberry shortcake ever is. The 
greater part of starch digestion is done in the small intestine after the acid 
of the stomach has been neutralized. Neutralizing the acid of strawberry 
shortcake is child's play as compared with neutralizing the muriatic acid of 
the stomach juice. 

If anybody tells you that breaking down the polysaccharid starch to disac- 
charid is done only by the saliva and that that is the difficult part of starcti 



FOOD VALUES 497 

digestion tell him that he does not know what he is talking about and you 
can prove it. 

Taylor says (and there is no better authority) that the mouth is essentially 
an organ of trituration, not of digestion. Starch digestion is essentially a 
function of the small intestine and pancreas. In the presence of the master 
acid, that of the gastric juice, the acid of strawberries is a puling paralytic, 
to use the language of Colonel Watterson. 

Finally, if the starch of strawberry shortcake did not digest it would 
be found in the feces. Examination does not show it there. 

Starches digest best when the mixture is slightly acid and a fair propor- 
tion of the starch eaten is digested in the stomach in which the mixture is 
acid. When the free muriatic acid present equals 1 to 500 of starch, digestion 
stops but the starch digestion is resumed when the stomach acid has been 
neutralized. Most of the starch is digested in the intestine. If the intestine 
neutralizes the strong acid of the stomach and digests starch, where is the 
difficulty in neutralizing fruit acid? 

In taking the position that starchy foods and fruit eaten together are 
not harmful, I do not overlook that some people are harmed by the com- 
bination. For several years, without much contradiction, the statement has 
been widely circulated that such a combination was harmful to digestion. 
A great many people have accepted the statement as true, because it has 
not been contradicted. That is the largest factor in the belief. But some 
people are actually harmed. Why? 

In the first place some people are poisoned by fruits. This is especially 
true of strawberries with these people. With them it is an idiosyncrasy. They 
are harmed. 

Some forms of fruit, especially fruit not quite ripe, contain a good 
deal of starch. As the fruit is eaten uncooked, the starch is raw starch. 
Raw starch is hard to digest. It is especially difficult for some people. 
The starch which fails to digest in the stomach and in the small intestine 
passes beyond the limits where the digestive juices are active; whereupon 
it is seized upon by bacteria and fermentative processes ensue. 

Some harm results from eating fruit and starch by reason of the fermenta- 
tion of undigested starch within the intestines. 

Of more importance are the results of the digestion and absorption of 
more starch than the system needs — a surfeiting of the system with sugars 
derived from starches. One very important disease is due to too much 
sugar — diabetes. In this disease the kidneys eliminate the sugar from the 
blood. 

Diabetes is not a kidney disease. One theory as to the cause of diabetes 
is that glucose, instead of pouring through the liver and being there changed, 
is poured into another set of ducts, called the lacteals, and by these is trans- 
ported to a large duct which pours its contents directly into the blood. 
In other words that glucose has found a by-pass into the general blood 
stream by which it escapes the liver. 

Another theory is that the liver is overwhelmed by the great amount 
of glucose brought to it and allows some of it to go by unchanged. There 
are still other theories. Whatever the theory may be, the fact is that in 
most cases of diabetes the body is suffering from too much sugar, the result 



498 FOODS 

of the digestion of too much starch and the absorption of too much sugar 
from starch and other sources. 

A large proportion of the people eat too much starch. Bread is 
thrown in, and they eat it without limit; or, having eaten a heavy meal, 
they eat strawberry shortcake or some fruit and starch concoction on top of 
it. Some of these have diabetes; more suffer in other ways. 

With. this group the trouble is not with the digestion of starch. The 
trouble is that they overeat, overdigest, and overassimilate starch and sugar. 

Salt in Food. — The body of a man of average size contains about 1,500 
grains, or about three ounces, of salt. This mineral forms a part of the 
tissues and some of it wastes with the ordinary wear of the tissues. Ex- 
perimenters have found that when a man is fed on salt-free food he throws 
off sixty-nine grains of salt the first day, thirty-seven grains the second, 
twenty-two the third, and three on the thirteenth. This salt represented 
the wear of tissue cells of which salt was one of the ingredients. 

A fasting man will excrete 150 to 200 grains of salt. The amount of 
salt in the excretions above these amounts represents excess of salt in the 
food. 

Salt taken in with food goes in part to the cells to replace that lost 
by wear. The excess passes from the body unchanged, forming one of the 
ingredients of the excretions. Herbivorous animals need to get salt in addi- 
tion to their ordinary food. Wild animals will not remain in a country 
where they cannot find salt licks. On the other hand, countries that abound 
in licks abound in wild animals of the grass eating kind, whenever other 
conditions are fair. 

Meat eating wild ( animals do not care for outside sources of salt. 
They get enough salt from the blood and flesh of the kills. Cy De Vry will 
tell you that he salts his herbivorous, but not his carnivorous animals. 

Since man eats a mixed diet he needs some salt in addition to that 
derived from his food supply. But Bunge is authority for the statement 
that, given an inch, he takes an ell. He says: 

"The use of salt enables us to employ a greater variety of the earth's 
products as food than we could do without it/' 

At the same time he holds that "we are accustomed to taking far too 
much salt with our viands. Salt is not only an element, it is also a con- 
diment and easily lends itself, as all such things do, to abuse." 

Sherman says: "Salt equilibrium can apparently be maintained on less 
than one-fourth the amount of salt ordinarily eaten." 

The prevailing opinion now is that when scurvy develops among people 
who have been living on salt meat almost alone the disease results from 
vegetable starvation and not from excess of salt, as was thought to be the 
case at one time. 

When salt is eaten in excess the chemical is passed into the urine, the 
sweat and the bowel content without change. However, it is somewhat 
irritating to the cells through which it passes. Excess of salt causes the 
cells of the body to break down somewhat more rapidly than they normally 
would. It acts as an artificial whip to the kidney cells. It is bad judg- 
ment to stimulate the kidney cells continuously for years. 

Table salt acts somewhat as a saline purge, as would a very small daily 



FOOD VALUES 499 

dose of salts kept up for years. That, too, is bad judgment. It acts as a long- 
continued mild stimulant to the sweat glands. Perhaps the people who com- 
plain of night sweats or of sweating under the arms, may find a suggestion 
here. 

No Brain Foods. — T, J. writes to know if there is a diminishing death 
rate equaling the improvements in hygiene and sanitation. Does eating 
the livers and hearts of animals strengthen the same organs in the person 
eating ? 

Reply. — 1. The death rates are much lower than they formerly were. 
The Chicago death rate for 1881 was 26. That of 1911 will be under 15. 
Figures for the years before 1881 are not accurate enough to be taken 
unreservedly. 

The sickness rate is less, but we cannot say how much less. About 
the only entire sickness figures of value are those furnished by the armies 
and by controlled populations such as those of the canal zone. 

The best evidence of improvement was a comparison between the figures 
of the Japanese army in the war with Russia with those of the American 
armies in the Civil War, or between the United States army along the Rio 
Grande in 1911 and the same army in 1898. 

Some people know hygiene and practice it, some know it and do not 
practice it, some do not know it and do not practice it. 

The diminution of the rates does not keep pace with the growth of 
knowledge. 

2. No. An idea prevails that to nourish the brain one should eat brains ; 
to nourish the heart, eat hearts ; that a nursing woman can drink milk and 
have it pass directly to her breast for her baby. 

The idea is wrong. "When brains are eaten they are broken up by 
digestion into new chemicals, and these are built up into new substances. 
These new substances have no special affinities for the brain cells of the 
person who has eaten brains. 

The way to build up and nourish any organ is to exercise it in modera- 
tion and then to feed it food which is good along general lines. There are 
no brain foods, or heart foods, or kidney foods, or toe foods. 

Not Blood Builders. — E. E. M. writes: "Is it not true that carrots are 
Mood builders; also beets? Does not corn make heat and rice build muscle? 
It occurs to me that physicians warn against meat as producing kidney dis- 
eases. Will you kindly enlighten me as to other foods that produce red 
corpuscles? Would not boneset tea (a pint a day), a good foot bath each 
night, and a good-sized carrot or a handful of dates to keep the liver regu- 
lated, do much to aid the system in overcoming the bacilli which give 
the infection of colds?" 

Reply. — 1. Carrots and beets are not blood-builders. 

2. Meat only produces kidney irritation when eaten in excessive quan- 
tities, and is usually only one of a number of causes. 

3. The articles you name and the daily foot bath can possibly do no 
harm. Greater security can be gained against the various bacilli producing 
colds by simple living, absolute cleanliness, and up-and-about habits. 

Food Value of Grapes. — H. W. M. writes: "As many people are now 
eating grapes, would not a few suggestions as to their value as food and 
the proper* way to eat them be helpful? 1. What food value does the pulp 



500 FOODS 

alone containf 2. What food value does the shin contain? S. Should the 
pulp and shin both be swallowed? Jf. Should grape seeds be swallowed? 

5. Is there any danger of producing appendicitis by swallowing grape seeds? 

6. If there is no danger in swallowing grape seeds and grape shins, would 
they not be as beneficial to the bowels as eating agar?" 

Reply. — 1. Has some heat value, but it is not great. 

2. Practically none. 

3. Yes. 

4. Yes, after being chewed. 

5. None if the seeds are chewed. The danger is but slight under any 
circumstances. 

6. Eating grapes, pulp, skin, and seed, is an excellent cure for constipa- 
tion. 

How to Tell Butterine. — M. B. J. writes: "Is butterine, properly and 
cleanly made, a wholesome and readily digestible fat? Is it inferior to 
butter as a food? Why shoidd the poor man have to pay the national gov- 
ernment 10 cents a pound tax on his fatty food in the shape of butterine, 
while the rich man pays the national government no tax on the butter he 
consumes? Is there an easy way for the housewife and cooh to differentiate 
butter from butterine?" 

Reply. — 1. Yes. 

2. No. 

3. No reason except that the law requires it. 

4. Yes. When butterine is vigorously boiled in a spoon it sputters and 
does not foam. Butter foams but does not sputter. Get Farmers' Bulletin 
No. 131, by Patrick, on "Household Tests for Oleomargarine and Renovated 
Butter." 

Evaporated Milk. — W. K. H. writes: "Please tell me if, in the evapora- 
tion of milh, any food qualities are lost. Is the evaporated milh offered in 
the market in cans better and safer than the milh usually sold by the milh 
dealer? They claim, the evaporated milh being sterilized, there are no 
germs left to do harm." 

Reply. — For adults none of the qualities is lost. For babies there are 
certain chemical changes which make the milk not quite so well balanced 
a ration. It is safer, but not better. Evaporated milk is practically always 
germ free. 

Mixed Diet Most Helpful. — J. S. writes: "1. Is it healthy to live on 
vegetables and milh only? 

"2. Is there any record that such diet would prolong life? 

"3. Is there any truth in the statement that people living on vegetable 
diet only can withstand sichness in the same degree that people eating 
mixed foods do? 

"If. Is it possible to reduce weight by fasting thirty or forty days with- 
out injuring health? 

"5. Do you consider it wise to fast until noon and eat only two meals 
or even only one a day?" 

Reply. — 1. No. The highest opinion is that the average man thrives 
best on a mixed diet. 

2. No. The histories of men who have lived to a great age record 
that they varied their diet. 



FOOD VALUES 501 

3. Chittenden and others whose opinions are entitled to great weight 
believe that people who live on a low protein diet (generally a very small 
proportion of meat) resist certain diseases better than others. In certain 
other directions these people are less resistant. 

4. Fasting for thirty or forty days to reduce weight is as foolish a 
procedure on the one hand as gluttony on the other. The gradual reduction 
of fat by the gradual reduction of food eaten is sensible. 

5. No. It leads to overloading the stomach at the two meals. 

No Reason for It. — N. P. writes: "Will you kindly tell me why the 
eating of fresh eggs, either soft boiled or fried, act as a physic? Cream 
has the same effect. Is this liver or bowel trouble?" 

Reply. — There is no reason why fresh eggs or cream should act as a 
physic. If you have noticed the effect described frequently and carefully 
enough to be certain that it is an effect and not a coincidence, it means 
some peculiarity in your makeup, an idiosyncrasy, or else some condition 
which your physician should investigate. I should rank the chances as 
follows: Coincidence, first; idiosyncrasy, second; condition, third. 

May Eat Too Much. — H. L. writes: "I am a healthy, strong, active 
young man, but for the last two weeks upon awakening in the morning I 
find my nose has been filled with blood. I am rather worried about this." 

Reply. — You are getting up too much arterial tension. Probably you 
are eating too much. Your nosebleed helps you. It would be better, how- 
ever, to prevent it by eating less and exercising more. 

Bulk of Food. — J. R. F. writes: "Does drinking moderately of tea or 
coffee with meals help or retard digestion? In answering one of your 
inquisitors you have stated tliat, in a great many cases, lack of bulk of food 
was the main cause of constipation. Do the liquids, such as tea, coffee, 
or water, which are consumed with the meals, help to make up this bulk?" 

Reply. — 1. Moderate drinking of tea or coffee with meals will not help 
or retard digestion. 

2. Liquids do not increase the bulk of food in the sense meant in the 
answer. The bulk should be made up of vegetable and meat fiber which 
pass through not much changed. For example, the bran of wheat, unbolted 
cornmeal, the woody parts of vegetables, the rinds of fruits — substances 
which correspond to hay, fodder, stalks, and other forms of roughening in 
feeding live stock. 

Bran and Agar for Human Food. — G. W. P. writes: "Kindly tell me 
what kind of bran to use and how to cook it. What is agar?" 

Reply. — Bran for human food is put up in packages. Ordinary bran, 
as sold in the feed store, is not so nice. It can be eaten like a cereal 
uncooked, but warmed, and served with cream and sugar, or it can be 
cooked in gems. Agar is a seaweed. Any druggist can get it for you. It 
comes in rough, shreddy strips. It is eaten raw. It is to be thoroughly 
chewed. Several handfuls can be eaten a day. It is just roughage without 
taste and with no food value. It acts by increasing the bulk of the intes- 
tinal content and by taking up moisture. 

Buttermilk Tablets. — R. M. H. writes: "Can you tell me anything 
concerning certain 'buttermilk tablets' supposed to convert sweet milk into 



502 FOODS 

buttermilk in a few hours? Where are they sold? 2. Do they make butter- 
milk which is wholesome?" 

Reply. — 1. If you cannot obtain them from your druggist, have him get 
them from the manufacturers. 
2. Yes. 

Fresh Buttermilk Better. — W. W. writes: "Is freshly churned butter- 
milk good for the health? Is it as good as buttermilk which is tart?" 

Reply. — The name buttermilk is given to the milk left after churning. 
Most of the reputation of buttermilk is due to the fresh buttermilk just 
out of the churn. 

Those who live in the country we advise to stick to freshly churned 
buttermilk. The same advice is given those who live in the city and know 
where and how to get this kind of buttermilk. 

Buttermilk made from the churning of sweet cream is better than that 
made by churning sour cream. 

Buttermilk. — F. H. H. writes: "Can you tell me something about 
Chicago buttermilk? I get it at the downtown fountains. It looks and 
tastes like buttermilk of the country with small clots of butter showing 
in it. It agrees with me. I order buttermilk of my milkman — one of the 
largest dealers in the city — and I get something very thick and sour and 
so white that it looks like a mixture of chalk and water. It does not sepa- 
rate on standing as does buttermilk from the churn. I cannot digest it. 
An employee of a milk concern told me it was made of skimmed milk and 
everything else that was left over. Most doctors recommend buttermilk as a 
summer drink — a little information from you as to the different varieties 
offered I know would be welcomed by many." 

Reply. — We might divide buttermilks, in a rough way, into three kinds 
— old-fashioned churn buttermilk, culture buttermilk, and ordinary market 
buttermilk. The old-fashioned churn buttermilk had more of the fat left 
in and was usually consumed when it was fresh. Most people like it best 
of all and I think it probably was and is the most wholesome kind. If you 
can get it made in the city from a good grade of milk it is the best for you. 
Be careful that it is' not churned from left-over job-lot milk. You must 
trust to the honesty of a high-grade merchant on that point. Don't buy 
from any Tom, Dick, or Harry just because you see it churned. He may 
be feeding the churn with aged milk. 

Culture buttermilk is made from pasteurized milk to which a laboratory 
culture of lactic acid bacillus has been added. It is smoother than the 
other sort, but it generally does not taste as well. When it gets old it sours 
as does any buttermilk. It is the second best kind and it is the safest 
kind. 

Ordinary market buttermilk may be made from raw or pasteurized 
milk. The lactic acid germs in it have fallen in from the air, mostly from 
the stable air. When it gets old it sours. All buttermilk "wheys out" as 
it ages, some quicker, some slower. It is a bad sign rather than a good 
one. Buttermilk is much the best summer drink. In hot weather it beats 
sweet milk a mile and beer ten miles. But there is more difference in the 
flavor and wholesomeness and nearly as much difference in safety in 
buttermilks as there is in sweet milks. Be careful to get good butter- 
milk in good condition from a good dealer. 



FOOD VALUES 503 

Colored Butter. — E. K. C. writes: "Is annatto coloring in butter pro- 
hibited by law? If not, is it objectionable?" 

Reply. — It is not prohibited by law. From the health standpoint it 
is not objectionable. It is the cleanest ingredient of butter. Commer- 
cially, of course, it is a means of fabrication, of making a poorer article 
look like a better article. Many of the most expensive hotels and 
restaurants now sell uncolored butter, giving the customer a chance to 
judge whether it is good or not. Probably, in time, this form of fabri- 
cation will go the way that commercial frauds seem to be headed. 

Bran Gems. — A correspondent sends in the following recipe for bran 
gems, which, she says, have proved efficacious in cases of constipation of 
long standing: 

Two cups of clean wheat bran, a little salt, one cup of graham flour, 
one cup of sour or buttermilk, one teaspoonful of baking soda, six table- 
spoonfuls of molasses. Add chopped figs or raisins to taste. Mix thor- 
oughly and bake in gem pans twenty or twenty-five minutes. This 
quantity should make not more than twelve nor less than eight gems. 
Eat one, two, or three a day, as necessary. 

Baked Beans Good Food. — A reader from Crown Point, Ind., writes: 
"Should foods that are difficult to digest, such as baked beans, be in- 
cluded in the diet of the ordinary person? Or should the diet consist 
entirely of easily digested foods? Is it possible for a person to chew 
his food too much?" 

Reply. — 1. Baked beans is a good food, easily digested and highly 
nutritious. Anyone with whom it disagrees should leave it off his bill 
of fare. 

2. Practically, no; theoretically, yes. 

Dried Fruits. — E. N. writes: "1. Do dry fruits tend to cause con- 
stipation? A doctor advised one troubled with constipation to avoid 
dry fruits. Would you so advise? 2. Why is whole wheat flour more 
healthful than fine white flour?" 

Reply. — 1. No. If you cannot get plenty of fresh fruit eat an 
abundance of dry fruit. Keep it up until May. 
2. Has more bran in it. 

Value of Oysters. — C. S. P. writes: "In making an oyster stew 
what is the minimum amount of heat required to render the oysters safe 
from any danger of infection? Why are oysters so insipid and tasteless 
as compared with a few years ago? What is their food value, by weight, 
as compared with lean beef or milk?" 

Reply. — 1. A temperature of 120° continued for twenty minutes will 
kill the typhoid germ that may be found in oysters. 

2. The taste and succulence of oysters depends upon the kind, quality, 
and quantity eaten. After eating a considerable quantity of oysters, at 
frequent intervals, the relish for them is lessened, and the palate per- 
haps is not so appreciative. We have not heard anyone else complain 
that oysters are more insipid than they formerly were. Maybe you have 
been unlucky in getting tasty ones. 

3. A pound of oysters in shell has a fuel value as food of 235 calories. 



504 FOODS 

A pound of lean beef of the various cuts has an average fuel value as 
food of about 850 calories. 

Candy Concentrated Food. — 17. G. writes: "Would a bar of choco- 
late a day injure me in any way? What benefit is candy to a person?" 

Keply. — 1. No. 

2. Candy is concentrated food, particularly heat-making food. It is 
bad for diabetics, and also for those who are overfat. If a man has 
trouble in keeping from overeating, a little candy half an hour before 
eating will take some appetite away. Banquets arranged on a gor- 
mandizing basis would do less harm if candy, instead of cocktails, were 
served fifteen minutes before each meal. 

Cottonseed Meal. — R. S. H. writes: "I have been informed that cot- 
tonseed meal is prepared the same as evaporated corn. The seed is first 
steamed for an hour under pressure of 120 pounds to remove the phos- 
phoric acid and soften the hulls. Then it is thoroughly dried by being 
heated with air passing over pipes at a temperature of 850 degrees. 
It takes about half an hour of this treatment, and, when cool, the seed 
can be ground into meal. There is another plant which has a very high 
protein content which makes an excellent soup or salad. It is the hudzu 
vine, which grows on thousands of porches through the Middle West. 
As it carries as much protein as beef, or mutton, or chicken, it can be 
used as soup stock, and in salad will take the place of chicken. Five 
cents' worth of seed will supply a family with all the plants needed for 
the summer's use, and, if the leaves and stems are cured and stored in 
the attic, they can be used all winter for soup slock or with potatoes and 
onions as a salad. It is a Japanese plant and is said to have carried 
the Japs through several severe famines during the last few centuries. 
In the hot moist summers of the gulf states it grows with remarkable 
rapidity and is extensively used as pasture for stock; but it is too val- 
uable for stock feed at this time, when there is such a scarcity of protein 
in the food the poor are forced to consume." 

Reply. — The literature on cottonseed meal and flour which has re- 
cently come to my attention advises the use of four parts ordinary meal 
to one part of the cottonseed product. Cottonseed products are of great 
nutritional value, and it is to be hoped that the objections to them as 
such have been removed. 

Cottonseed Oil Nutritive. — F. E. C. writes: "Is there any nutritive 
value to cottonseed oil? The magazines say so much about the adultera- 
tion of olive oil with this product that it has raised a lively curiosity in 
my mind. I priced a registered brand of olive oil, and it was 95 cents 
a quart; then asked for cottonseed oil and vms shown a bottle labeled 
salad oil. This was 35 cents. Do you recommend olive oil as a part of 
the daily diet of ordinary people or is it for special cases only?" 

Reply. — 1. Cottonseed oil is just as nutritious as olive oil, but lacks 
the fine flavor of the latter. 

2. Olive oil, as usually found on the market, is most always adul- 
terated, containing cottonseed oil. The fraud in this instance is more 
of an economic and moral issue. It is put up in fancy bottles with 
gaudy labels and sold as imported. The bad French sometimes displayed 



FOOD VALUES 505 

on the labels frequently testifies to the adulteration of the domestic 
product. 

3. Olive oil may be used as a part of the daily diet with salads. 

Foodstuffs. — J. W. C. of Utah writes : "Nature has provided many ways 
of keeping well, and probably if all its laws were strictly observed as to 
body and mind, there would be less work for the doctors. It is said 
various foods, both animal and vegetable, contain certain chemical ele- 
ments which are necessary to good health and proper functional opera- 
tions of the human body. Whether this is true or not I know not. 
I know that asparagus gives a very decided odor to the urine, whether 
beneficial or not I cannot say. Fish has been said to provide brain food 
and strawberries and lettuce iron. I have understood that administration 
of lime in some form or other to growing children improves their bones. 
What I would like especially to know is whether there is anything ad- 
ministered either as a medicine or through elimination from foodstuffs 
which will retard to any considerable extent the decay or diminution 
of usual functions of the bones with regard to the nerves; and if so, I 
would like to know what it is and how administered. In other words, 
to keep the bones in the condition they are at 50 years of age in status 
quo as long as possible. The bones of some are 0. K. at 80 to 90 years." 

Reply. — I think it is definitely proved that the claims that certain 
foods feed certain organs and that by giving certain foods you stimulate 
the growth or function of certain organs are fallacious. The men who 
advertise to do these things are quacks. In fact, people having become 
too intelligent for the old style quackery, the born quacks are exploiting 
this field. 

This matter of bone foods lends itself to investigation. Stock men 
have tried it from every angle and they have found there is nothing in 
it. Of course, absolute lime starvation results in harm, but a certain 
minimum quantity of assimilable lime having been reached any changes 
made above that make no difference either way. 

Another field thoroughly explored by the stock men is that of foods 
to produce milk, particularly cow's milk. What counts is the cow — her 
inheritance, her digestion, and her health. If she is starved, her milk 
product suffers with her other functions but, given enough food of proper 
balance and easy of digestion, her milk is not influenced by varying the 
articles therein. There are no brain foods or bone foods. 

Water at Meals. — /. writes: "Will you kindly publish the name of a 
good book on diet, something concise? What is the latest conclusion as 
to eating meat? I notice you advise drinking water between meals. 
What ill effect is there from drinking a pint [two glasses'] per meal? 
What advantage is there in refraining from this and drinking between 
meals?" 

Reply. — 1. "The Fundamental Basis of Nutrition," by Lusk; price, 
50 cents. 

2. There is no general conclusion, and there is no machinery for 
arriving at any. Some writers hold one way and some another. The 
subject is handled well by Lusk. 

3. A moderate amount of fluids with meals does no harm; it doe* 
good. Too much retards digestion by overdistending the stomach and 
oyerdiluting the gastric juice. One pint is not too much. 



506 



FOODS 



Tomatoes Not Harmful. — C. P. J. writes: "I have read that toma- 
toes contain oxalic acid; that they destroy the iron in the blood, and 
leave the system a prey to rheumatism. I have also read that they 
contain calomel and should not be eaten to excess. Which is correct? 
Is it a fact that strawberries are indigestible and unfit for food?" 

Reply. — Someone has given you much misinformation. Tomatoes 
do not contain any harmful chemical substance. They do not cause 
rheumatism or destroy the iron in the blood. Strawberries are not indi- 
gestible. They are not unfit for food. 

No article of diet should be eaten to excess. Some people cannot 
digest strawberries. Some are poisoned by tomatoes. But the same may 
be said of milk, eggs, and meat. 

Fruit Acids Weak. — M. T. D. writes: "The statement is made that 
oranges, four to six a day, neutralize the effects of heavy smoking. Do 
you agree? It is also said that a whole grapefruit, eaten in the morning, 
will have a tendency to promote indigestion as to other foods eaten at 
the same meal, on account of the large amount of acids contained in the 
fruit. Will you kindly give your opinion?" 

Reply. — 1. No. 

2. Do not agree. The stomach secretion contains a much stronger 
acid than that contained in grapefruit. Fruit and vegetable acids are 
weak acids and are quickly changed into substances other than acids. 



FOOD PRESERVATION 



On one occasion Woodrow Wilson, then a candidate for president, gave 
an opinion on the benzoate question. It will be remembered that Dr. Wiley, 
making use of a poison squad, had decided that a small dose of benzoate of 

soda eaten each day with the 
food was harmful. Presi- 
dents Roosevelt and Taft had 
not indorsed the opinion of 
Dr. Wiley as he felt they 
should and he was attacking 
them. Thus benzoate became 
a matter of enough interest 
to demand an opinion from a 
candidate for the presidency. 
Mr. Wilson said that he 
was opposed to the use of 
benzoate in food whether Dr. 
Wiley was right or wrong. 
His reason was that by us- 
ing benzoate spoiled or over- 
ripe products could be pre- 
served and the consumer would be harmed by them. 

This statement opens up the entire question of preservatives. The 
same argument has been used against refrigeration. It has been asserted 




Farmers' Bulletin 84, Dept. of Agriculture. 

Fig. 183. — For Sterilizing by Heat, as in Canning 
Tomatoes. 



REFRIGERATION 507 

that some of those who opposed preserving with benzoate were preserving 
with peppers and spices, and that these substances not only are more harmful 
than benzoate but also are better preservatives, and therefore permit the use 
of even worse foods — an important point and an interesting one, especially as 
women have always used spices to preserve with. 

Professors Hoffman and Evans of the University of Wisconsin have 
spent some time trying to find out whether spices will preserve and how they 
compare with benzoate. They found ginger, black pepper, and cayenne of 
no service. Nutmeg and allspice have some preserving power, but not much. 

Cinnamon, cloves, and mustard are fine preservatives — even better than 
benzoate. Cinnamon and mustard would preserve even when the amount 
present did not change the taste much. They took some spoiled tomato 
catchup and tried the relative powers of cinnamon, mustard, and benzoate 
to stop further spoiling in it. They found cinnamon the best, mustard 
next, while benzoate acid was much the least efficient. 

Now, if the manufacturers want to go to school they can learn the art of 
preserving with cinnamon and mustard from the women folks who prac- 
ticed it long before anybody ever heard of benzoate. 

It is clear that there are many methods of preserving foodstuffs. 
Refrigeration is one; sterilizing and canning another. Among the chemical 
methods are preservation of meat with salt, of hams by cures, of corned 
beef with pickle, of dried beef with smoke, of tomatoes with spices and 
oils, and other foods with benzoate, and still others with boracic acid. 
Any one of them will permit the use of foods that are overripe in some 
sense. 

What are we going to do about it? I cannot see any other way out 
of it except a national licensing system, with inspectors in every food 
factory. The duty of the inspectors will be to pass on the wholesomeness of 
products that are to be preserved, embalmed, or refrigerated. 



REFRIGERATION 

In ten years the rural population of the United States increased 
4,000,000, the city population 12,000,000. In Canada the increases were 
500,000 and 1,200,000 respectively. 

"This movement cityward/' Dr. Mary E. Pennington of the govern- 
ment service says, "makes development of the art of refrigeration a necessity." 

Dr. Pennington has been studying market eggs all over America 
for several years and when she speaks on the subject the wise housewife 
will listen. The woman who lives close enough to the farm to hear the 
roosters crow and the hens cackle will get the best by using fresh eggs for 
ten months in the year. The rest of the world had better eat refrigerated 
eggs. 

The amount of faking in the fresh egg business makes the wooden 
nutmeg business look amateurish. Even on the farm, July and August "fresh 
eggs" are frequently "bum." The mowing machine frequently uncovers 
many an undated nest. In addition, unchilled eggs deteriorate rapidly in the 
summer heat. 



508 FOODS 

Dr. Pennington says: "We have traced eggs less than twenty-four hours 
old, shipped by express in a hot car nineteen hours, and found them lower in 
quality when they reached the market than fresh eggs shipped for a six day 
haul in a refrigerator car." 

And elsewhere — "The summer egg, as it comes now to the packing 
house, is at best a very unsatisfactory product to ship on long hauls. More 
and more one finds the packer who is supplied with refrigerator rooms 
holding back a few carloads of late May or early June eggs to be sent to 
his clamoring customers in August or September when the egg supply 
is the worst of the whole year and when the highest grade eggs on the 
market are those cold stored in the early spring." 

Eggs begin to go stale immediately upon being laid. The rate of de- 
terioration depends upon the temperature at which they are kept, and in 
some measure upon how well they were cleaned immediately upon being 
gathered. The warm pantry of the farmer's wife, the hot store of the country 
merchant, the hot ride in a hot car, the hot places in which they are kept 
in the city, all suffice to cause a loss of 10 per cent before the eggs get to 
the customers. Of course, they go stale continuously after they get to 
the kitchen, unless they are kept in the refrigerator. This 10 per cent 
loss referred to only means the loss from decomposed eggs. The loss of 
freshness of taste cannot be computed. 

When the farmer gathers eggs they should be chilled to as near 40° 
as they can be. As soon as possible they should be placed in a moist, 
ventilated, chill room held at 40°. They should go to market in a refrigerator 
car, iced but not salted. 

If they are not chilled before shipping it will take four or five days 
to reduce the egg temperature to the car temperature. All the while de- 
terioration is going on. They should be held at 40° in the stores. Eggs 
handled in this way will keep for nine months and may even keep longer. 
Such eggs in the city will average better than city fresh eggs. 



COLD STORAGE 

At one of its meetings not long ago the American Public Health As- 
sociation received a report from its committee on cold storage. At the same 
meeting Professor Barnard read a paper on "Cold Storage in Eelation to the 
Food Supply" in the course of which he indicated the nature of a report to 
be made to the National Association of Food Officials by a committee appointed 
to draft a model cold storage bill. 

I think the conclusion is justified that these two organizations, national 
in scope and composed of men and women of character and standing, are in 
favor of cold storage under proper regulation. Their ideas as to regula- 
tion are set forth in the report of the public health committee. 

The first three articles of this report I omit, as they do nothing but define 
"Cold Storage," "Cold Storage Buildings," and "Articles of Food." The 
others follow: 

"4. No article of food should be placed in cold storage which is not 
mature, fresh, free from disease, or deterioration of any kind. 



COLD STORAGE 509 

"5. It is essential that all foods possessing a temperature favoring some 
degree of deterioration should be cooled to a proper temperature as rapidly 
as possible with a view to maintaining it in its natural condition of fresh- 
ness. 

"6. After placing in cold storage it is essential to successful storage that 
the temperature and humidity found best for each particular food be 
maintained as evenly as possible. 

"7. It is further essential that with certain types of food products 
circulation of air be maintained in the cold storage warehouse, and that 
an adequate amount of fresh cooled air be introduced each twenty-four 
hours; or, that the circulating air be passed through some solution depriving 
it of the volatile emanations of food. 

"8. Every storage warehouse should be constructed of such materials as 
will not cause organic emanations and in such a manner as will facilitate 
maintenance in as good sanitary condition as maintained in the most modern 
plant employing the most modern methods for the preparation and handling 
of perishable food products. 

"9. The periods of time during which food products should be allowed 
to remain in cold storage should depend upon their original freshness of 
condition, the continued maintenance of their optimum cold storage conditions, 
and on the results of further investigations on each class of food products. 

"10. It is desirable that frozen cold storage food products be raised gradu- 
ally to higher temperatures varying according to the size and nature of 
the article of food in order to preserve the tissues in their natural condi- 
tion. 

"11. Articles of food should not be returned to cold storage which have 
once been released and raised to materially higher temperatures. When 
it becomes necessary to transfer food products from one cold storage ware- 
house to another the temperature should not be allowed to rise to a point 
favoring deterioration. 

"12. In order both to maintain cold storage foods in the best condition 
possible and to preserve the credit of cold storage methods it is essential that 
municipal control of foods placed in retail stores for consumption be of the 
most practical and scientific character/' 

CONTROL OF COLD STORAGE 

Cold storage is a public servant. Like the railroads, it gets the pro- 
ducer and consumer within reach of each other. Like the railroads, it makes 
new producers for consumers and new consumers for producers. Also (but 
to a much greater extent than the railroads) it scrambles the seasons. It 
carries winter foods to the people who need them in summer; it admin- 
isters summer foods to those who in winter are liable to develop ills by reason 
of the want of them. 

Like the railroads, cold storage needs regulating. When the proposi- 
tion to regulate railroads was suggested, the railroads were not anxious 
to have the proposal succeed. The cold storage people have shown no great 
anxiety for regulation. The railroads now do not oppose some regulation, 
and some railroad officials want even more railroad regulation than now 



510 FOODS 

prevails. Eventually, the cold storage people will ask more regulation than 
governments will feel like giving. Many railroads were subsidized. Canada 
and Argentina are subsidizing certain of the cold storage equipments of 
their country. 
• So much for the industry side of the question. 

Sedgwick of the Massachusetts Institute of Technology comes out 
strongly for cold storage from the health standpoint. He says : 

"I believe that by cold storage today, rightly supervised by boards of 
health, as it should be, the public health has been and will be immensely 
promoted/' 

To the use of cold storage food Sedgwick ascribes much of the credit 
for the practical disappearance of scurvy. 

"In the past, without cold storage, the public health was endangered 
by the temptation to use food that had not been properly kept and by 
the lack of sufficient variety at certain seasons." 

Professor Barnard, food and drug commissioner of Indiana, agrees with 
Professor Sedgwick. However, he is anxious that cold storage laws should not 
pass until pure food and sanitary food laws are in efficient operation. He 
says: "The committee of the National Association of Food Officials is unani- 
mous in its belief that cold storage legislation should not antedate pure food 
and sanitary food legislation, but rather should follow and supplement it." 



ICE BOX ODORS 

The ordinary household ice box is usually neglected. People proceed 
upon the theory that the temperature of the ice box being low everything 
about it will be sanitary and healthful. There is truth in this opinion, 
but the little truth in it is overworked. Food will spoil in an ice box but the 
spoiling proceeds more slowly than at room temperature — so slowly, in fact, 
that the food is usually consumed before spoiling time has come around. 
Nevertheless, food absorbs ice box odors and, although that does no harm, it 
does no good, and nobody relishes the idea. As a rule, ice boxes smell or can be 
smelled. Sometimes the former way of putting it better expresses the ag- 
gressiveness of the odor. 

Ice box drain water has a temperature of 35° to 55°, and slimes, molds, 
and some bacteria grow well at that temperature. The jellylike masses of 
slime commonly found in the refrigerator drain is a vegetable, low temperature 
growth. The odor from this cold water growth goes into the refrigerator. 
Sometimes refrigerator drains are connected, without traps, with the sewers 
and sewer odors travel up the pipes to the refrigerator. 

In addition, the slow bacterial and chemical changes in cold food 
generate odorous gases. In the ordinary household refrigerator these gases 
flow out when the door is opened. In the large business establishment 
refrigerator, door ventilation is far from being enough. Their refrigerators 
never smell perfectly sweet. 

But the reader is more interested in the cure. 

The cure for slime in the drains is to rod them out, wash them out 
with ammonia, and then with a chlorinated lime wash. 



ICE BOX ODORS 



511 



The washing must be done periodically since nothing prevents the slime 
from growing. 

The remedy for the odors in the refrigerator proper is periodic airing 
and sunning. Antiseptic and deodorizing washes only temporize. Once 
every so often the entire outfit must be thoroughly washed out with ammonia 
water or soap and water, dried, and then so placed that the sun can shine 
into the interior for several hours. 

If the household has no ice box, one can be made from a soap box, a tin 



IN. i.UMB£« 



VENTILATING 
SPACES %IN 




■>SN££r3 OT /V£WS f>Af£4 
' S*££T or wst/rE TABL£ 
OIL CLOTH 



SIDES, ENDS ANO BOTTOrl 
OF INSlOE 0£ WOODEN BOX 
LINEO WITH HIDE fir SCHICK. 




SPACS AfOl/nlD Z/NC TANK 

to &£ jt/lleo r\/*o packeo r/c#r 

WITH S-/NE WOCO SfMVWCS . 



Health Bureau, Rochester, New York. 
Fig. 184. — Rochester Homemade Ice Box. 



can, a few newspapers, and some sawdust. To make this homemade ice 
box follow these directions : 

Take a soap box or fruit packing case. In this is placed a tin pail 
surrounded with a sheet of tin bent in circular form which makes an air space. 
Between this and the walls of the box pack sawdust. Place a pail in the 
circular chamber, place the milk bottle in the pail and pack ice round the 
bottle. Fold a dozen thicknesses of newspaper the size of the box and place 
over top with the lid. The cost for ice for a box of this kind would be 
but a few cents a day and will keep the baby's milk cool. The box as here 



512 FOODS 

suggested is practically that known as the Hess ice box, and is furnished 
by the Department of Health, New York City. 

The Chicago Health Department gives away a "Save the Baby" circular 
in which are directions for making this ice box, directions for home pasteuriz- 
ing milk and a great deal more of valuable information. 

Refrigeration. — J. K. A. writes: "1. Is one and a quarter inches of 
granulated cork enough insulation in a refrigerator? , 

"2. What should he the temperature in a first-class refrigerator? 

"3. What sort of insulation is best? • 

"Jf. Which is the better, a refrigerator made of metal or one made of 
wood? 

"5. What lining is best?" 

Keply. — 1. No. Three inches is little enough; four is better. 

2. 45° or under. 

3. Corkboard. 

4. Metal is a better heat conductor than wood. A metal refrigerator 
will require more insulation than one of wood. 

5. The lining should be metal, porcelain, glass, enamel, or some other 
easily cleaned, dirt-showing substance. 

To Cleanse Refrigerator. — M. writes: "My refrigerator has an odor, 
although I think I keep it clean. Can you tell me how to get rid of 
the odor?" 

Reply. — Empty and scrub ail parts inside with soap and water. 
Then sprinkle with chlorid of lime and add enough water to make a 
paste. Scrub thoroughly with this paste and then rinse thoroughly with 
boiling water. Put some of the chlorid of lime in the pipes and pour 
some boiling water through them. Then leave open for twenty-four 
hours, sunning if possible. 



CHAPTEE XXIX 

Milk 

COW'S MILK 

Cow's milk enters largely into the food supply of the present day. Its 
products — butter and cheese, condensed milk, malted milk, and ice cream — 
are among the staples. It is used in the culinary department of every house- 
hold in many ways. Its most important use as a food is in the raw state 
and especially by children. 

Any criticism that applies to raw milk as a food for children applies 
also to adults but in lesser degree for with adults it rarely is the sole article 
of diet at any meal and in any evil event adults are better able to withstand 
the harm it may do than children are. 

It is claimed for cow's milk that it is a natural human food; that it 
contains the necessary elements of nourishment ; and that it is easily digested 
and is especially commended in the diet of children. 

These ideas of milk gained currency in the days when practically every- 
body kept his own cows, when the milk was obtained twice every day and was 
consumed while it was fresh. It was not then necessary that any of it should 
be more than twelve hours old and much of it could be used before it was 
two hours old. 

City dwellers rarely get their milk now before it is twenty-four hours old. 
Some of it is not used before it is seventy-two hours old and sometimes it is 
still older. m 

Nature provides that milk go direct from the mother to the offspring 
without exposure to the air or to any contamination and without change of 
temperature; and it may be laid down as an elementary principle that the 
nearer we keep to nature and its methods the nearer we are to being right. 

Bacteria grow and multiply in cow's milk at room temperature with great 
rapidity. In addition to the filth bacteria of the barnyard, milk may become 
infected with the germs of contagious disease. 

The older the milk the greater has become the increase of the infection; 
and the larger the dose of such infection the more certain is the development 
of the disease in the victim who drinks it and naturally the more virulent the 
attack will be. 

If the milk be consumed within a few hours after the milking time 
and before any germ has had time to multiply the disease may be escaped; 
or if contracted the chance of recovery will be greatly increased. 

Epidemics of typhoid fever and scarlet fever have been traced directly 
to the milk supply where persons suffering from these diseases handled the 
milk and infected it at the dairy. 

513 



514 



MILK 



Cow's milk begins to deteriorate as to its digestibility and wholesome- 
ness from the moment it has been exposed to the air. Under the best methods 
of production it has caught up from the air from 300 to 1,000 bacteria to 
each teaspoonful. In twenty-four hours, unless checked by cold, they have 
multiplied to 1,000,000 or even more to the teaspoonful. 

Many of these germs are the bacteria of stable manure and when taken 
in large numbers are irritating to the stomach and intestines of infants. 

They cause vomiting and diarrhea, a disease of children which is com- 
monly called "summer complaint.-" It is highly fatal in hot summer weather 
and occurs in the bottle-fed more or less all through the year. 



AGE OF MILK 

For six hours after cow's milk is drawn bacteria do not grow readily in 
it, which indicates that until it is six hours old it has some power to retard 

the growth of germs. 
After milk is six hours 
old the bacteria multiply 
hour by hour in increas- 
ing ratio until it becomes 
sour. 

The exact age at 
which milk becomes sour 
to the taste depends upon 
the amount of dirt bac- 
teria that get into it at 
milking and its tempera- 
ture. 

In summer heat it 
may sour within twenty- 
four hours. If it is clean 
to start with and if it is 
speedily reduced in tem- 
perature to 50° Fahren- 
heit or below and con- 
stantly kept at that tem- 




New York Health Dept. 

Fig. 185. — Straus Home Pasteurizer. 



perature it will keep from souring for several days. 

It must, however, be kept in mind that long before it is sour to the taste 
it is dangerous for children's diet. As the uncountable generations of bacteria 
multiply, live, and die they consume much of the nutrient principle of the 
milk and leave the useless, if not toxic, properties of their dead still in the milk. 

Such milk is less nourishing for adults and to expect a child, with its 
delicate digestion, to thrive when fed with it is wholly irrational. 

As milk stands the cream rises and it can never again be mixed as com- 
pletely as it was originally. This is an additional reason for using it fresh. 

Consumers of milk must learn that poor milk or cheap milk is worth 
nothing as an article of diet. It is even worth less than nothing for it cer- 
tainly will disarrange a delicate stomach while new, fresh milk produced 
under clean conditions from healthy cows is of priceless value if used as an 
article of diet for the young. 



COW'S MILK 515 

Six-hour-old milk is worth very much more than twelve-hour milk. 
Twelve-hour milk is worth double that of forty-eight-hour milk; while milk 
more than forty-eight hours old is not fit diet for children except that it be 
produced and constantly kept under the most favorable conditions. 

AS INFANT DIET 

Milk in nature is infant diet only. Not alone is this true of man but 
throughout the animal kingdom. As the young grow the teeth appear and 
they should be used on solid food. Liquid food may be a useful adjunct 
but it should not predominate. 

Physicians sometimes prescribe milk for adults; but it may be pointed 
out that in patients sick with typhoid fever (where a milk diet has had its 
greatest vogue with physicians) the infant conditions in some particulars are 
again set up — the patient is helpless and partakes of no other food. 

Even in the treatment of this disease medical opinion is changing and 
milk as a sole diet has fewer advocates than formerly. 

Milk is repugnant to many people and often is quite indigestible in both 
young and old even at its best. 

MILK PRODUCTION 

As a substitute for mother's milk in the feeding of infants fresh pure 
cow's milk modified in strength to suit each child stands at the head of the 
list of infant foods. For this reason the character of a city's milk supply is 
of vital importance and every effort should be put forth to reduce the hours 
between the milking time in the country and the time of delivery to the 
consumer in the city. 

In modern dairies the cows are almost wholly stall-fed all through the 
year. They are permitted to graze as a rule for two or three months in the 
year, but dairymen do not attach much importance to the value of grass as 
food for milk cows. 

The balance of the year the cows are stall-fed and are turned into a 
paddock every day for air and exercise — and this seems to answer every 
purpose. 

There is a growing feeling among dairymen that grazing is not advan- 
tageous to the herd from the food standpoint and that grazing is the least 
profitable use for arable land. 

If it ultimately be demonstrated that cows can get along healthfully 
without grazing the dairies may be moved nearer to or even within the limits 
of the city. 

If this were done it would permit of delivery to consumers twice a day. 
Milk then would never be more than twelve hours old and it would permit 
of delivery within three or four hours of the time of milking. 

MILK TRANSPORTATION 

The milk of cities is produced mostly within a radius of fifty miles. The 
milk of the night before and that of the morning are brought to the railroad 
station in the forenoon. 





70 percent of city babies get their 
food through a tube 60 miles long. 

It takes about 36 hours — often 
42 hours — for the milk to run from 
the cow end of the tube to the 
baby end of the tube. 

This tube is open in many places 
and baby's food is frequently pol- 
luted. It is often wrongly kept in 
overheated places. 

Then there may be a diseased 
cow at the country end of the tube. 

And Yet Some People Wonder Why 
So Many Babies Die ! 

On the other hand the mother- 
fed baby gets its milk fresh, pure 
and healthful — no germs can get 
into it. 

To Lessen Baby Deaths Let Us Have 
More Mother-Fed Babies. 

You can't improve on God's plan. 
For Your Baby's Sake— Nurse It! 



PRE5H W. **- 



J 



Fig. 186. 
516 



Chicago Health Department. 



COW'S MILK 



517 



The milk reaches the city between noon and three or four o'clock in the 
afternoon and is delivered to the consumer the following morning. 

Half of the milk, then, is twenty-four hours old and half thirty-six hours 
old before it reaches the consumer and, as there is but one delivery a day, 
half of the milk is forty-eight hours old and half is sixty hours old before 
it is used and before the next delivery is made. 

Such delay in shipping milk so short a distance is unpardonable in this 
day and age and it is* death to the babies. 

Shipping milk by steam railroads is altogether too clumsy a method. 
Electric lines could do better. They can make as much speed while run- 
ning as the steam roads and by running over the city's system of passenger 
transportation they could deliver the milk at widely distributed points in 
the city. 

While the electric lines were hauling milk they could haul in addition 
eggs and garden truck and other things that are only at their best when 
fresh. 

CITY DELIVERY OF MILK 

So long as there is but one delivery of milk a day from the country there 
is not much sense in hauling milk twice a day to the consumer. The milk- 
man properly argues that there is no gain in bringing back to the consumer 
the same milk that he had at his door in the morning. 

HtRLb A Cheap Home-Made: let Box 

CotX 30 cer?t6 ; Ice, 2 centt pef db^ 




Department cj VjefcltK Cb«ca$c>^ 



Fig. 187. 

His argument cannot be disputed when the consumer owns an ice box, 
but it is another story in the homes of the poor who cannot afford the luxury 
of an ice box. A twelve-hour supply cannot be cared for without ice during 
the hot months of the summer. 

If we are to have but one delivery a day why not have the milk delivered 
in the evening instead of in the morning? That would put the milk into the 
hands of mothers twelve hours earlier and add mightily to the chances of 
the babies. 

It would have other advantages. The delivery wagons in large cities now 
start upon their routes at the unearthly hour of two o'clock in the morning 
and are through in time to go to the railroad station to remove the fresh 



518 MILK 

supply from the cars and haul it to the depots of the dealer. Everybody then 
rests while the milk goes on aging until the following morning. 

It would be more sensible to deliver the milk in the afternoon and eve- 
ning when the household is awake to take care of it instead of putting it on 
the doorstep at two, three, four, and five o'clock in the morning to freeze and 
break in the wintertime or sizzle and rot in the morning sun of the summer. 

It would be worth something to the sick, suffering, and sleepless ones 
to be rid of the noise of the rattling wagons in the early morning hours. 

One naturally wonders why the delivery wagons should not meet the 
trains at the depot when they arrive from the country and start at once with 
the milk to the consumer. Why should it be loaded on the wagon, hauled to 
a depot, allowed to rest twelve hours or more, and then be reloaded again 
for delivery? 

One more item of error in the delivery of milk is that of too many dealers 
with interlacing territory for delivery. One may see the wagons of half a 
dozen different dealers deliver milk in the same block. 

Upon whom does all this delay and extra cost fall ultimately? It falls 
upon the helpless infants. 

The trouble with the whole retail milk business is that it is gauged upon 
the culinary needs of milk and is not sufficiently considered from the standpoint 
of the babies' welfare. 

INDORSED MILK REPORT 

The American Public Health Association indorsed the report of the Milk 
Standard Commission of the New York Milk Committee. It had been 
rumored that there was to be opposition to the adoption of this report. The 
International Milk Dealers' Association sent a representative to the meeting 
and he traveled there in company with certain men known to be opposed to 
adoption of the report by the association. 

When the report came up for consideration it was opposed by two speak- 
ers. One declared himself in favor of the principles of the report though he 
was not in favor of certain details. His objection was to the precedent estab- 
lished by the action. 

For many years the laboratory section has been getting out standards. 
Being reports on laboratory methods by the laboratory section they had never 
gone into administrative methods. They had covered such standard methods 
as those for the analysis of water, air and milk. The public health officers' 
section had never reported any standard methods. In consequence the asso- 
ciation had not gone on record in recent years as approving any administrative 
method. 

The second speaker objected to allowing the sale of grade C milk. Grade 
C milk is milk for cooking purposes. It is allowed to contain one million 
bacteria before pasteurization. In cities where the milk is more than a day 
old before it is delivered a large percentage of the milk is grade C. 

If this milk is not allowed on the market the supply will be far less than 
the demand and the price of milk will be doubled. The report allowed this 
milk to be used for certain purposes after being properly pasteurized. 

These were the only two speakers against the report. The Association, 



MILK STORE SCORE CARD 519 

having listened to the objections, voted to approve the report. The American 
Veterinary Association had approved it the week before. It is very much to be 
hoped that the International Milk Dealers' Association will approve it when 
it meets in December. 

After some years of talk the authorities adopted chemical standards for 
milk several years ago. At first the milk dealers opposed those standards 
because they did not know much about buttermilk percentage ; they knew the 
farmer did not and, all in all. they did not see how they could conform. 
Xow every up to date farmer has his hand Babcock and knows about the 
chemical standards. He has found that they are the very backbone of the 
business. 

After many years of talk it is now proposed to establish sanitary stand- 
ards. The way to measure the fat of 'milk was a chemical-mechanical test 
known as the Babcock. The way to judge of whether the milk is clean, fresh 
and cold is by the bacteriological test. The dealers are somewhat afraid of 
it as they were a generation ago of the fat test. In time it will be the salva- 
tion of the business. Standards should be expected to advance at least one 
step in a generation. 

MILK STORE SCORE CARD 

The Department of Agriculture does not think bulk milk should be sold. 
By bulk milk is meant milk that is shipped or hauled into town in cans 
and then, without being bottled, is loaded into wagons or kept in stores. 
When the customer buys a few cents' worth the dealer dips into the can with 
a ladle and fills a bottle brought by the customer. This latter part of the 
custom is responsible for the name, dipped milk, by which the commodity 
is known in some towns. 

The Department of Agriculture has found that bulk milk means dead 
babies. Milk is too delicate. It will not keep when the dealer is constantly 
taking the lid off and dipping the ladle in. The milk, started bad, is made 
worse by the dirty bucket or bottle into which it is put and the warm room 
in which it is kept. 

The agricultural department has watched thousands of babies indirectly 
for years and it knows. But the poor woman who has watched but one or 
two babies does not know and she has no way of finding out until it is 
too late. 

Knowing that the selling of bulk milk in stores cannot be stopped at 
once the department has compiled a score card for use in such stores. It 
describes this card in Circular Xo. 217, Bureau of Animal Industry. 

The dairy farm score card started with a score card devised by Health 
Commissioner Woodward of Washington. It has been perfected and pushed 
by the Department of Agriculture until it is in general use all over the 
country. 

The milk store score card cannot be so effective but while a town is 
accumulating public sentiment against dipped milk its use will help to keep 
the death rate down. 

On the score card 100 is perfect. If the utensils are steamed and thor- 
oughly cleaned and kept so the fact counts 20. If the store is properly 



520 MILK 

equipped to clean and sterilize the utensils it counts 15 — a total of 35 for 

utensils that are right. A good ice box counts 10 ; cleanliness of the ice box, 
3; placed on ice as soon as received, 5; temperature of milk below 50°, 10; 
51° to 55°, 8; 56° to 60°, 5; 61° to 65°, 2; a total of 28 for proper attention 
to cooling. 

The remaining thirty-seven points are divided between items of lesser 
importance. Screening and freedom from flies gets a total of 9 ; so that the 
building, the attendant and a few miscellaneous items divide 28 between 
them. 

In Boston 45 per cent of the dipped store milk contained over half a 
million bacteria. In St. Paul the average count of the dipped store milk was 
over 8,000,000 bacteria. 

The Department of Agriculture thinks that where its score card is used 
the bacterial counts of dipped milk will decline. 



HOW BAD MILK DOES HARM 

How good milk does harm is another story. This one relates to bad 
milk. Unfortunately good and bad milk look much alike, smell much alike, 
taste much alike and act much alike on many of those who drink it but 
differently on others. Men differ greatly in their susceptibility to disease. 

Nobody tries to judge of milk by its looks. AYhen we come to the taste 
and odor the dealer habitually, and customers occasionally, make use of this 
method of judging. 

Most of the milk odors and flavors are of stable origin — but the people 
have acquired a stable palate. When a pure milk (and therefore an odorless 
and almost tasteless milk) is introduced the public palate must be reeducated. 
The odor and flavor test is not much help in determining the wholesomeness 
of milk. 

This is what is meant by varying susceptibility : If one hundred grown 
people were to drink a quantity of tuberculous milk, few of them would contract 
tuberculosis. If one hundred children were to drink from the same milk 
many of them would get abdominal tuberculosis. If the germ in the milk 
were that of scarlet fever or diphtheria, the difference between the sickness 
rates of grown people and the children would be greater still. When it comes 
to typhoid fever the shoe would be on the other foot. It is in the disease 
known as summer complaint that the greatest difference lies. 

Every now and then we read of a picnic party being poisoned by ice 
cream. In such cases at least 80 per cent of the party is poisoned; few 
escape because of immunity. 

The milk poison which harms babies is much more subtle. It misses 
all of the grown people and even many of the babies. If a mother concludes 
that because the milk has not made her baby sick it has not made other babies 
sick or that it may not make her baby sick next week or that it is good 
milk for all time she will be in error frequently. If she is to protect the 
health of her baby she must be constantly vigilant. 

The most important quality to watch for is freshness. Where the cow 
is kept on the lot or the milk is bought from a neighbor little watching is 



CERTIFIED MILK 521 

needed; but when the cows are in one state and the babies in another and 
all sorts of trains, wagons, and people in between, getting fresh milk is 
difficult. 

In some towns all of the dealers and in Chicago some of the dealers 
stamp or write the day of the week on the cap of the milk bottle. I wonder 
if consumers always look for the date on the cap and I wonder how many 
refuse to take a bottle on Tuesday because it is stamped "Monday." Milk 
may be thoroughly wholesome on Monday and by Tuesday be bad enough to 
knock down one of every ten babies who drink it. 

Taking it all in all the milk which does most harm is that which is not 
quite fresh enough to be good for all the babies who drink it and yet is too 
fresh to harm all — dangerous but not showing it. 



CERTIFIED MILK 

"Certified milk is the product of dairies operated in accordance with 
accepted rules and regulations formulated by authorized medical commissions 
to insure its purity and adaptability for infants and invalids." 

This is the opening paragraph of the report on methods and standards 
for certified milk adopted by the American Association of Medical Milk 
Commissions and published as the June 14, 1912, report of the Public Health 
and Marine Hospital Service. 

The steps to be taken by a community to get certified milk are as follows : 

"Sanction for a commission with the right to use the word 'certified' 
is to be had from the above named association through its secretary, Dr. 0. P. 
Geier of Cincinnati. 

"The commission having been formed, it may receive applications from 
any who desire to enter into contract with them. 

"The commission investigates the applicants and decides whether or not 
any or all of them are equipped to produce milk up to the certified standard. 
With those that pass they then enter into contract. 

"The commission contracts to allow the milkmen contracting to use the 

label, 'Certified by medical milk commission/ and to provide for such 

inspection as is provided for in the contract. 

"The milkmen contracting agree to live up to the ninety-seven require- 
ments of the contract and to pay the cost of the required inspection service. 

"The ninety-seven provisions of the contract relate to the milk, the herd, 
the helpers, and stable and milkhouse hygiene. Some of them are: 

"The milk must be fresh — less than thirty-six hours old. 

"It must be cold — under 45 degrees. 

"It must be clean. 

"It must have a low bacterial count — less than 10,000. 

"It must be produced from cows proven free from tuberculosis by the 
tuberculin test, and otherwise healthy as certified by a veterinarian. 

"The cows must be properly housed in sanitary barns. 

"The handling of the milk must be by clean, healthy men employing 
clean methods." 

In order that these results may be accomplished there must be a corps of 



522 



MILK 



bacteriologists, physicians, veterinarians and inspectors and these must make 
systematic inspections at short intervals. 

The requirements of the contract are set forth in great detail. 

With this report as a manual a certifying commission will know just 
what to do. The purchaser of certified milk should read this document 
that he may know what he has a right to expect when he buys this milk at 
double the market price. 

Milk made by men holding such a contract is entitled to the confidence of 
the community. Those who seek to cheat in the use of the term "certified 
milk" are not entitled to such confidence. 



CLEAN MILK 



"All is not gold that glitters." Not all white substances are clean. The 
cleanest appearing of all foods — virgin white milk — is the dirtiest of all foods. 
One can eat a good deal of dirt with safety if it has been cooked but raw 
dirt is dangerous. If one can eat a peck of dirt with safety it must be 
cooked dirt. 

Dirt gets into milk from the milkers hands, from the cow's udder, from 



nV 




flys? 1 1 &&k 




A GOOD 
MILK PAIL 



Chicago Health Dept. 



Fig. 188. 



Fig. 189. 



the swish of the cow's tail, from the milk pails and milk cans, from the air 
of the stable and from any faulty handling after it leaves the farmer. 

Simple procedures are all that are necessary to keep the dirt down to 
small proportions. They are clean hands, clean udder, and clean pails and 
cans. 

Clean hands and clean udders require just a little time and some soap 
and water. Absolutely clean pails and cans require steam under pressure and 
this will not be available for the farmer unless he can persuade the factory to 
do it for him. If the factory will sterilize the cans the farmer need not expose 
them to the dust, air and sun as he must do now to keep them from stinking. 



A FLYLESS, ODOELESS DAIEY 523 

There is one other necessity that the farmer should meet and that is the 
use of the small mouthed milk pail. 

A consumer who uses milk from a small dealer can form a fair idea of 
the cleanliness of milk production by looking for dirt in the milk at the 
bottom of the bottle. The consumer who buys milk from a large dealer cannot 
judge by this method because it is the custom among large dealers to filter 
the dirt out before bottling the milk. 

Even a better method is to filter a pint of milk. Milk will filter slowly 
through ordinary filter paper particularly if it is well warmed. It will filter 
better through a pledget of absorbent cotton placed in a funnel. The dirt 
left behind will show up plainly on the paper or the cotton. 

One of the most effective procedures used by the Chicago health depart- 
ment is the dirt test applied on the farms, at the factories, in the stores 
and in the streets. 

The method is described in its annual report for 1911. It consists of a 
little filter in which the milk filters rapidly because it goes into a bottle 
from which some of the air has been exhausted. 

Most of the visible dirt in milk is stable manure. However disgusting that 
may be the real harm is done by the growing bacteria washed from the stable 
manure. 

The best test of dirt is the bacterial count. If fifteen drops contain less 
than 10,000 bacteria the milk is, and has always been, clean. If more than 
10,000 and less than a few hundred thousand it is, and always has been, 
moderately clean. If in the millions it is, or has been, dirty. 



A FLYLESS, ODORLESS DAIRY 

For a number of years the big, husky boys at the Annapolis Naval 
Academy had a good deal of bowel trouble from time to time. Several epi- 
demics of typhoid fever occurred. Paymaster Bryan investigated and came 
to the conclusion that milk was the cause. He made his recommendation 
on that basis. He was turned down. Even the medical staff would have none 
of it. 

In 1910 a pretty fair epidemic of typhoid occurred. An investigation 
showed that there was a good deal to support the view of Paymaster Bryan. 

The navy department put in its dairy, acting, however, with the advice 
of the dairy division of the Department of Agriculture. There has been no 
typhoid since. 

What is remarkable is the drop in "excuses from duty" for minor in- 
testinal disorders. For instance, the number of days lost for this cause was 
in April, 1911, 102 ; in April, 1912, 6 ; in April, 1913, 20. 

In no month since the good milk was provided has the time lost from 
duty been more than one-fifth of what it was before and it is usually only one- 
tenth. 

Mind you, these are not nursing babies. They are great, husky, resistant 
men. They each drink nearly a third of a gallon of milk a day. And you 
would drink milk, too, if you could get it as fresh, as safe and as good as 
they get it. 




WHY? 





Mary 8<?n Sam 



A FLY VISITED AN 
COLLECT E.0 SOME 
THEN GATHERED 
GERMS FR0T1 SAM'S 
DROWNED IN THE 
FAMILY DRANK 




OPEN PRIVY AND 
TYPHOID GERMS. 
TUBERCULOSIS 
SPIT. AND LATER 
MILK PAIL THE 
THE MILK 






^ A LITTLE LATER PA AND MA AND \ 
LITTLE BEN BEGAN TO FEEL TIRED 

ALL THE TIME AND TO COUGH A GREAT ) 
DEAL. JOHN AND MARY CAME DOWN 
WITH TYPHOID FEVER — — _ 5AM 

DIED-NOBODY CARED, AND 

EVERYBODY AVOIDED THEM 



HOG CHOLERA GERMS GOT INTO T«E 
PIGS FEED, AND THE HOGS BECAME 
SICK 8UT NOT FOR LONG HOG 
CHOLERA SERUM WAS RUSH- 
ED TO Jntn AND EXPERT VET- 
ERINARIANS WERE HURRIEDLY 
CALLED 




THE REfULT 



"** THE RESULT 

State Board of Health, Jacksonville, Florida. 
Fig. 190. 



524 



LA SALLE (ILL.) MILK 525 

The site chosen for the dairy farm was about a quarter of a mile from 
the hospital. The hospital authorities objected. They said the odors and 
flies would disturb their patients. Paymaster Bryan and Chief Eawl said : 

"We'll have no flies to disturb your patients but your flies may disturb 
our cows and infect our milk." 

The dairy went in. There were no flies in the barns when we were there. 
They say they never have any. 

They bought four dozen fly traps and put them around the barns, the 
lots and the pastures. Fly traps are easy to make and cheap to buy. 

What perhaps does even better is that everything is extremely clean. 
There are no odors. No odors being in the air none get in the milk — which 
is also true of flies. 

The cows are tuberculin tested; they are healthy. The milk is cooled 
to a little above freezing almost immediately upon milking and it is held at 
that temperature until it is ready for use. The barn is a, long shed with a row 
of stalls down each side and a passage down the middle. 

The ventilation and light are of the best. The drainage is so good that 
the yard does not get muddy. In consequence it is easy to keep the cows 
clean. 

Things are so clean that there are no flies and, since this is true, the doors 
and windows may be thrown wide open. No screens are required. This means 
better air and fewer odors. 

However, these are not the main points. The main points are that clean, 
fresh, cold, good milk reduces the sickness rate among grown people enough 
to pay for itself. When people can get high grade, clean milk they will drink 
a lot of it. 

LA SALLE (ILL.) MILK 

Dr. Greaves of La Salle, Illinois, set out to investigate the condition of 
milk in Illinois cities ranging from 6,000 to 15,000 inhabitants. He sent six 
questions to the proper officers. To this circular letter he received twenty- 
five replies. It is safe to say that the towns which did not reply all belong 
to the group of nothing-being-done. 

In regard to the twenty-five from which replies were received there are 
milk ordinances in twelve but there are no efforts to enforce them. In four 
there were laboratory examinations for percentage of cream but in none was 
there an examination for dirt. In one there was a biennial visit from an in- 
spector to the dairies. In the others there were no inspectors. 

It is as a result of such conditions that the statistics show the infant 
mortality of towns of that size is as high as that of the large cities. In 
fact, the babies of the people of high intelligence are now much safer in the 
large cities than they are in the small. 

The milk of the small place has the advantage of being close at hand. 
It is distributed while still fresh. On the other hand in and around the small 
place milk production is an on-the-side business, an extra-money, pin-money 
maker. 

The highest grade city milkman, to whom the sale of milk is his one 
thought, will do his job so much better than the extra-money producer as to 



526 ' MILK 

much more than offset the disadvantage of distance. The highly intelligent 
parents use milk but only from the highest grade dealers and in consequence 
their children are safer than the babies of small cities. 

However, it is easy for the people in smaller cities to have good milk if they 
will go after it. La Salle determined to have good milk. There is a level 
headed old time moneymaker, Matthiesen, who was willing to lend his brains 
as well as his money. Within two years La Salle was getting milk that ran 
below 10,000 bacteria — merely another way of saying the people were get- 
ting clean milk. Within two years they were subscribing to the following 
creed: 

"1. That it was not necessary for milk to smell of the cow to be real 
milk. 

"2. That milk which would never sour was preserved. 

"3. That a certain percentage of the healthy looking cows was tubercular. 

"4. That milk must be cooled immediately after milking and kept cooled. 

"5. That milk could not be successfully delivered in open wagons in ordi- 
nary cans. 

"6. That the good old family cow might be diseased, and if not milked 
under sanitary conditions the milk could be as infectious as any dealer's 
supply. 

"7. That milk carried contagious diseases." 

The school laboratories of any city of 5,000 are all that is needed to secure 
a clean milk for it. Let the milk brought to it be examined by the pupils 
for dirt and bacteria and publish the results in the local papers each week. 
The trick will be turned. 



MILK OF RICHMOND, VA. 

When at meetings of the Milk Standards Commission Dr. Levy had told 
of the excellent milk of Eichmond, Virginia, the members of the commission 
had felt like asking the question asked about the hen : "Has she laid or lied ?" 
So they voted to hold their 1913 meeting at Eichmond to see for themselves 
what the answer was. 

The milk of Eichmond is produced in dairies licensed by the city health 
department. They are located about five to fifteen miles from the city hall, 
outside the city limits. The cows are milked about 5 A. M., and the milk 
reaches the retailers in town about 8 to 11 a. m. 

The morning's milk is delivered before supper time. The evening milk- 
ing is done about 2 p. M., and the milk reaches the dealer about 6 p. M. 
The evening's milk is delivered in time for breakfast the next morning. 

The barns are not expensive as barns go in the Middle West. In fact, 
from that standpoint they are cheap. They are light and airy and clean. 
Most of them are of poured cement. All of them have cement floors and 
excreta troughs. They are all whitewashed and clean. 

The cows were as clean as a dining-room table. The milk is cooled by 
spring and well water. The temperature of water in that vicinity is 60°. 
The milk heats up to 70° by the time the wagon gets to the bottling plant. 
By the time it is three hours old the milk has been chilled to 50° and bottled. 



MILK AT SUMMER EESOETS 527 

The bacterial counts are phenomenally low; more than half of them 
run below the standard for certified milk. A count in the millions is rare. 
In April the number of counts above 500,000 was but two. 

Of course we expect the raw milk of a large city to run into the millions. 
There seems no way to avoid it. But the counts of Eochester, New York, a 
city not much larger and with a larger percentage of wagon-hauled milk, 
average much more than ten times as high. 

There are but two cities in America as large as Chicago. Its large- 
ness makes its milk problem different. There are many cities as large as 
Eichmond. What Eichmond has done Peoria, Lexington, Charleston and 
Pueblo ought to do easily. 

TJie smaller cities have been content to do little because they have thought 
the dairy problem was a big city problem. In consequence the dairy division 
of the Department of Agriculture usually finds their dairies the worst of all. 

They have usually done nothing because the way to do, as written about, 
is the way to do for the city of a million or more. If they followed the 
same plan it might not be the proper plan for them. The Eichmond plan is 
one that fits their needs better. 

The farms are scored on the government score card. They average more 
than 70 and some of them go as high as 90. When the government sent its 
inspectors through New England the scores averaged 43. When Mr. Whit- 
taker would occasionally come through the Chicago district checking the 
local inspectors he rarely found a farm scoring over 5. Somehow we take 
it for granted that scores of 80 and 90 never can be attained by any except 
certified farms. 

MILK AT SUMMER RESORTS 

"The person who contracts typhoid fever as a consequence of drinking 
city water contaminated with city sewage has a moral, if not a legal, 
claim against the municipality for damages." 

The above statement occupies the front page of Public Health, June, 
1912, the bulletin of the Michigan Board of Health. 

The Minnesota Supreme Court held Mankato, Minnesota, liable for the 
damage done to individuals by typhoid fever due to polluted city water. Eng- 
lish decisions hold hotelkeepers responsible for damages to those of their 
guests who have contracted typhoid fever fyom milk. 

The resorter should be as careful to patronize a hotel with a good milk 
supply as he is to select one with a good water supply. The responsibility, 
legal and moral, for the safety of the milk supply is the same as that for the 
water. 

It is easy for most resorts to have good milk. The cow and the consumer 
can get close together and that makes the milk problem simple. As a general 
proposition a resort community has no adequate municipal milk inspection; 
but there is no reason why the proprietor should not have his dairies scored on 
the government score card and the milk tested in his hotel for dirt, tempera- 
ture and freshness. These are simple tests. He can put in a fairly satisfac- 
tory pasteurizer for the cost of a horse. 

He can pasteurize his supply and be certain that he is not making his 



528 



MILK 



patrons sick. He can see that his milk is dated. Having taken proper 
precautions he can advertise the fact. He can post his dairy scores, the 
results of dirt tests and other data. These things he can do easily. The 
trouble is little enough and he should do them. It should not be difficult at a 
summer resort to get clean milk with no dirt in the bottom of the bottle, cold 
milk less than 50° Fahrenheit, and fresh milk less than twenty-four hours 
from the cow. 

Now comes the guest's duty. It is his duty to be discriminating, to refuse 
to patronize a place that does not have clean milk or does not give the facts as 
they are, and on the other hand, to patronize the proprietor who goes to some 



lfeepD&i}\/6 Milk Clean. m\& Cool 



Uae only 

Good 

Bottled 

Milk. 




Keep The cap 
onlbe bottle— 
Keen the 



P 
bottle m & 

clean, cool place 



NlvLr A llow FIies Near M ilk. 
HtRtb A Cheiap Hoiy^-Made. let ho/. 

CotX 30 cerrtt,; Ice, 2 cents pef dtoj. ' 




Department <A rlea-ltK Cfotc&go. 



BT 



Department of Health, Chicago. 



Fig, 191. 

f 



KEEPIXG MILK COLD 



529 



trouble and expense to have things right and then tells the truth to his cus- 
tomers. 

If the resorter cannot get good milk he will be moderately safe if he sticks 
to hot milk — hot milk in his coffee in place of cream, hot milk as a drink 
instead of cold. It may not suit his taste so well but if he be forced to 
stay in a dangerous place it will decrease his danger. 



KEEPING MILK COLD 




Fig. 192. — Arrangement of 
Apparatus for Rapidly 
Cooling Milk after 
Pasteurization or Ster- 
ilization {Kilmer). 



Cow's milk is not fit for baby food unless it has 
been cooled within thirty minutes of milking and 
maintained cold until it comes to the baby. Cheap 
coolers are now on the market. These are to be 
used by the farmers to chill the milk just as soon 
as the milking has been finished. 

Unless the farmer uses ice he usually cannot 
reduce temperature in this way below 60°. Some 
farm wells and springs, however, run as low as 55°. 
The milk should be delivered as soon as pos- 
sible at some central' point where a lower tempera- 
ture is possible. 

At the different meetings of the Commission 
on Milk Standards Dr. Levy took the position that 
milk could be marketed in good shape without ice. 

He thought so because the farmers did 
not have ice in and around Eichmond, 
Va., and the Eichmond milk was low in 
bacteria. When the commission went to 
Eichmond it learned the reason. 
/( EfjS^^ v ""^ jf ^^fff The dairymen chill the milk on the 

v^JJ /5M^^^^^^|^9i§§f|3b ' farm with well water. They get it to 

about 60°. They deliver it twice a day 
(within four hours of milking) at the 
central plants where it is iced down 
to 50. 

Eichmond milk is about the best 
iced milk that we found anywhere al- 
though no icing is done on the farms. 
The double daily delivery of milk less 
than four hours old at the factory makes 
it possible for the Eichmond dairyman to 
do without ice and still market good milk. 
Where milk is shipped into town on 
cars the custom (where things are done 
right) is to ship in refrigerator milk cars. 
The railroads easily meet the require- 
ment when they have to. 
Milk in cans on wagons is kept cold by wrapping the cans with wet 




Fig. 



193. — Pasteurization at Home. 



530 MILK 

cloths. When in bottles the boxes are packed with ice and wrapped with 
wet cloths. 

To keep the milk cold from the time of delivery till getting-up time a 
covered bucket in which some water and a lump of ice is placed the night 
before suffices. After the milk is taken into the home it should be kept on 
ice in the ice box. 

Rarely is the temperature of the ordinary domestic refrigerator cold 
enough to keep the baby's milk. 

Bacteria multiply exceedingly rapidly in warm milk. The multiplication 
almost stops at 50°. It is extremely slow at 55°. It is slow enough at 
60° to make it possible to keep milk for a day or more in good enough condi- 
tion for a baby. At 65° within a few hours the changes are so great that it is 
too risky for baby. 

WARM AND DIRTY MILK 

Aside from lack of freshness milk may do harm because it has not been 
kept cold. If baby is to drink milk less than four hours old it does not matter 
much that it was not chilled as soon as it was milked. But when the cows are so 
far away that the milk is several days old when it comes to baby temperature 
does not matter. 

Under such circumstances there is only one plan to follow — the farmer 
must chill the milk as soon as it is drawn. (The Omaha farmers have 
cheap, effective milk chillers.) He must keep it cool until he turns it over 
to the railroad; the railroad must keep it cool until it turns it over to the 
milkman; the dealer must keep it cool until he turns it over to the house- 
wife and she must keep it cool until she gives it to the baby. Nowhere, at no 
stage must it go over 55°. 

And the next point is that milk may do harm if it is dirty. If the 
housewife will always look at the bottom of the milk bottle she will protect 
herself against some, but not all, dirty milk. Many milkmen clarify their 
milk before they bottle it. Some farmers strain it as they milk it and others 
soon after. Clean cows, clean hands and clean pails standing at one end 
of the line and clean refrigerators, clean nursing bottles and clean nipples 
at the other end and everything in between clean is the ideal, though seldom 
attained. If the milking has not been as clean as it ought to have been 
straining is better than leaving the dirt in. If milking has been dirty and 
straining has not been done clarifying is better than doing nothing — but each 
is far from ideal. 

Certainly, wherever there is visible dirt in a bottle of milk the milkman 
should be swatted and he in turn should swat the man who passed the dirt on 
to him. 

There is a way by which the central office can tell whether the milk is or 
has been dirty or warm or old, or whether in it several of these bad qualities 
are combined. It is the bacterial count. Milk with a high bacterial count, 
with large numbers of germs, may do harm. Not all milk which has a high 
bacterial count will make the baby sick but such milk is that doubly dangerous 
borderline — good looking, bad acting milk, milk which tastes all right and 
which does not harm all the babies who take it. That it harms only 10 per 



ANOTHER MILK EPIDEMIC 531 

cent of the babies makes it worse for that partial safety throws mothers off 
their guard. The ninety should stand with the ten in efforts for protection. 



THE GOVERNMENT'S POSITION ON MILK 

Milk has a high bacterial count when it is dirty, or old, or warm. When it 
is clean there are few bacteria to multiply. When it is cold the bacteria 
multiply slowly. When it is young the bacteria have not had time to multiply. 

To see that milk is cold inspectors are provided but as these inspectors 
cannot stand over every milk producer as the meat inspector stands on 
the killing floor the inspection service needs to be supplemented. 

To see that milk is cold ordinances are passed and inspectors provided; 
but controlling the temperature by law has proved difficult. 

To watch milk to prevent the sale of old milk has proved difficult. The 
method worked out to check the man in the field, to make certain that the 
milk sold is clean, cold and fresh is the bacterial count. 

At this point comes the crucial test. Eight here is to be fought out the 
battle for standards of wholesomeness in milk. Such standards have been 
indorsed not only by the national government but by the state and municipal 
governments — at least by a large number of them. They represent a crystal- 
lizing, a focusing of all the talk about clean milk. 

These standards are being fought as were the fat standards ten to twenty 
years ago. 

The Bureau of Chemistry of the Department of Agriculture has just 
issued a bulletin which sets forth : 

"All statements that the Department of Agriculture has abandoned or 
will abandon the bacterial examination of milk shipped in interstate com- 
merce as a means of determining its cleanliness and fitness for human con- 
sumption are without foundation. While the department has not fixed any 
specific bacterial count as a standard in the enforcement of the food and drugs 
act, it does use bacterial examinations in reaching its conclusions, and will 
continue to use these methods, irrespective of what action any association 
may take. 

"The only change in the policy of the department has been to discon- 
tinue basing prosecution upon a bacterial examination of a single specimen. It 
now collects a number of samples at different times and examines them. If 
the bacterial examination shows the milk is not clean but is not a serious 
menace to health, and the bacterial deviation from clean milk is a small one, 
the department, through the bureau of animal industry, endeavors to teach 
better methods. If this fails, the department prosecutes the offender/' 

This statement of the position of the national government commends 
itself as being fair to consumer and producer. 



ANOTHER MILK EPIDEMIC 

In Wakefield, Massachusetts, in February a few years ago, a milker on a 
dairy infected about 200 people with streptococcus sore throat. The man was 



532 MILK 

taken sick with quinsy on February 3. His abscesses discharged within a few 
days and the man was able to go back to work by February 25. His wife also 
had a sore throat and cold in the head but she, too, was able to go back to 
bottling on February 25. 

Cases of tonsillitis among consumers of milk from this dairy began to 
develop on the evening of February 26. The cases multiplied rapidly from 
that date to March 4. On March 3 the health authorities discovered the 
source of infection and took action. 

The number of cases reported declined rapidly from the fourth to the 
seventh and after the latter date a few cases developed from contact with the 
existing cases. But it was evident that the source of the infection had been 
done away with. About two hundred cases of sore throat were brought to the 
attention of the health authorities in ten days. 

The infected people were not very sick. They had sore throat, head- 
ache, suppurating ears, quinsy and enlarged neck glands. In some cases 
the neck glands remained swollen for several weeks. 

The infection did not travel to the abdomen or elsewhere in the body. It 
remained localized in the head and neck. 

This is noted because occasionally someone asks if milk-borne streptococ- 
cus infections are not always fatal. They are not. 

The state laboratory found the infecting coccus to be a streptococcus. 
The field inspectors traced the infection back to one dairy and then to the one 
milker and his wife. 

What was done? The milker and his wife were made to stop milking. 
The milk was pasteurized. As the dairyman had no facilities for pasteurizing 
it was necessary to carry on the process without apparatus. 

The milk was placed in bottles. The bottles were set in a wooden vat 
which was filled with water to the top of the bottles but not over them. 
Then live steam was run into the vat until the temperature of the water 
reached 145°. It was held at that temperature for thirty minutes. 

These two simple expedients stopped the epidemic within two days. 

It never occurred to the milker that he and his quinsy could harm 
anybody. Yet he did more harm in three days than he will live long enough 
to offset. 

The average milker knows about as much about the harm that he can do 
as did this man. It is just this fact which makes so many health officers 
believe that no raw milk should be sold. The law should require all milk 
to be pasteurized. 



MILK SOLD IN SMALL CITIES 

If you live in a city of 25,000 and want to know the condition of the 
milk that is being fed your babies read the report on the milk supplies of 
Urbana and Champaign (111.) made by Professor Barker of the University of 
Illinois. 

The twin cities use 1,200 gallons of milk a day. Of this 115 gallons 
is brought in by interurban cars an average distance of twelve miles, and 
seventy-six gallons by steam roads an average distance of sixty miles. The 



"PLAIN TALK TO CHICAGO MILK PRODUCERS" 533 

remaining 1,000 gallons is produced by small dairies located within ten 
miles of the university. 

The milk is produced by twenty regular milk producers (possibly entitled 
to be called dairymen) and by twenty-five farmers who are intermittent and 
casual milk producers. Two dairies deliver 30 per cent of the supply and 
seven 70 per cent of it. The report does not say whether milk is delivered 
once or twice a day. 

The price of bottled milk is ten cents a quart ; of dipped milk, eight. 

A few years ago Professor Rickards persuaded the councils of these cities 
to pass a good milk ordinance. No provision for enforcing the ordinance was 
made. No prosecutions have been made. The ordinances are dead letters. 
This everyone will recognize as about an average situation. And now for 
the interesting part of the report. 

The university scored most of the dairies on the government score card. 
The average for twenty of the more permanent dairies was 25.5 out of a 
possible 100. Professor Parker says: 

"This is believed fairly to represent the state of the average dairy 
farm in the vicinity. Under such conditions it is difficult to produce 
milk that is of uniform quality, or even milk that is tolerably clean." 

Professor Whittaker, for many years of the Department of Agriculture, 
held that milk from dairies scoring 40 should not be a marketable commodity. 
It was either indecently dirty all the time or else at times was indecently 
dirty and dangerous ; and there was no way of knowing which were the times 
of danger. 

An average bacterial count of thirty-seven samples of milk from one 
dairy was 14,900 ; an average of seventeen samples from another was 453,000. 
The average counts of three dealers was over 100,000. Nineteen samples 
from one dealer averaged 664,000; twenty-one from another averaged 
8,383,000; one sample contained 50,000,000, another 32,000,000, a third 
27,000,000, a fourth 26,000,000. 

The temperature of the milk ranged from 60° to 75°. The cows are 
not tuberculin tested. No effort is made to protect the milk from typhoid, 
tuberculosis, scarlet fever, diphtheria or septic sore throat bacteria. 

The agricultural college of the university has some influence on the 
neighboring producer. Therefore, Mr. Reader, in a small city consider that 
the milk fed your children is, say, 10 to 20 per cent worse than that of 
Urbana and Champaign. 

Milk that has been handled less than ten miles away and that is less 
than twelve hours old and yet has a bacterial count as high as this has 
been produced under conditions that are grossly wrong. 



" PLAIN TALK TO CHICAGO MILK PRODUCERS" 

This title we borrow from the Orange Judd Farmer. It heads one of the 
most sensible articles on the milk situation that has come to my notice recently. 
While it was written especially for the producers in the dairy district sup- 
plying Chicago, by leaving out names and incidents and using principles it 
applies to dairy districts everywhere. 



534 MILK 

The readers of the Orange Judd Farmer are farmers; therefore the 
article properly considers the question from the standpoint of the producer. 

It begins with the agreement that tuberculosis is present in milk cows 
in increasing amounts; that human beings can be and are infected from 
drinking tuberculous milk. It says there are two ways of protecting the con- 
sumer. The best of these is pasteurization. 

If pasteurization in operation could be made 100 per cent perfect and 
could be applied to all milk the tuberculosis-in-cows question would be 
exclusively a question of economics and the farmer the person most con- 
cerned. 

The advice is given the farmers to exercise every bit of influence they can 
to obtain universal, closely controlled pasteurization. The nearer they can 
come to obtaining that result the more they will help to eliminate tuberculosis 
from their herds. 

"Isn't this straight doctrine, milk producers?" the article says. "Get 
together on the pasteurization proposition and in so doing make the agitation 
on tuberculin testing unnecessary. Settle later the tuberculin test." 

As to the second part of the above quoted advice they advise the farmer 
to get the best advice possible. "By sending speakers at $15 per speech 
who know nothing about the subject to talk about the unreliability of the 
tuberculin test, the producers are made ridiculous before the public," they 
say. 

For some years the milk producers have been misled by those who have 
made money through misleading them. Is it not time now for them to break 
away from their exploiters and accept leadership from the editors of 
Orange Judd Farmer, Hoard's Dairyman, and other well informed papers 
and people? 

TREATING TAINTED MILK 

August is the season for tainted milk. The pastures are dry and the cows 
nibble at weeds that they do not touch when the grass is good. In conse- 
quence the cows eat bitter weed, wild onion, and garlic, and about four 
hours later the odor and taste of the aromatic foods appear in the milk. 

While there is no evidence that these flavors poison children they render 
the milk less palatable and sometimes they disturb digestion by disturbing 
appetite. 

I know a physician who holds that the infant diarrheas of August result 
from certain weeds eaten by cows during that month of poor pasturage. His 
remedy for the baby illness problem of the great city is a requirement 
that all milk cows be stabled during the months when cows are apt to eat 
weeds. This, however, is speculation and the doctor alluded to does not 
claim to be able to prove his point. 

The Department of Agriculture has been experimenting to find a way 
to remove the flavor from such tainted milk. The experts found that the 
following method worked satisfactorily: The milk is heated to 145° and 
while it is held at that temperature a current of air is passed through it. A 
ten minute treatment makes the milk fairly palatable; a thirty minute treat- 
ment removes all the flavor. 



TIML AND TEMPLRATURL 
MILK PA5TE.URIZATI0IN. 



FOR 




20' 30 40' 

Tl ME. IN MINUTES 

Public Health Service Report. 

Fig. 194. — Time and Temperature at which Some Bacteria are Killed and at which 
the Composition of Milk is Changed. Example: At temperature 140-149 for 20 minutes 
the bacteria of diphtheria, tuberculosis, typhoid fever and septic sore throat are killed; but 
neither the cream line, the enzymes, the albumen, the taste or the fats, sugar 'casein or salts 
is affected. 

535 



536 MILK 

The apparatus devised by Ayres and Johnson consists of the following 
parts : 

A tank (A) is surrounded by a water jacket. From the bottom of 
this tank a pipe leads to a tank (B) set on top of tank A. The milk is 
pumped through this pipe from A to B by a small pump. The tank B has a 
bottom perforated with holes one-thirty-second of an inch in diameter, placed 
at a distance of one-half an inch from one another. The milk flows in a fine 
spray through these holes into tank A. An air pipe leads into tank A, 
delivering air under pressure near the bottom of the tank. The air must be 
washed clean. 

The milk is placed in tank A and by heating the water in the jacket the 
temperature is brought to 145°. If the milk is to be made into butter the 
temperature should be carried to 160°. The milk having been heated the pump 
is started and the steam travels from tank A through the pipe to tank B and 
then through the perforations back into A. Meanwhile the air is running 
into the milk in tank A at the rate of one-fifth of a cubic foot of air per 
gallon of milk per minute 

The evaporation is 3 per cent — which can be made up with boiled water. 
The cream line suffers slightly. 

The process continued for thirty minutes will result in a fairly satisfactory 
pasteurization. 

ICE CREAM 

The ice cream manufacturers are willing to spend money to prevent 
the government from having much to do with the control of their product. 
When Dr. Wiley set chemical standards they went to a great deal of trouble 
and expense to set the ruling aside. Now Dr. Alsberg is considering sanitary 
standards and the manufacturers are again active. 

They object particularly to having bacterial standards incorporated as 
one of the requirements. When the question was before Dr. Alsberg they 
had a number of bacteriologists contend that bacterial standards as applied 
to ice cream were valueless. The investigations of these men have been made 
into a pamphlet which is circulated by the National Association of Ice Cream 
Manufacturers. 

The following important statement was made by Professor Gordon : 

"Given raw materials of low bacteria content, it can be said in absolute 
assurance that the ice cream manufacturers can produce with great ease 
ice cream of low bacteria count." 

One of this group appeared before the recent meeting of the American 
Public Health Association, presented this report, and argued that ice cream 
should not be subjected to a bacterial standard. His argument was that, 
since ice cream commonly contained one to one hundred million bacteria, a 
variation of a few hundred thousand bacteria was of no great signifi- 
cance. 

The discussion of the presentation for the ice cream men is worthy of 
consideration. The general consensus of opinion was that the variations noted 
were to be found and were unavoidable in the ice creams with bacterial 
counts running into the tens of millions but that they were not found in ice 



ICE CREAM 537 

cream with low bacterial counts; furthermore, that it is possible to market 
ice cream with very low counts. 

Dr. Wiley said: "The experiments made by these gentlemen were not 
made on real ice cream, but on some other frozen products, unfit to be fed 
to hogs." 

Dr. Freeman, secretary of the Virginia Board of Health, asserted that 
ice cream properly made from proper ingredients had a low bacterial count and 
that the reason these investigators had found such high bacterial counts was 
because they worked with ice cream made from ingredients that were unfit 
to eat. 

Drs. Rogers, Kenyon, North and several other speakers said that ice 
cream could be made in such a way as to have a low bacterial count. It was 
a matter of starting with proper ingredients, freezing them while fresh and 
operating always in a sanitary fashion. 

Many epidemics have been traced to ice cream as the source of infec- 
tion. Improperly made ice cream has the highest bacterial count of any 
food substance. The Commission on Milk Standards is now at work on 
standards for ice cream. The national government is gathering information 
on which to make a ruling on ice cream. 

Regulation of the manufacture of ice cream is certain to come. If the 
manufacturers are good business men they will help to bring it about. 

What Constitutes Fresh Milk. — Daily Reader writes: "In a recent 
article you said that milk that is not absolutely fresh is not wholesome. 
Do you mean that milk left from one day's supply to the next is not safe 
to use? Why is it that sour milk is supposed to be more wholesome and 
beneficial than fresh milk? Do you consider certified milk enough better 
to warrant the additional price? Do you think milk left standing in the 
glass bottle in which it is received, with the cap on it, fit to use in the raw 
state next day?" 

Reply. — Milk properly kept — covered, cold and clean — is safe to use 
when left from one day's supply to the next. That is, it is safe for every- 
body except children under two years of age. Children under two should 
not use milk which has stood a day in the refrigerator. Occasionally, and 
for some people, properly soured milk is better than fresh milk but this is 
by no means an argument for old milk. If the certified milk is certified 
by a certifying body holding a permit to certify the certified milk for the 
baby is worth the difference in cost. 

Flesh Made by Milk.— P. S. C. writes: "1. Will milk, if taken daily, 
make flesh? If it will, how much ought to be taken, and how? 2. Is olive 
oil good for the system and does it make flesh? 3. Will either of these 
force pimples to appear?" 

Reply. — 1. Yes. Three pints a day in addition to plenty of other 
nutritious food. 2. Fairly good, but not especially so. 3. Yes — both. 

Use of Milk Diet.— IF. B. F. writes: "Please tell me what benefits, if 
any, can b% derived from an exclusive milk diet. How should it be carried 

out?" 

Reply. — The milk cure is frequently recommended for Bright's disease, 
gout, neurasthenia, intestinal putrefaction and a few other diseases. The 



538 MILK 

treatment usually begins with four ounces of warm, skimmed milk every 
two hours; after a few days, six to eight ounces every four hours. Some- 
times it is given flavored with weak tea, coffee or diluted with vichy. Con- 
stipation needs to be overcome. After four to six weeks other food is 
gradually added to the dietary. 

One number of the Clean Milk Bulletin quotes an article from Nickel 
(Milch Zeitung, 1911, No. 39) in which it is stated that Pope Pius X par- 
takes of boiled milk in the morning and during the forenoon and fre- 
quently has milk soups, milk dishes and milk puddings at his meals. He 
says the pope is half a vegetarian and from the beginning of his ecclesiasti- 
cal life has used milk freely. 

Effects of Milk Diet.— Mrs. G. W. J. writes: "A diet of milk only for 
a period of four weeks is recommended in a health magazine as a cure for 
constipation and minor ills. It is stated that the arterial blood pressure 
will be permanently improved and organic functions restored. Will this 
increased pressure be beneficial or will it be accompanied by any danger?" 

Reply. — It will help your minor ills; may lower your pressure some; 
will probably help you in every way except that it will make your constipa- 
tion worse. 

Milk Disagrees with Her. — E. B. W. writes: "I am fond of milk, but 
it gives me what old-fashioned people call a 'bilious attack' violent head- 
ache and nausea. I have been intensely nervous all my life. I have always 
lived at high pressure, but have never indulged in liquor. I am a woman 
1$ years old. Why can I not drink milk? Lime water does no good. I've 
a fine digestion." 

Reply. — You have an idiosyncrasy against milk. Many people have it. 
Send to the Bureau of Animal Industry, Department of Agriculture, to 
get its bulletins on "Milk as a rood" and read about it. 

Milk as Food. — J. S. W. writes: "I read an article some time ago by 
some doctor, whose name I do not remember, stating that milk is not good 
for middle-aged persons. Kindly give me your opinion." 

Reply. — You misunderstood the statement. I imagine good, wholesome 
milk is good food for people of any and all ages. There are exceptions; 
but the rule holds. 

Be Careful of Milk. — A. K. K. writes: "We have a seven months baby 
whom we have been feeding with modified milk for the past three months. 
Our success is rather indifferent, for although the baby weighs seventeen 
pounds, he gets upset frequently. Do you think that the addition of oat- 
meal or barley water to the milk might help?" 

Reply. — Adding barley water will not help much. While you do not 
say how the milk is modified or what the trouble is my guess is that the 
baby has occasionally spells of diarrhea but that in the intervals the bowels 
are normal. If this is true it probably means that the milk is a little off at 
times. • 

Be certain that the modification is proper. Be certain tha£ the milk 
is proper. See that it is properly pasteurized for at least six weeks yet. 

Care of Milk. — J. S. C. writes: "Some time ago you had an article 
on the care of milk and said it should not be kept in the bottles in 



ICE CEEAM 539 

which it is delivered. Please state what it should be kept in and any 
further details regarding care of milk, particularly in an ice box, where 
sanitary conditions and circulation are none too good" 

Reply. — You misunderstood me. Milk should be kept in the bottle until 
it is consumed. Especially is this necessary if the ice box is not sanitary. 

Grape Fruit with Milk. — B. W. W. wants to know if grape fruit eaten 
with milk is liable to make it curdle in the stomach. 

Reply. — Milk should curdle in the stomach. Something is wrong if it 
does not. Grapefruit does not make milk indigestible. 

Thermos-Kept Milk. — R. W. writes : "I should like to know your opin- 
ion of the use of the thermos bottle for keeping warm during the night the 
baby's modified milk. The nurse prepares the warm milk about 8 o'clock 
and feeds the baby after midnight, sometimes not until 3 or k o'clock. 
The thermos seems a blessing for nurse or mother. But is it safe for the 
baby to keep the milk warm so long?" 

Reply. — The habit of keeping food in vacuum bottles is growing. Some 
years ago some ladies appeared before the finance committee of the Chicago 
city council asking that an appropriation be made to furnish bottles to 
poor people. 

The convenience is so great that such use should be encouraged if it 
is hygienically proper. It should be prohibited if it is doing harm. 

It is not enough to say that babies six months to one year old should be 
fed but once during the night and that babies over one year old should not 
have any night feeding. 

If parents are going to feed more frequently than this at night the in- 
formation must be furnished them. 

Dr. F. A. Tonney, director of the city laboratories, made bacteriologic 
examinations of milk held in thermos bottles with the following results : 

If the milk as it is put into the bottle has a temperature of 115° or be- 
low the bacteria multiply very rapidly and in a few hours the milk is 
unfit for baby use. If the milk is put in at 140° or above the bacteria 
diminish until in a few hours the milk is sterile. 

The conclusions are these: 

1. Putting the baby's milk into a thermos bottle is never justified unless 
the temperature of the milk is first taken. 

2. If the temperature of the milk is under 135° it will be unfit for use 
in a few hours. 

3. If it is 135 to 140° it can be kept in a vacuum bottle with safety. 

Is Centrifuged Milk Safe? — W. J. C. writes: "Is the process of run- 
ning milk through a centrifugal cream separator (and again mixing the 
milk and cream together) any benefit or improvement to the health con- 
ditions of it? 

"Does the centrifugal force remove the bacteria or microbes?" 

Reply. — No. The centrifuging is done to remove the cream. The 
milk and cream are then mixed in the proportions required by law. 

The number of bacteria is higher in the cream than in any other part 
of the milk. That is to say that when the milk is centrifuged most of 
the bacteria stick in the cream part and few are thrown out. 

It is the custom of men having centrifuges to filter the milk in addi- 



540 MILK 

tion. Filtering takes out the gross dirt and a fair part of the bacteria, 
though not all of them nor even most of them. 

Proper pasteurizing kills 99 per cent, of the bacteria. As compared 
with the result filtering and centrifuging may be said to have no effect. 

My advice to you is : patronize no dairyman who does not sell "tubercu- 
lin tested" or pasteurized milk. 

How to Get Safe Milk. — M. A. S. writes: "How is a person to know 
that milk is free from tubercle bacilli? I was brought up in the old- 
fashioned way, but what of the new way I am learning has certainly 
been a benefit to me and I will keep on. I have an idea how hard it is to 
convince others of this truth from my own experience." 

Eeply. — You are on the right track. Keep it up. The way to get milk 
free from tubercle bacilli is to patronize only responsible people who guar- 
antee that their milk is from non-tuberculous cows or who guarantee their 
pasteurization ; or else heat the milk before you use it. 

Do Not Drink Raw Milk. — Taylor writes: "I am living in the eastern 
part of North Carolina, where the weather is hot and malaria prevails 
abundantly. Am troubled every summer with dysentery. Please publish 
how that could be prevented?" 

Reply. — If you are certain the condition is not pellagra but is dysen- 
tery proceed as follows : 

From June to November each year drink no new milk. Heat every par- 
ticle taken. Drink no raw water unless you are certain it is good. That 
about limits raw water to artesian water. Eat about half as much as in 
winter. 

Questions on Milk Answered. — C. C. J. writes: "I read an article in 
the Chicago 'Tribune' recently entitled 'Sterilized Milk Is Bad.' It gives 
the conclusions of a London chemist and other authorities and points out 
that sterilized milk is not only less nutritious than plain milk, but is ac- 
tually dangerous. What is sterilized milk and what is pasteurized milk? 
Do these processes of preserving the milk injure or spoil it as a food? 
How does pasteurized milk compare with natural milk in nutritive prop- 
erties?" 

Reply. — I judge the article refers to milk that has been sterilized by 
boiling. Some authorities are of the opinion that boiled milk is less nutri- 
tious than unboiled milk. Others hold the contrary opinion. The opinion 
is rather general that boiled milk putrefies but does not sour. When milk 
is boiled most but not all of the bacteria are killed. Those which survive 
are the putrefiers. Some authorities hold the milk is dangerous on that 
account; others hold the contrary opinion. They say the milk becomes 
offensive and nobody will drink it. Pasteurized milk is milk that has 
been heated to somewhere between 140° and 170° Fahrenheit. This amount 
of heat kills the disease germs but does not kill the souring germs. Pas- 
teurized milk sours but the process is delayed one to two days. The nutri- 
tive properties of pasteurized milk are the same as those of ordinary milk. 

Good Milk Proposal. — T. C. L. writes: "Since milk, next to water, is 
the chief necessity of life, why should it not be imperatively a city's busi- 
ness to supply it as well as to supply water? Could not Chicago have a belt 
of municipal milk laboratories surrounding the city, one laboratory to each 
railroad supplying a dairy region, to which milk could be brought by the 



* ICE CEEAM 541 

quickest possible route? In such a laboratory the quality of the milk sup- 
plied by each farmer could be recorded, and the milk treated as the scientific 
staff of the laboratory should direct. The cans could be sterilized and 
sealed, and sent back to the farmer all ready for him to use. He should 
not waste time straining or separating the milk through imperfectly 
sterilized utensils, and he would be saved much time, and we should be 
saved having an easily contaminated food handled by a person not properly 
equipped for it. The morning milk could probably be delivered by late 
afternoon to specified areas and save night work for the milk wagon drivers. 
Downtown could be cared for by subways. Since all children, rich and 
poor, and all invalids, rich or poor, need the same grade of milk and need 
it badly, cannot public opinion be aroused to an activity that will eventuate 
in the city's supplying it as cheaply as possible and thus lessen the diseases 
and deaths that come from a lack of clean cheap milk and plenty of it? 
The many surveys of the milk supply of cities, as at present carried on, 
show that the present method is far from being an economical one." 

Reply. — The proposal, subject to some modification, is a good one. 
Portions of it are in use in different parts of the world. In time the 
general plan will be in universal use. 

Milk Safety. — N. S. writes: "Please advise as to what preventive meas- 
ure should be taken by milk consumers of Chicago in the present prev- 
alence of foot and mouth disease. How are we to know whether our supply 
is safe? What is to be done about butter, buttermilk, sour milk, and 
sweet and sour cream?" 

Reply. — Use no milk that has not been pasteurized. This advice ap- 
plies also to butter, buttermilk, sour milk, sweet and sour cream. Beyond 
this you need not go. 

The best guarantee available is the reputation for integrity of the 
dealer who gives you the assurance that his product has been pasteurized. 

Until the danger is past the people should be on the watch for sore 
mouth, especially in their children. 

Certified Milk Safer. — P. B. writes: "A friend has advised me to use 
certified milk for my baby. Will you please inform me the difference be- 
tween this and the ordinary milk and if it is better for the baby? Also 
how to obtain it?" 

Reply. — Certified milk contains 4 per cent fat. Certified milk is 
fresher and cooler, and has fewer bacteria. It is produced by healthy, tu- 
berculin tested cows and the milkers themselves are subject to inspection. 
Carefully inspected certified milk is safer than market milk. It costs 
about twice as much as market milk. 

The Chicago Medical Society (see telephone directory) will furnish 
you a list of certified milk producers. 

Is Boiled Milk Nutritious? — Mrs. A. T. Z. asks: "Is the nourishment 
impaired in any way by boiling milk? Is it harder to digest than raw or 
pasteurized milk? Does cottage or 'Dutch' cheese, made from raw milk 
clabber, contain wholesome nourishment? Is it easy or hard to digest? 
Should boiled milk or cottage cheese have a tendency to constipate?" 

Reply. — Probably the majority of practicing physicians believe boiled 
milk is hardly less nutritious pint for pint than unboiled milk. The dif- 
ference is slight. It is probably harder to digest than raw or pas- 



542 MILK * 

teurized milk of the same grade. The bacterial products in raw milk are 
harder to digest than any changed albumins in boiled milk. The bacterial 
changes in raw milk decrease its nourishing power more than does the 
boiling of boiled milk ; therefore boiled milk taken soon after being boiled 
is both more nutritious and more easily digested than raw milk as you get 
it under ordinary circumstances. 

Cottage cheese is highly nutritious and when of good quality is thor- 
oughly wholesome. It is easy to digest. All milk and cheese has a slight 
tendency to constipate. This is not through any definite action. The 
largest factor in ordinary cases of constipation is lack of bulk; and milk 
and cheese, especially after the water is absorbed, are concentrated foods; 
therefore constipation follows a milk and cheese diet unless some bulky 
food is added to it. In milk with a high bacterial count there are occa- 
sionally bacterial products that are laxative. These sometimes produce 
violent diarrheas and cholera infantum. In boiled milk there will be less 
of these products and therefore the use of boiled milk is more apt to be 
productive of constipation than the use of raw milk. 

Refers to Boiled Milk. — M. C. W. writes: "In a recent number of 
'The Tribune' an article appeared giving the views of an eminent scien- 
tist on the use of sterilized milk for children, pronouncing it an unfit ar- 
ticle of food. I am sure many mothers would appreciate it if you would 
give your ideas on this subject. 1. Do the leading dairies use the sterilized 
milk? 2. How can one know whether the milk one is buying is sterilized 
or not?" 

Reply. — 1. The milk referred to in the article is boiled milk. No dairies 
furnish boiled milk. 

2. There is a test known as the Storch test. It will tell whether or not 
milk has been heated to 170 or over. It is not dependable when milk has 
been heated from 140 to 160. Any laboratory will make a Storch test. 

Heating Water and Milk. — J. A. M. writes: "Does not boiling the 
water precipitate nearly all mineral matter or the vital salts in the same 
and render them impossible of solution and assimilation afterwards? If so, 
does it not affect milk similarly?" 

Reply. — Boiling the water does not precipitate the mineral matter or 
the vital salts in the same. Mineral matter is more soluble in boiling water 
than it is in cold water. A kettle of water boiled until it is pretty well 
evaporated will precipitate its mineral matter because of the concentration 
from evaporation. 

There are no vital salts in water. 

Boiling milk does not precipitate its salts unless the boiling is kept up 
until most of the milk is evaporated. Mineral matter thrown out of solu- 
tion through concentration will go back into solution when enough water 
is added so that concentration no longer exists. 

Vary Warm and Cold Milk. — N. E. F. writes : "I am drinking three 
quarts of milk each day in an effort to gain in weight. Would you advise 
it taken warm or cold, and do you think three quarts is enough to get 
results? In addition to the milk I have my breakfast and dinner at 
night with the family. I am perfectly well in every way, but need a few 
more pounds. I am also taking a physical course" 



ICE CEEAM 543 

Reply. — It does not matter whether you take the milk warm or cold. 
Vary it that you may not grow tired of it. 

If three quarts of milk in addition to your regular diet does not 
fatten you you cannot get fat. Some people cannot. I would not advise 
you to continue using so large a quantity for many months. It strains 
your eliminating organs a great deal. 

Are you certain that you do not worry? Peace of mind and regular 
habits are nearly as effective as milk. 

Condensed Milk Safe. — J. P. writes: "Is this so-called evaporated 01 
condensed milk as good as fresh milk, or is it injurious to the health? In 
several instances, when using evaporated milk, I have found in the hot- 
torn of the can tiny bits of lime or some other substance. On account 
of fresh milk being so poor in the winter we have decided to use evap- 
orated milk, but have been told that it is not vjell to use it continuously." 

Reply. — If it is to be used by grown people, condensed milk is just as 
wholesome as fresh milk. It is somewhat safer. It is a better summer 
food than a winter food since it is somewhat low in fats. It is better to 
give babies fresh milk. This is especially true in winter. If in summer, 
say for three months, the choice lay between a dirty whole milk and a 
condensed or evaporated milk the decision would be in favor of the latter. 
If the whole milk is clean it would be in favor of the former. 

Try Cheese and Milk. — R. A. writes: "Every summer at the beginning 
of the hot weather I have something like summer complaint. The doctors 
have called it colitis. The first attack generally starts with dysentery 
and much pain. I am troubled all summer and I generally can control it by 
taking a strong astringent. I took an astringent all last summer and, 
unless I do this, I become terribly run down and nervous. Can you tell 
me any diet that would help me get through the hot weather without the 
usual attack? I am now 38 years old and don't believe the attacks are 
quite so severe as when I was younger. I fatten up every winter and eat 
anything in reason." 

Reply. — Write to the Department of Agriculture at Washington for 
its bulletins on cheese and milk as foods. Try living on cheeses, boiled milk 
and bread. 

Ice Cream Poisoning. — F. C. writes: "On Sunday last a man, his wife, 
and two children were all taken sick with the following symptoms: Fever, 
vomiting, and a severe diarrhea. All had chills, and the temperature 
ranged around 102 to 103 degrees. All had eaten ice cream the evening 
before. Was this ptomain poisoning, or was it from the cream, freezer, 
or from the vanilla flavoring? Two of the neighbors ate of this cream and 
were attacked in the same manner. All recovered." 

Reply. — They certainly had some form of food poisoning. The evi- 
dence you present points clearly to ice cream poisoning. The poison in 
that case was tyrotoxicon. It is the custom to age milk before freezing it 
into cream. Sometimes the aging is overdone. 

Pasteurized Milk. — B. F. W., Jr., writes: "You say 'always and ever 
drink no raw milk.' Bo you mean that pasteurized milk should be heated 
or boiled to insure safety?" 



544 MILK 

Reply. — Pasteurized milk is not classed as raw milk. Unless you are 
certain the pasteurization is properly done you had better heat the milk 
at home during June, July, August and September. 

Pasteurization Enough. — J. 8. writes : "I saw a statement in a newspaper 
recently in which the claim was made by some physician that pasteuriza- 
tion of milk was not sufficient protection against foot and mouth disease. 
This doctor claimed that all milk should be boiled in order to insure 
protection." 

Reply. — Pasteurization is enough. Boiling is recommended by Euro- 
pean physicians where the milk is from cows having the disease or sus- 
pected of having it. In this country such cows are killed. 

Pasteurized Milk Constipating. — E. G. S. writes: "Will pasteurized 
milk, used as a drink, cause constipation?" 

Reply. — Yes, it will contribute somewhat. Milk is indirectly constipat- 
ing ; that is, it is not bulky enough to be an ideal food. Pasteurized milk 
is somewhat worse in this particular than raw milk because the germs 
in raw milk may be slightly laxative at times and may cause diarrhea. 
Continue using boiled milk to be safe against tuberculosis and typhoid. 
Eat vegetables, fruit and bran enough to cure constipation. 

Pasteurize the Milk. — C. E. writes: "In a country town where there 
is no such thing as certified milk or inspection of dairies, how can we pro- 
tect our children from tuberculous milk?" 

Reply. — Keep a tuberculin tested cow, for one thing. Pasteurize the 
milk, for another. The Illinois Food Commission distributes a circular 
on home pasteurization of milk. 

Sour Milk. — H. A. T. writes: "Professor Metchnikoff suggests the 
drinking of sour milk, on account of the lactic acid it contains, as a cure for 
colon infection. If the use of enemas and cathartics has ceased to destroy 
the colon bacillus what is your opinion regarding use of sour milk? Would 
there be any harmful results besides the good it might do? How much 
should be taken during one day?" 

Reply.- — The souring germs in sour milk are not very strong. It 
will help some. Eat as much as you like. 

Sweet Milk and Buttermilk. — H. N. W. writes: "Will you please tell 
your readers what you think of thick milk, clabbered milk, and buttermilk 
as regular articles of diet? Will you tell us what you know about their 
nutritive value?" 

Reply. — When buttermilk retails at 4 cents a quart and sweet milk at 
8 cents $1.00 buys 1.8 times as much protein in buttermilk as in sweet milk 
and $1.00 buys the same amount of heat and energy in buttermilk as it 
does in sweet milk. Buttermilk is, generally speaking, more easily digested 
than sweet milk. Therefore, buttermilk is somewhat of a bargain in winter 
and much of a bargain in summer. 

Clabber and sour milk have all of the nutrition of sweet milk. When 
the human stomach starts digesting milk the first step is to sour and 
"clabber" it. 



ICE CREAM 545 

It is generally held that good soured and "clabbered" milk is not only 
nutritious but easily digested. 

Buttermilk Safer. — L. C. W. writes: "Will you kindly inform me 

whether buttermilk, as ordinarily sold in Chicago, is as apt to contain 

typhoid germs as regular milk? What is the relative nutritive value of 
milk as compared with buttermilk?" 

Reply. — Buttermilk as sold in Chicago is somewhat safer as regards 
typhoid fever than is sweet milk. Typhoid bacteria in milk tend to die 
out, especially in the acid of buttermilk. A large part of the buttermilk 
sold in Chicago has been pasteurized preliminary to churning. However, 
we will make a mistake if we are careless about buttermilk. There is the 
same necessity for getting it from clean and careful people as there is with 
sweet milk. 

The nutritive value of milk as compared with buttermilk is about as 
20 to 18 — that is to say, you get about as many energy units out of a pint 
and a quarter of buttermilk as you would out of one pint of sweet milk. 
The difference between the two is largely in heat making qualities. The 
fat of milk goes in the main to the making of heat. 

The albumins of buttermilk, however, are somewhat more easily di- 
gested and absorbed unit for unit than those of sweet milk. I mention 
these things in order to make it clear that a measure of calories is not the 
only thing to be taken into consideration in the selection of foods. 

Buttermilk. — F. A. H. writes: "1. Is not buttermilk wholesome to drink 
when it is sour? 2. I am fond of thick or loppered milk and have sup- 
posed it was healthful, although sour. Do you consider it so? 3. Why do 
we guard against sour milk for babies and others if the loppered milk is 
healthful?" 

Reply. — 1. Yes. 

2. Yes. 

3. Clabbered milk is wholesome for grown people, but not for babies. 

Buttermilk as Beverage. — Mrs. A. L. S. writes: "For how long a period 
will buttermilk remain in condition for drinking purposes, supposing of 
course it is kept in a chilled atmosphere?" 

Reply. — Under the proper conditions buttermilk will remain in a con- 
dition for drinking purposes about twenty-four hours longer than sweet 
milk. 

Kind of Buttermilk. — Constant Reader writes: "What kind of butter- 
milk is the most effective, artificially soured milk or the regular butter- 
milk?" 

Reply. — If you can get freshly churned buttermilk made from milk 
known to be right it is the kind to use. If this cannot be had get the 
artificially soured milk made from pasteurized milk. If your dealer does 
not handle this kind of buttermilk patronize one who does. Do not buy 
buttermilk churned in a store in the city unless you know they churn 
good milk. Some churn bargain milk bought here and there — milk that 
dealers have had left over. Buttermilk from whole milk is not as whole- 
some as buttermilk from soured skim milk or buttermilk left after butter- 
making. One of the advantages of good buttermilk is that it is low in 
fat or grease. 



546 MILK 

Gives Buttermilk Formula. — G. M. S. writes: "Will you please give 
me a formula for the proper preparation of soured milk, to he used for the 
prevention of intestinal putrefaction?" 

Reply. — The method of making culture milk is as follows: 
Take one quart of skimmed milk without preservatives. Heat it until 
it begins to simmer, put bottle in cold water, add one-sixth quart hot 
water. When the temperature of the mixture is about milkwarm, add 
one lactone of culture tablet, cover it up and let it ferment at room 
temperature for thirty-six hours, then keep cold until it is used up. Shake 
before using it. If you wish to make a buttermilk out of the home milk 
instead of the skimmed, use one-third quart of hot water instead of one- 
sixth. Note that skim milk and not buttermilk is used. 

Culture Buttermilk Better. — Daily Reader writes: "1. Is the natural 
buttermilk from the churn any more wholesome than the artificial or cul- 
ture buttermilk? 2. Which would have the better effect against intestinal 
putrefaction? 3. Would impure or carelessly handled milk lose its un- 
healthy quality when turned into buttermilk? Jf. Are dairies under any 
compulsion to label buttermilk according to whether it is churned or arti- 
ficial milk? I know of only one large dairy selling buttermilk that is labeled 
f culture' but most people seem to think that we do not get any natural 
buttermilk from any of the dairies." 

Reply. — 1. No. Some people prefer the taste of old-fashioned churn 
buttermilk. From the standpoint of wholesomeness the culture product has 
the better of it. 

2. Probably the culture kind. In the one the acid producers are hit 
and miss. In the other the added acid producers are more uniform. 

3. No. 

4. No. 

Value of Buttermilk. — F. L. F. writes : "Please inform me why butter- 
milk is healthy and in what way it is conducive to put one in good con- 
dition?" 

Reply. — Buttermilk contains less fat than sweet milk. For this reason 
it is the better summer drink. The casein in buttermilk is chemically and 
physically in better condition for digestion by grown people at least than 
is that in sweet milk. The idea that the lactic acid bacilli of commercial 
buttermilk are conducive to health of themselves is not correct. 

"When Buttermilk Disagrees. — M. W. D. A. asks: "Is buttermilk harm- 
ful to me, subject to acid conditions? Have fancied when I drank it that 
sensations were unpleasant in digestive tract and that indirectly the 
nervous system was affected." 

Reply. — There are many people who are not pleasantly affected by 
buttermilk. You may be one of those. If it does not agree with you by 
all means discontinue it. 



CHAPTEE XXX 

Lymphatic Glands 

About every so often when reading the morning paper your attention is 
claimed by an account of where, and how seriously, a herd of cattle is 
afflicted with lumpy jaw (actinomycosis). Sometimes this disease attacks the 
lymphatic glands in and about the region of the neck and jaw. It may 
attack the lymphatic glands in other regions of the body. Usually, however, 
it attacks the bony structures of the jaw. 

Lumpy jaw is caused by a specific, vegetable parasite. These parasites are 
unusually large. For this reason it is difficult for them to trail along the 
lymphatic system. Hence, the gateway through which they enter the system 
is perhaps through cavities in the teeth. 

Lumpy jaw as a disease is not confined to cattle. It attacks man as well. 
It may attack any organ or structure in the human body. Osier refers to the 
fact that Dr. Hektoen makes the statement in an unpublished paper that this 
disease attacks the myocardium even more frequently than syphilis. 

If you chance to visit the Stockyards be sure to observe the method of 
handling hogs in the various steps of slaughtering. You will notice that 
after the hog is slaughtered it is placed in a guideway for transportation to its 
final destination in the preparation for ultimate consumption. 

Stationed along this guideway at points some distance apart are two 
men. These are inspectors. They are experts. They are supposed to be, 
and, in fact, are, able to detect disease by examining the kernels (lymphatic 
glands) in and about the neck and jaw of the carcass. 

The first inspector thrusts his hand into the gap in the flesh about 
the neck, made for the purpose of affording free bleeding, to examine the 
glands in and about the neck. On account of his acuteness of touch and 
wide experience he is able to tell quite accurately and quickly if the glands 
are diseased. If they are, he places his sign somewhere about the carcass 
(ears perhaps), so that its final disposition may be in accordance with the 
rules and provisions of constituted authority. If they do not indicate 
disease he signifies that it has passed inspection by not marking it at 
all. 

The second inspector makes his examination after the animal has been 
drawn. Like the first inspector, he places his approval as to whether it is 
or is not of a certain grade by some predetermined mark for identification. 
By this means much of the unfit meat and by-products are identified and 
prevented from being worked in with the final food products for general 
consumption. 

As a matter of historical information, it will be interesting to know that 
the first facts concerning the lymphatic glands and lymphatic system were the 
results of some observations made by a number of eminent scientists upon 

647 



548 



LYMPHATIC GLANDS 



living animals. Although the lymphatic glands and lymphatic system were 
known to Hippocrates their true significance and functions were not under- 
stood until within comparatively recent years. 

In the early part of the sixteenth century Asellius noticed the behavior of 
the lacteals in the living dog. This skilled anatomist saw that the lacteals, 
when cut, exuded a whitish liquid. This led him to conclude that he had 
discovered a new kind of vessel. 

A series of experiments and observations made by him established beyond 
question that there existed a relation between the presence of a white liquid 
(lymph) in the lacteals and the products of digestion. 

While it is rather unfortunate, especially for 
him, that he failed to comprehend the true sig- 
nificance of this phenomenon, his discoveries served 
as a stimulus to those who followed in their efforts 
to determine the part played by these organs in 
the general metabolic processes. 

About the middle of the sixteenth century 
the general functions, origin, distribution, and 
structure of the lymphatic glands and the lym- 
phatic system, as we understand them today, were 
discovered, and worked out more in detail by 
Pecquet of France, Bartholin of Denmark, Jolive 
of England, and Eudbeck of Sweden. 

A few years later another set of scientists 
began the refinement of the work already done. 
About this time the work which was done was 
preserved in books and in the form of charts. 

These documents, even at the present time, 
are considered authoritative. Among these workers 
might be mentioned Hunter, Hewson, Cruickshank, 
and Mascagni. 

A still more delicate refinement of the lym- 
phatic system and its functions as we know them 
today was worked out and handed down to us by 
Sappey, a noted French scientist. 

It is hardly saying too much, I believe, to say 
that in the discovery of the lymphatic system Sap- 
pey, Starling, and the other scientists and investiga- 
tors who labored in this field of useful endeavor did as much, or even more, 
when they discovered the lymphatic system and its function for the science of 
medicine and surgery than Harvey did when he discovered the circulation of 
the blood. 

In discussing the diseased conditions of the lymphatics, Osier has the 
following to say : 

"The great majority of the diseased conditions of the lymphatic glands 
are secondary in nature, and are the direct result of the part played by 
the lymphoid structures in the protection of the body. In the exercise of 
their function as niters of the lymph stream, whereby they remove from the 
latter both the bland and the harmful substances gaining entrance into the 




Fig. 195. — Lymph Vessels 
and Glands of Arm 
and Hand. 



LYMPHATIC GLANDS 549 

lymphatic vessels, their own integrity is often sacrificed to the welfare of 
the organism as a whole. 

"Into the lymph stream of any region of the body a great variety of 
formed elements may pass, such as dust, carbon, bacteria, disintegrating red 
and white blood cells, blood pigment, dead tissue cells, inflammatory exu- 
dates, tumor cells, toxic substances, etc. Usually the regional lymph nodes 
filter out such foreign substances, and retain them either permanently or 
temporarily, in some cases rendering them harmless or destroying them, 
while in other cases the injurious agent is able to cause degeneration or 
necrosis and inflammation within the lymphoid tissue itself. 

"In this conflict, particularly when pathogenic bacteria are concerned, the 
lymphatic glands may suffer severe inflammatory processes, even to the 
extent of total destruction by suppuration; but in the great majority of 
cases the infective agent is disposed of by the gland after a more or less 
marked local inflammatory reaction. . . . 

"Since the involvement of the regional lymph glands is usually secondary 
to some primary infection within the region tributary to them, we find, for 
example, involvement of the axillary and cubital glands in the case of in- 
fection of the hand, arm, of mammary gland; involvement of the cervical 
glands in infections of the mouth cavity and pharynx, of the bronchial glands 
in pulmonary infections, of the mesenteric glands in intestinal diseases, of 
the inguinal glands in infections of the external genitals and lower extremi- 
ties, etc. 

"Such an involvement of the regional lymph glands occurs also in 
chronic inflammations of the corresponding regions, and in the case of 
malignant tumors occurring therein, particularly carcinoma." 

Some years ago a baby show was held in Chicago. The babies were all 
registered. As a precaution, the officers conducting the show provided for 
the physical examination of all of the babies entering the contest. 

Stationed at the entrance of the hall where the show was held were a 
number of physicians, whose duty it was to examine the lymphatic glands in 
and about the neck and jaw of each baby as it entered the hall, to see if they 
were diseased. 

If they showed evidence of disease the baby was excluded from enter- 
ing the contest. If they did not the child of course was permitted to enter. 
By this means the health of the entire body of children was greatly safe- 
guarded. 

Diphtheria, scarlet fever, measles, mumps, and the like usually cause en- 
largement of the kernels {lymphatic glands) in and about the neck and jaw. 
Even a bad sore throat, particularly when the tonsils are involved, may, and 
often does, cause enlargement of the glands at the angle of the jaw, and where 
the inflammatory process extends to and involves the ear, those just back of the 
ear within the region of the mastoids. 

Occasionally the glands under the tongue just back of the chin become 
enlarged. This is usually the result of an infection that has got in through 
the cavities in the teeth. 

Enlargement of the glands under the arm is usually caused by some dis- 
ease of the mammary gland. Because of the nearness of these glands to 
the primary seat of infection they are exposed to a concentrated form of- toxin. 



550 LYMPHATIC GLANDS 

The inflammatory processes resulting from this form of infection is some- 
times so severe that the glands become large and soft, and then suppurate. 

A general inflammation of the lymphatic glands may occur in any one 
of the several infectious diseases. It may occur in either the adult or the 
child — usually the latter. 

The most common form of this inflammatory process is that which 
results from so-called scrofulous conditions and tubercular infection. These 
conditions are ofttimes neglected and terminate in suppuration. 

A similar chronic suppurative condition of the glands is not infrequently 
found in children who have rickets. Where these and similar conditions of 
the glands are recognized early enough by proper treatment resolution may be 
established without a dissolution in the continuity of the tissues which results 
in the formation of so many unsightly scars. 

The lymphatic glands are globular, ovoid bodies, made up of a fibrous 
framework, lymph sinus and lymph follicles. They are widely distributed 
throughout the body. They follow all of the blood vessels to their remotest 
ramifications, in many cases being even more remote than the blood vessels. It 
is through these canals that the lymph must percolate in its course to 
join the blood vessels. 

The lymphatic glands enter into the formation of the lymphatic system. 
Other organs of the lymphatic system are minute and larger spaces of defi- 
nitely walled capillaries and vessels containing lymphatic glands. It is 
through these canals that the lymph must percolate to join the venous sys- 
tem. 

The lymphatic glands probably stand at the gateway of all lines of dis- 
ease invasion. Up to the present time disease of the lymphatic glands have 
not received as much consideration as they possibly deserve. 

When anything interferes with the normal flow of lymph the lymph 
glands and vessels soon become distended. Since their walls are of low 
resistance their fluid is easily forced into surrounding tissues. 

If the obstruction continues the tendency to set up various diseases 
greatly increases. While many of these diseases are only secondary in nature 
they should more often be considered of primary importance, as by so doing 
the more serious sequelae of many infectious diseases can be prevented or 
at least greatly mitigated. 

A tolerably correct pictorial idea of the relation of the lymph to the 
tissues of the body can be formed by considering the tissues as made up of 
the structure of a sponge, and the sponge as having been suddenly immersed 
in water and then withdrawn. In other words : 

"All the cellular elements of the tissues are to be considered as bathed in 
a sea of lymph." 

Since this is true, it can be readily understood that a thorough knowl- 
edge of how disease attacks the lymphatic system becomes of highest im- 
portance. 



HODGKIN'S DISEASE 551 



HODGKIN'S DISEASE 



A London brewer dying in 1724 without issue left his property as an 
endowment to found a hospital bearing his name, Guy. One hundred years 
ago a physician at that hospital described a disease observed in the ward. 
The physician was Hodgkin, and the disease took his name. 

In Hodgkin's disease the lymph glands swell. These small hard nodules 
under the skin, in the neck, under the arm, in the groin, and in the in- 
ternal organs make one think of infection. Such enlargements, as we or- 
dinarily see them, are due to infection, and, in many instances, the ordinary 
man knows just when the infection entered and what was the nature of it. 

Hodgkin's disease has all the earmarks of a mild, slow, relentless 
infection — one that never kills tissue and causes abscesses but one that weakens 
the person little by little and causes death in a few years. But no laboratory 
examination of Hodgkin's showed the infection, and so nearly a hundred years 
went by. However, the money of the London brewer and the brain of 
Hodgkin, the hospital physician, had laid the foundation. 

Recently Bunting, at the University of Wisconsin, announced that he 
had found the cause of Hodgkin's. When these glands begin to grow the 
customary thing to do is to run to a surgeon to have them cut out. But cut- 
ting them out does no good. New ones grow back almost at once. 

Many people with Hodgkin's go to Rochester, Minnesota, to the Mayos. 
Bunting asked them for some material and they removed a few glands from a 
patient and sent them to him. Bunting found a bacillus, grew it, and, in- 
jecting it into monkeys, produced a disease with the symptoms of Hodgkin s. 

Then Billings took some glands, grew the bacillus described by Bunting 
(and perhaps also described by Erankel) and made from them a vaccine. This 
vaccine he gave to a dozen patients. The dose ranged from 5,000,000 to 
100,000,000 bacteria. The injections are given hypodermically once every 
five to seven days. Following the second or third injection there is a high 
fever lasting a few hours. Some of the patients are apparently well now. 

Neither Bunting nor Billings makes any positive statements yet. They do 
not say they have found the cause or the cure of Hodgkin's. They tell 
what they saw and what they thought of what they saw and they ask others 
to check what they did and then tell how it impresses them. 

It seems fairly certain that the vaccine will not be of service in late 
cases of Hodgkin's — that is, for people too weak to stand a day of high fever ; 
that it will not be of service where the glands in the chest are large enough 
to be shutting oft the wind or interfering with the heart. Other cases of 
Hodgkin's are proper for trial. Physicians who want to use it can secure it, 
I am sure, through their druggists. 

Let us hope that the problem of Hodgkin's has been solved. If so, the 
next step will be to work out a cure for its kinsman, leukemia. 

Leukemia and Hodgkin's.— There are a few diseases which are char- 
acterized by enlargement of lymph glands but in which, if germs be present, 
their presence has not been proved. The most important of these is leukemia. 

The white blood corpuscles are highly serviceable. They are the fight- 
ing forces of the body. They are powerful in repelling any invading enemy. 



552 LYMPHATIC GLANDS 

Unlike the red blood cells, they can do their work wherever the work is to be 
done, either within or without the blood vessels. 

They are constantly going through the walls of the blood vessels and 
over to some nook where there is a job to be done and then back through 
the vessel wall into the blood stream. 

They are so efficient that not many of them are needed. The red 
blood cells are six hundred times as numerous. 

In leukemia the number of white cells is increased. Instead of a 
count of 8,000 there may be a count of 400,000 in each cubic millimeter, 
merely meaning that they are fifty times as plentiful as normal. In pneu- 
monia, in blood poisoning, and in a few other diseases, the leukocytes are in- 
creased three or four fold because their work is increased three or four 
fold. In leukemia they are increased fifty fold and if their work is in- 
creased nobody has ever been able to prove it. 

Leukemia in older people is characterized by an enormous enlargement 
of the spleen without much enlargement of the lymph glands. Leukemia in 
younger people is characterized by enlargement of the lymph glands without 
much enlargement of the spleen. There are other cases in between. 

If the lymph glands enlarge and no local reason can be found the blood 
should be examined to decide whether leukemia is present. 

Protect Lymph Glands.— When a lump can be felt the person most 
interested is liable to become greatly alarmed. Sometimes this alarm is 
justified and sometimes it is not. It all depends on what caused the lymph 
gland to swell for the lymph gland in swelling was merely doing its duty. 

If fear stimulates one to find out what lies back of the swelling and 
to try to remedy it, it does good. If it is carried beyond that point, of course 
it does harm. 

The sane course to follow when one discovers an enlarged gland is to 
find where the absorption is taking place (if possible), what is being absorbed, 
and then to devise a method of preventing the absorption. 

Lymph flow is not as uniformly in one direction as is blood flow. The 
arrangement is comparable to the stream arrangement at the mouth of the 
Mississippi river where the water, though usually flowing down one channel, 
is rather easily diverted to another. 

Nevertheless, the lymph flow is regularly enough in one direction so 
that, given an enlarged lymph gland, we can guess pretty well where the 
absorption got in. For instance, enlarged glands in the neck well to one side 
directly below the ears mean absorption from the throat. 

As nearly all of the infections of the throat get in through the tonsils, 
the wise procedure, when the neck glands enlarge, is to examine and re- 
examine the tonsils. If kernels come under the arm the wise procedure 
is to go over the arms and fingers minutely for the focus of infection. 

The old plan of treating enlarged lymph glands was to paint them with 
iodin or to poultice them, and finally to lance them — as though the real seat 
of the trouble were in the gland. It may be necessary to lance kernels. If they 
are full of pus it is the proper policy. 

It may be necessary to remove them radically by operation. If they are 
damaged beyond service and beyond repair, it is proper to remove them. 
But no kernel that is not damaged beyond repair should be removed. It is 



HODGKIN'S DISEASE 553 

better by far that it should be there filtering out poison, even though swollen 
and hurting, than that the poison should reach the blood. 

What should we say about the person who allows absorption to proceed 
uncared for until his faithful servant, the lymph gland, breaks down and must 
be removed ? 

What can he do? That depends upon the glands. If they are the neck 
glands, let him clean up his tonsils and his teeth. If the crypts of the 
tonsils cannot be cleaned and kept clean let him have them removed. If 
the trouble is with the teeth and gums, let them he cleaned and kept clean. If 
the kernel is in the groin and there is an ingrowing toenail, that must be 
cleaned up. 

Wherever the focus, if it be made right, the glands will get right in time. 

Lumps on Neck. — Subscriber writes: "I have had enlarged lymph 
glands for two years. Lumps come and go on both sides of my neck. 
Recently I have felt them in the bach of my neck. When they swell they 
cause considerable pain and stiff neck. I have consulted three physicians. 
They can't discover anything wrong with either lung, but say these en- 
larged glands indicate a 'tuberculous condition.' If the infection is tuber- 
culous, what would you advise me to do for it? Would a change of climate, 
say to southern California, be of benefit? Do the lungs become affected 
from these glands in time? I am on a farm and live an outdoor life. I am 
well otherwise, but get run down every spring." 

Reply. — 1. Ask them to make sure of the diagnosis by a blood examina- 
tion and a tuberculin test. If the glands are tubercular, have them give 
you appropriate treatment, including tuberculin. As there seems to be a 
recurring infection, probably your tonsils are feeding tubercle bacilli into 
your glands. 

2. Some, but probably not much. It is better for you to change your 
tonsils rather than your climate. 

3. Sometimes. 

4. A good tonic would benefit you. 

Hodgkin's Disease Symptoms. — L. N. writes: "What are the symptoms 
of Hodgkin's disease? Is it curable? How can it be cured? Are tuber- 
cular glands in the neck liable to cause consumption? Are tubercular 
glands painful? Would an infection from the tonsils be painful?" 

Reply. — 1. Enlarged glands, anemia, general weakness. It is especially 
liable to be confused with leukemia and with tubercular glands. A blood 
examination will show whether it is leukemia or not. A tuberculin test 
will show whether the enlargement is tubercular or not. 

2. No. 

3. Yes. 

4. Yes, moderately so. 

5. Yes, moderately so. 

Consult Family Physician. — A. H. writes: "I have a daughter, not 
quite lJf., who is healthy and has never been sick. In the last year she has 
grown rapidly, but shows absolutely a normal development physically and 
mentally. Recently we have noticed a little swelling or enlarging of the 
right side of the throat. Sometimes it is not noticeable, but at certain 
movements of the head or when she is laughing it will show distinctly. 



554 LYMPHATIC GLANDS 

What is the cause and what kind of treatment do you recommend to stop 
it growing, or, if possible, to make it disappear?" 

Reply. — She may have a goiter; she may have enlargement of some 
of the other glands in her neck. An examination is necessary to deter- 
mine this; it is also necessary before prescribing. Consult your family 
physician. 

May Need Draining. — I. C. writes: "I have a lymph gland directly 
underneath the chin and it stands out prominently when I raise my chin. 
Do you advise having it cut out? It pains sliglitly when touched." 

Reply. — If it is red, soft, and sore it probably contains pus and should 
be drained ; otherwise not. The infection is getting in through your teeth 
or gums, mouth or lips. Have the focus of infection cleaned up. 

Are Easily Cured. — Subscriber writes: "Are little balls which have 
come in the neck and are apparently loose from the glands a form of tuber- 
culosis? Fresh air seems to have a tendency to lessen the enlargement, 
also quiet and rest. No pain is attached. What will they develop into? 
Are baths and dieting helpful?" 

Reply. — They may or may not be. Tubercular glands of the neck 
frequently seem to be "little balls not attached to the glands." Tubercular 
glands of the neck are usually easily cured and therefore develop into 
nothing. 

Swollen Lymph Gland. — S. T. G. writes: "I have a swelling on my neck 
near the ear. I have had it for two months. I have not consulted a physi- 
cian about it but I think it is a swollen gland. Do you think that has 
anything to do with tuberculosis?" 

Reply. — It is a swollen lymph gland, the result of some infection, prob- 
ably of a tubercular infection. You should have it attended to to prevent 
it from softening and suppurating. More important still, you should find 
where the infection is getting in. 

Enlarged Lymph Glands. — Irene writes : "1. 1 am bothered now and then 
with lumps about the size of a marble in my neck just under my jaw- 
bone. What causes these? 2. Is antitoxin a poison? 3. Does it affect the 
heart?" 

Reply. — 1. They are enlarged lymph glands. Such enlargement indi- 
cates the presence of germs of consumption, or pus, or something similar. 
The germs get there from the tonsils or from the teeth. By all means have 
your teeth, tonsils, mouth, and nose looked after. 

2. No. 

3. No. 



CHAPTER XXXI 

Ductless Glands 

The ductless glands have been a neglected field in practical medicine and 
surgery. From the surgical standpoint nothing has been done except to im- 
prove the method of operation on goiter; to determine when a given case 
should be operated on or when it had gone too far for an operation to be 
safe; to remove a few adrenal tumors, and to do an occasional removal of 
some one of the other glands. 

On the medical side more has been done, but not much headway has been 
made. There were many practical difficulties in the way. It was difficult 
to get the secretions of the glands for analysis and research; it was difficult 
to operate experimentally on the glands without disturbing neighboring 
structures in such a way as to make it difficult to decide what part of the 
effect was due to the operation and what part of the effect was due to the 
removal of the gland. 

When glands were given by the stomach the first necessity was to know 
whether the digestive juices broke the gland chemicals up into simple sub- 
stances and thus made them ineffective. For example, on the one hand, 
snake poison can be swallowed without injury, because the digestive juices 
change it to harmless substances; on the other hand, the virus of infantile 
paralysis when swallowed is probably not changed. 

Over growth in stature three influences preside — first, heredity; second, 
food supply; third, secretion of the ductless glands. 

We learn from the Journal of the American Medical Association of some 
experiments by a physician in Neiv York City who fed tadpoles on thymus 
and thyroid glands. Those fed on thymus retained their youth and remained 
immature frogs overlong. Those fed on thyroid began to develop legs at once 
and speedily dropped their tails. Maturity without much growth was reached 
ahead of time. It seemed that the impulse to grow came from the thymus 
and the impulse to mature from the thyroid and these qualities of these glands 
were not modified by the digestive juices. 

If we can apply this to human beings it would indicate that the great, 
large, gawky, overgrown youths would be helped by thyroid. Those who are 
small, old before their time, mature in advance of the years for maturity, 
would be helped by thymus. 

However, it is well to bear in mind that ductless gland therapy is now 
a field of active study and many halfway facts will be discovered from time 
to time. It will be some years before our stock of information will be great 
enough to support far reaching or final conclusions. 



555 



556 DUCTLESS GLANDS 



ACROMEGALY 

Growth is not a matter of chance. One determining factor is heredity. A 
child is born destined to reach a certain size. However, circumstances, such 
as an attack of summer complaint or measles, may intervene to prevent 
the child from developing as destined. More than that, the person is destined 
to grow after a certain fashion until about fourteen ; then to radically change 
his growth so as to fit a new set of specifications ; then, at about twenty-five, to 
quit growing, but to fatten ; about the forties to fatten more rapidly ; about the 
seventies to lose fat ; and finally, about the eighties, to dry out and shrink. 

These changes are not matters of chance. The growth in childhood is 
due to the secretions of the ductless glands and principally to those of the 
thyroid (in the neck), the thymus (in the chest, just over the heart), and the 
pituitary (in the train, just back of the eyes). 

At fourteen, the rapid growth along new lines is due to the absorption of 
the internal secretion of the sexual glands. The changes in percentage of fat 
which come later in life are the result of thyroid changes. 

Acromegaly is a disease in which the bones grow to giant size as the 
result of overactivity of the pituitary body. Many of the museum giants are 
acromegalics. Dock says: 

"The sculptures of many French and Italian churches show interesting 
examples/' 

Jack the Giant Killer and perhaps also David, who slew Goliath, had 
rather an easy time of it, as giants are generally weak both physically and 
mentally, "furnishing more drum majors than academicians," and dying 
before they reach middle life. 

Acromegaly is somewhat different from giantism. One out of every 
five acromegalics is a giant, and one out of every two giants is an acromegalic. 

In acromegaly the bones grow large — sometimes rapidly, sometimes slowly; 
the brow bulges, the cheeks become prominent, the chin protrudes, the fingers 
and hands, feet and toes, become heavy and "bony." 

In acromegaly the bones grow large at one end and not at another. 
Certain bones may be enlarged and not others. In fact, it is the unevenness 
of development which makes the difference between an acromegalic giant and 
a so-called normal giant. 

In acromegaly the pituitary body is found enlarged or overactive, 
without being enlarged. The gland oversecretion poured into the blood 
causes certain bones to overgrow. 

Some day somebody should discover an antibody to neutralize this 
secretion or some surgeon should find a way to remove a part of the gland. 

Irregular and abnormal growth, whether resulting in giantism, acromegaly, 
or some less obtrusive deformity, is a fair field for the investigator. 



THYROID MALADIES 

Lying on the front of the trachea, or breathing tube, just below the 
Adam's apple and just above the breast bone, lies one of the most important 






THYROID MALADIES 557 

organs in the body. It is located just under the skin and therefore is 
easily felt. It is known as the thyroid gland. 

The painters and sculptors knew of it in the earlier days of art, for the 
old Grecian statues and pictures show it plainly; yet the physicians were 
slow in discovering it. The first medical man to recognize definitely disease 
in the thyroid was Paracelsus, who wrote on goiter and cretinism about 1500. 

The reason for the tardiness with which knowledge of the thyroid 
has grown is that it is a ductless gland. Its secretion is absorbed directly 
into the blood stream. The peculiarity which made this gland secretion 
of the very greatest importance served to hold back knowledge of it. It 
was not possible to tap a duct, gather the secretion and analyze it, as can 
be done with the secretion of the duct glands. 

Paracelsus, the Swiss scientist of the sixteenth century, was deprived 
of one of his glands having a ductless gland function. In consequence his skin 
was smooth and his face grew no beard. 

Possibly he had some thyroid disease when he was young, for it is said 
that he was rickety. Possibly the bony changes of rickets are due to the 
effects of poor food and poor air acting through some of the ductless 
glands. 

Robinson says that, compared to Paracelsus, "the magpie is shy and the 
peacock modest/' Be that as it may, Paracelsus recognized that the thyroid 
was an important organ. 

The thyroid gland weighs from one to two ounces. It is about two inches 
long, three-quarters of an inch broad and an inch thick at the thickest part. 
Shaped like a pair of old fashioned saddle bags, it lies across the windpipe. 
The two main bodies, called lobes, rest on the sides of the windpipe, and they 
are joined by a band of thyroid tissue, called the isthmus, lying on the front 
of the windpipe. 

In the ordinary person the edge of the thyroid is about three-quarters of 
an inch above the top of the breastbone. In some people some part of the 
thyroid is behind the breastbone in the upper portion of the chest. 

The secretion of the thyroid cells is poured into microscopic cysts or 
tanks and from these it is absorbed by the blood. If the amount of thyroid 
secretion is just enough and not too much the work of the body is liable 
to go along about right. 

The thyroid is the master gland. More than any other gland it governs 
the work of other glands. The other organs are tied rather narrowly to their 
accustomed tasks. The thyroid has special tasks and in addition it has some 
capacity to help out with the tasks of other glands. 

If there be a general infection the thyroid is liable to swell. Indigestion 
causes it to enlarge. It enlarges during menstruation. Some pelvic troubles 
in women cause it to swell. 

If there be very much of an excess of thyroid secretion the heart beats 
too rapidly and is irregular ; there is a tremor in the hands and the breathing 
is shallow. The change in the mental state is very striking. There is great 
nervousness, excitability and general on-edge-ness. 

If there is too little thyroid secretion absorbed, the pulse is slow and 
strong, the skin is thick and dry, and the hair is lifeless. The mind is 
dull. 



558 DUCTLESS GLANDS 

The amount of thyroid substance absorption has a great deal to do 
with size and weight. Children with thyroid deficiency are small. Dr. 
Hertoghe dwarfed small animals by removing their thyroids in their early 
youth. He caused dwarfed animals to grow larger by the use of thyroid. 

Children with an excess of thyroid are nervous and learn and grow 
rapidly. 

As people approach the meridian of life the thyroid begins to show the 
effects of its great activity during the earlier years. The pathologist says 
that there is an overgrowth of the framework of the organ, the interstitial 
tissue — a sign of wear. 

The person says he is getting bald, is taking on weight, is less aggressive 
mentally, and that his judgment is better. The physician puts together the 
testimony from the two sources and says that the thyroid is secreting less. 

When the thyroid oversecretion is enough to bring the condition into the 
realm of disease the name given is hyperthyroidism, or too much thyroid. If 
the thyroid is enlarged, the condition is called goiter. There can be goiter 
without the on-edge-ness due to hyperthyroidism. There can be hyperthy- 
roidism without any goiter. 

If the absorption of thyroid secretion is too small in amount the condition 
is called hypothyroidism. If the deficiency is very great the condition is 
known as cretinism. A less marked stage is called myxedema. If the amount 
of secretion is still nearer normal the condition is known as partial myxedema. 

In cretinism the gland is very small and the amount of secretion is 
almost at the zero point. In consequence none of the life processes goes right. 
The subjects are somewhat dwarfed in body and very much dwarfed in 
mind. 

Cretins are such by inheritance. In fact, heredity is a prominent factor in 
both goiter and cretinism. Of cretinism, the Sardinian Commission reported : 
"Sometimes cretins are born to cretinous parents. Sometimes the children 
of such parents have no more than a disposition toward cretinism." 

In a considerable group of people there is a temporary condition known 
as partial myxedema. In others this condition of slight hypothyroidism is 
persistent. French described six groups of people who surfer from partial 
myxedema as follows: 

"1. Certain infants who without being true cretins, present symptoms 
of idiocy. 

"2. Certain backward children between two and five years of age showing 
various symptoms, of which the two most familiar are slowness in learning to 
talk and delay in learning to walk. 

"3. Growing boys and girls suffering either from general mental back- 
wardness or a persistence of the habit of wetting the bed at night. 

"4. Certain stout, sterile women of the child-bearing age. 

"5. Certain females at or about the menopause who have rapidly become 
too stout. 

"6. Sufferers from certain nerve affections which closely resemble and 
are frequently called neurasthenia and tic douloureux." 

There is no better way to discover that a given condition is the result 
of too little thyroid than giving thyroid for a while and noting the effect. 

If the physician who is observing the case notes that the symptom 



THYROID MALADIES 559 

is disappearing he is justified in feeling fairly sure that hypothyroidism 
was the underlying cause. For instance, if a child is noted to be months 
behind in walking or talking, or if a boy wets the bed years after he should 
have stopped, there is evidence enough to warrant a trial of thyroid. 

Belladonna, worm medicine and scores of other remedies have been 
tried in vain, for none of them is worth anything for bed wetting. Thyroid, 
under proper control, is worth a trial. 

An idea of another type of thyroidism can be had from a description of 
a case given by Dr. Barton in the Journal of the American Medical Asso- 
ciation. 

A woman forty-four years of age, the mother of three children, noticed 
that she could not comfortably put on her shoes or her gloves. Her feet and 
hands would swell and stay swollen for a while, then the swelling would 
go down. Examination of the urine showed that she did not have Bright's 
disease. This came on slowly and lasted for four years. 

Then she noticed that she was getting stout; her mouth was feverish; 
she felt cold when others did not, and her hands and feet would "go to 
sleep" easily — in fact, they had that feeling most of the time. Her skin 
was dry, glossy, and rough, and she never perspired. She had pains in her 
legs, especially when she went up and down stairs. 

In time her gait became very wabbly. Her memory became poor, 
she spoke slowly, and was disposed to cry a good deal. 

Her lips thickened a little and her tongue swelled. One consequence 
of this trouble with her lips and tongue was that her speech got a little 
thick. For instance, she pronounced s as sh. 

From her speech, her gait, and her mental impairment the neighbors 
got the idea that she was mildly intoxicated most of the time. 

Finally she went to a doctor and had a thorough examination made. 
He found a stout woman whose weight had recently increased from 170 to 
189. The lips and tongue were thick and stiff. There was enough of the 
appearance of dropsy in the skin to blot out the lines which ordinarily give 
expression to the face. At the same time there was no typical dropsy. 

She said she sat at a window for hours at a time, aimlessly looking 
out. Her mind was clear, but there was no snap to it. Her speech was 
thick. Her pronunciation was a mild imitation of that of the stage drunk. 

Dr. Barton decided that she was not suffering from Bright's disease. 
The near dropsy in the face and legs was suspicious but there were no albumin 
or casts in the urine. He decided that she was suffering from partial 
myxedema. 

He gave her two grains of thyroid extract three +imes a day. Her 
pains kept up for several days. Then she had flashes like a woman passing 
through the change of life. 

Then her disagreeable symptoms began to clear up and within a few 
weeks she was a well woman again. That is to say, she was well in so far as 
her symptoms were concerned. Her thyroid deficiency was permanent. At 
her time of life that could never be cured. 

After she had got over her symptoms her dose of thyroid was reduced 
to one two-grain tablet a day. That dose she will probably be compelled to 
keep up until her other organs have grown as old in structure as her 



560 DUCTLESS GLANDS 

thyroid is. She may be able to leave it off when she gets to be an old 
woman but not before. 

Of the six groups outlined by French those in Nos. 4 and 5, having 
begun thyroid, will probably need to continue it for many years. The 
members of Nos. 2 and 3, being young, should only take thyroid long enough 
to get well started towards cure. The elasticity of youth ought to bring 
them out and should be given a chance to. 

The members of group No. 1 will need to take thyroid longer than those 
in groups 2 and 3. How long will depend upon how near they are to being 
cretins. The members of group 6 must be guided by the circumstances of the 
individual case. 

In those days when the only variety of hypothyroidism known was 
cretinism thyroid, deficiency was thought to be a very rare condition in this 
part of the world. Then came knowledge of the milder condition, myxedema, 
but still the condition was regarded as rare. Then came knowledge of partial 
myxedema. 

Now it is known that a minus thyroid condition may complicate almost 
any disease condition. It may cause various kinds of aches and pains, various 
kinds of mental disturbance, and various symptoms that appear in other 
diseases, but which are the result of lack of thyroid. A few days of thyroid 
treatment may unravel more than one puzzling case. 

Fortunately the discovery of the remedy preceded the full knowledge 
of the disease. Thyroid extract bears much the same relation to this disease 
that quinin does to malaria or antitoxin to diphtheria. 

Difference in Goiters. — The general run of people are very well in- 
formed about goiters. They know a goiter when they see one. They even 
know how to protect themselves against goiter fakes of various sorts. Those 
who have goiters are not indifferent about them. In fact, as a rule, they 
are rather more uneasy than the danger warrants. There is need for in- 
formation on which to base judgment as to which of the goiters need 
treatment and especially which need surgical treatment. 

The thyroid gland goiter is very apt to enlarge as a result of disturbance 
somewhere away in the body — disturbance with the digestive organs or with 
the pelvic organs, for example. Plainly it would be a mistake to operate 
on such goiters. Whatever treatment is given should be given the organs 
in which the disturbance is located. The thyroid is not at fault, except it be 
a fault to help out. 

In young men and women it is not infrequent to see a certain amount 
of enlargement of the thyroid, but with no symptoms. These cases do not 
require treatment, either medical or surgical. The young woman who does 
not like the "looks" given her neck should console herself by remembering 
that the beautiful women painted and chiseled by the Greek artists had some 
simple goiter. 

If the goiter is pressing on important nerves or other important structures 
in the neck and causing either cough or suffocation operation may be called 
for. 

People older in years sometimes have simple goiters without any symp- 
toms. The goiter is there and that is all there is to it. Most of these cases 
require no treatment, medical or surgical. If in such a case the goiter 



THYEOID MALADIES 561 

grows rapidly, or gets very large, or produces pressure, or causes cough, opera- 
tion may be called for. A good surgeon must decide the question. 

The goiters for which good judgment is required, if the ship is to be 
properly steered, are what is known as toxic goiters. In the toxic goiter 
cases the subjects are nervous and flighty. The heart palpitates, races a 
while, and then pounds hard and slowly. The hand trembles. Breathing 
is shallow. In some of the cases, perhaps half of them, the eyes bulge and 
much of the white of the eyeball shows. The superficial observer sees the 
bulging eyes easily. It is for this reason that the name exophthalmic goiter 
is given to this disease. Some cases in which the eyes bulge do not show 
the other signs of poisoning. 

The essential signs of thyroid poisoning are the mental excitability, 
nervousness, the tremor of the hands, the nervous heart, the nervous diges- 
tive organs, and the bulging of the eyes. 

Some of these cases can be cured without operation. Antithyroid prepa- 
rations, iodin preparations, electricity locally, resting in bed are the meas- 
ures which succeed in some cases. Most of them need operation. 

Good judgment is required to decide when to operate and when not to 
operate. A case may pass quickly from an operable to an inoperable stage. 
Some inoperable cases can be treated medically and brought back to the point 
where they are operable. 

The Thyroid Gland.— When you encounter an unduly irritable, flighty 
woman and are upset by her unreasonableness, before you condemn her notice 
the size of her neck. She may have a goiter and by that token be entitled to 
your patience. 

When you encounter a logy, heavy, phlegmatic man, before you condemn 
him, think of the possibility that he is a cretin or cretinoid and entitled to 
your help. 

There are glands like the liver and kidneys that take chemical sub- 
stances out of the blood and discharge them from the body. They have been 
well studied, because it is easy to collect their secretions, to examine them 
chemically, to look at them under the microscope, and to inject them into 
animals. These glands are important just as the garbage man is im- 
portant. 

There are other glands, called ductless glands, which secrete substances 
that are poured into the blood stream, not out of it. These glands are im- 
portant just as the milkman is more important than the garbage man. 

The most important of the ductless glands is the thyroid — a gland located 
on the front and sides of the neck just above where the collar is worn. The 
thyroid secretion is poured into the blood and by it is carried to all the tissues 
of the body. ^Yhen the gland is wholly removed, death results in a few days. 
When a child is bom with too little thyroid it is dwarfed physically and men- 
tally, the limbs are short, the skin thick, the lips protruding — the child is 
idiotic, it hears and sees poorly and comprehends imperfectly. 

So much for those having far too little thyroid secretion — the cretins, 
the cretinoids, and, perhaps, the Mongolian idiots. 

Those having far too much thyroid have bulging eyes, a flushed face, 
irregular pulse, a flighty, irrational, illogical, quick, nervous, fidgety mind, 
asthma, and nervous diarrhea. Below this, which is the extreme, there are 



562 DUCTLESS GLANDS 

cases which grade all the way down through exophthalmic goiter, goiter 
thyroid enlargement, goitrous states, hyperthyroidism — through inexplainably 
nervous people to the absolute normal. 

Having established as a base line the man into whose blood the thyroid 
gland is pouring just the right amount of secretion each day and who in 
consequence is well nourished, well developed, well muscled, not obese, and 
whose mind works coolly, calmly, collectedly, alertly, judiciously, we recognize 
men and women both above and below, some in low and others in the high 
registers, and still others in the deep basses. 

Cretins. — It is probable that there always have been cretins. The 
ancients had a habit of deifying that which they could not understand and, 
therefore, stood in awe of. Dr. Parrot says that the ancient Egyptian god, 
Ptah, especially venerated at Memphis, was a cretin. An examination of 
the models of this god in the Egyptian galleries shows that he was big 
bellied, squat, with short limbs — not unlike a cretin. At the present time 
there is no romance and no legend attaching to the cretin. He is just 
plainly unfortunate in having less than his share of thyroid gland, or a 
thyroid gland secretion which is less rich than it should be. 

Most cretins are born with so little gland that they are doomed to cretin- 
ism; a few acquire this deficiency. There are parts of Switzerland where 
cretins abound. In a district in Styria there are 1,045 cretins for every 
100,000 population. In certain parts of Austria the rate is 71 per 100,000. 
In Piedmont, Lombardy, and Venetia there are 12,882 cretins in a population 
of 9,565,000. In this country there are a fair number of cretins, but far less 
than in the region of the Alps. 

Going above the line, we get into a field of greater interest. 

If the Egyptians worshiped a cretin god, the Greeks showed a fondness 
for those with an excess of thyroid. Greek statues were usually modeled after 
men and women with- enlarged thyroids. The earlier Eoman art, among 
other ways, showed the influence of the Greeks in that the women portrayed 
had necks that were overfull. If this evidence is to be accepted goiter was 
frequent and not a thing to be ashamed of in those early days. 

Goiters. — Goiter occurs so frequently as to make it worth while con- 
sidering. Ma jet says that in France there are 400,000 people with goiter. 
Ewald said that 12,277 recruits were rejected for goiter in Switzerland in 
three years. Hocher says that 80 per cent of the school children of Berne 
have it. Munson found that one in fifty Indians had it. Dock found a lot of 
it around the Great Lakes. Adami found that in certain French Canadian 
villages about two out of every thousand had goiter. Of the young women, 
10 per cent had it. 

A slight projection in the lower part of the neck is frequently seen, 
especially in women, on the streets of Chicago and generally among the people 
of the upper Mississippi valley. Many of these cases have not only enlarged 
glands but also the prominent eyes which designate them as exophthalmic. 
Some are goiter, some exophthalmic goiter. 

The amount of disturbance is not proportionate to the size of the gland. 
The real cause of the trouble is the pouring of too much or too rich thyroid 
juice into the blood. While we naturally expect a big gland to make more 
juice than a small one sometimes the little fellow is the more active of the 






THYROID MALADIES 563 

two. The large gland may be made up mostly of gristle and the little fellow 
mostly of secreting cells. A gland that is not too large may slip around 
in front of the muscles of the wind pipe and seem to be larger than it is, 
or it may slip back under the muscles and appear to be smaller than it is — 
in fact, may be hard to see at all. It may be so situated that it catches, 
pinches, squeezes nerves or blood vessels, causing the eyes to protrude, the 
breathing to be asthmatic, the face to flush, or it may be so placed that it 
does not pinch. Whether or not it does many of these things is a matter 
of chance. The real question is : Is the thyroid gland over- or underactive ? 

The cause of goiter has not been worked out to the complete satisfaction 
of anybody. Many causes have been discovered. No doubt these are factors, 
but nobody has given to these different factors their proper values. 

One of these causative factors is the drinking water. There is much 
reason for believing that water is of some importance as a causative factor; 
another of some importance is the soil. Osier's "Practice of Medicine" tells 
us that the belief that water causes goiter goes back as far as Pliny, and is to 
be found in Africa, India — in fact, in all parts of the world. In several 
places in Italy and Switzerland whole goitrous districts have been improved 
by getting water from a nongoitrous region. 

Then we have some pretty good proof that while some goiter comes from 
water, some is inherited. Occasionally it breaks out in epidemics in schools, 
barracks, and neighborhoods. Some develop from mental strain, some about 
those times in life when the body is undergoing profound changes, particularly 
adolescence and change of life. 

But much more important than any other cause is inheritance. Hirsch 
says: "There is very nearly unanimity among observers that goiter is trans- 
mitted by inheritance. That cretinism is influenced by inheritance is now 
quite generally accepted. The Swiss, acting on this view, regulate marriage 
among those with thyroid abnormalities. This procedure is eliminating cre- 
tinism from certain highly cretinous districts. Goitrous families are prone to 
contain a number of cretins. 

What is to be done about it? What can a person with thyroid do? 

Certain of them are operative cases and no other course is open to them. 
Goiters, just as certainly as cancers,' pass into an inoperable stage. After 
the thyroid has for years poured a daily poisonous dose of secretion into 
the blood there comes a time when no surgeon is justified in operating. 
The nervous control of the vital processes, particularly the heart action, gets 
to be so badly impaired that operation is unwarrantably dangerous. 

Xo surgeon is justified in operating on a case of goiter unless he has 
kept watch of the case long enough to know the patient as well as his 
goiter, and no patient with goiter is justified in allowing himself to be 
operated on, or even to take an anesthetic for any purpose, until the anes- 
thetist and the operator have had a chance to size up the entire situation. 
Therefore, any woman who has goiter should carefully consider lest she 
pass from a stage where operation is advisable to one where operation is 
inadvisable. 

Can anything be done for those who have too much thyroid but are 
not in need of operation? Yes; much can be done in teaching them how to 
control themselves, how to maintain an equilibrium. Various drugs have 



564 DUCTLESS GLANDS 

been used with benefit in certain cases. In the main these are made from 
other ductless glands — those that are supposed to be antagonistic to the 
thyroid. One is made from the milk of goats whose thyroids have been in 
part removed. 

What can be done for those that have too little thyroid? Fairly satis- 
factory results follow continued giving of thyroid gland and various kinds 
of extract of thyroid gland. Preparations of iodin, especially organic iodin, 
are valuable. The thyroid secretion is rich in iodin. But the trouble 
is that these are only remedies. They must be kept up as long as life lasts. 
If stopped, the patient relapses. Now, this is tiresome and quite unsatis- 
factory. 

Therefore, surgeons occasionally take a thyroid from a lower animal 
and implant it into a cretin or a cretinoid. 

Of the greatest interest is the subject of moderate hyperthyroidism and 
hypothyroidism — people who are irritable, nervous, and flighty because they 
have not much thyroid, or who, because they have too little, are phlegmatic 
and heavy. Some, being young, have too little and are undersized, or, becoming 
old, are having their thyroid shrink and are, therefore, getting obese. 

While we do not have many cretins in this country, we do have many 
phlegmatic, thick skinned persons who are suffering from thyroid deficiency. 
When there is a poor bony development the thyroid may be at fault. Small 
people are usually such as the result of inheritance but occasionally a person 
is undersized without having this as an explanation. 

This is a great field for the immediate future. Those who know 
most know little enough. Even when it comes to questions of cause and 
prevention there is need for more information. 

That there is a goiter inheritance has been proven abundantly. That in 
goitrous districts cretins abound has been proven. Acting on the few known 
inheritance facts, the Swiss government is greatly reducing the goiters and 
cretins in the districts where they are working. That water, soil, fright, 
emotional states are factors is known, but the information is only half in- 
formation. We need more study of the cause of goiter and cretinism and 
greater effort by the government to control the ramifications of thyroid 
problems. 

However, let us bear this in mind: those who are afflicted with having 
too much thyroid and those who have too little, as well as the slightly goitrous, 
are entitled to more kindness and patience than they receive. 

Enlargement of Thyroid. — There is goiter and then again there is 
goiter. There are cases of goiter in which the constitutional symptoms 
are profound and the only course, if life is to be saved or if the patient 
is to be spared confirmed invalidism, is prompt operation. 

In another group of cases the disease progresses slowly but inevitably, or 
nearly so, toward the stage in which the only help is operation. Another 
group of cases responds well to thyroidectin and similar preparations taken 
internally. This article does not deal with these groups. 

In a routine examination of 800 people applying for positions in three 
branches of the civil service in Chicago, in 1914, Dr. E. T. Olsen found goiter 
present in a surprisingly large percentage of the cases. 

In one series of 449 women 69 were rejected on account of goiter. 



THYKOID MALADIES 565 

This was 15.37 per cent of the whole. Analyses of the nativities and ages 
of these women showed nothing out of the ordinary. It seems probable that 
somewhere about 15 per cent of all the women of Chicago have enough of 
a goiter to be somewhat affected thereby. 

In another series of 157 examinations of women there were 32 rejections 
on account of goiter — 20.38 per cent. In a series of 193 examinations of men 
there were 13 rejections on account of goiter — 6.72 per cent. 

If you are a Chicago woman there is one chance in seven that you have 
goiter. If a Chicago man, your chance is one in sixteen. 

From the state of Washington comes a similar report. The probability 
is that goiter is not especially abundant in either of these regions. 

These surveys have merely revealed conditions that are about average 
throughout the country. The fact is the thyroid gland is an important organ. 
Whenever anywhere in the body any organ is put under stress there is a 
fair chance that the thyroid may enlarge by reason of its efforts to help 
out in the extra strain. Therefore enlargement of the thyroid is frequently 
an indication of trouble somewhere else in the body. 

If a woman has pelvic trouble, uterine trouble, or pus tubes or abscess 
of the broad ligament her thyroid may enlarge. 

I know one physician whose digestion is poor and who has an enlarged 
thyroid. By eating cautiously he has managed to keep down his thyroid 
trouble for years. With him his thyroid is a barometer showing the condition 
of his digestion. 

The Journal of the American Medical Association quotes a Swedish 
physician, Norregaard, who studied the relation between the thyroid and 
conditions of the adenoids and tonsils. From a careful study of thirty-five 
cases he concluded that whenever thyroiditis develops there is a focus of 
infection somewhere in the body, and the most frequent location is the 
tonsils. 

Therefore whenever he found a case of thyroid enlargement he first 
carefully examined the throat. If no source of trouble was found there an 
examination of all the organs was made. It is only a short distance from 
the tonsils to the thyroid. Any infection can easily travel the route. 

In some animals there are direct channels from the tonsils to the 
thyroid. Weglowski carefully examined 153 human cadavers, finding in 50 
direct routes from the tonsils by which bacteria could have readily traveled 
to the thyroid. But even if Weglowski had failed to find any small tubes 
the relation between infection of the tonsils and enlargement of the thyroid 
would have stood. There are no tubes between the pelvic organs, the ap- 
pendix, the gall-bladder or the digestive organs and the thyroid. The point 
is that enlargement of the thyroid is often merely a card which reads: 
"Trouble here ; look for the cause/' 

Goiter — Endemic. — When the thyroid gland enlarges or gets unduly 
active, the condition is called goiter. This gland, located in the lower part 
of the neck, is extremely important. Just enough of its secretion is necessary 
for health. Too much causes a train of symptoms. 

The number of people in Switzerland with thyroid out of balance — too 
large or too small — is great. In Aosta a large part of the people had small 
thyroids. The condition was getting worse as the years went on until the 



566 DUCTLESS GLANDS 

inheritance factors were recognized. The marriage of cretins was prohibited, 
whereupon cretinism began to lessen in Aosta. 

Every now and then a goiterous condition runs riot through a com- 
munity- The condition becomes epidemic (or endemic). Scientists studying 
some of these endemics thought the spread was due to water. They said 
that water from certain types of soil caused it. 

This idea that water causes goiter is widespread. It is extensively be- 
lieved in this country. In fact, I think most people accept the water theory 
as a fact. 

Scientists never thought water had anything to do with the ordinary 
types of goiter. It was only in the goiter endemics, regarding the localities 
where nearly every woman and many of the men had goiter, that the water 
was thought to be the cause. 

The Hygienic Institute at Zurich says that water has nothing to do 
with goiter. In their study the investigators examined 6,000 people. In one 
town 77 per cent of all the people had goiter. In another, two-thirds of the 
people were affected. In certain families all the members had the disease. 
Here were endemic conditions beyond a doubt. 

Examining the source of the water carefully, the experimenters found 
that it did not come from the rock strata supposed, for some of the original 
studies had been made in these towns and the whole theory was based 
on the presumption that the water came from a certain rock formation. 

The next experiment was with rats. Ordinarily rats do not have goiter. 
Rats caught elsewhere and exposed in the epidemic localities got goiters. It 
made no difference whether they drank boiled water or water from other 
sources or water from the local supply, goiter developed just the same. 
Eats kept in another district but fed on water from a goiter district did 
not develop goiter. 

It became evident that goiter is slightly catching in a goiter district. 
But it is not spread by water. Something else in wide use in such a 
district spreads it. 

What it is is not known. This does not mean that there is danger of 
spread by water, air, or anything else in a district where goiter is some- 
what rare, where, say, less than one in one hundred has goiter. 

Battling with Goiter. — When a person has a goiter, he or she should 
be in good hands, medical or surgical — sometimes one, sometimes the other. 
Such a person is one who has bulging eyes, enlargement of the thyroid, ir- 
regular, rapid pulse, muscular tremor, and diarrhea. All of these are 
symptoms, or at least two or three of them are. 

However, outside of this group are a large number of people who are 
not much disabled now and hope not to become disabled. They want to know 
what they can do. 

A while ago I was lunching with an intelligent physician whose thyroid 
was plainly enlarged. He ate carefully. He told me his trouble had existed 
for years; that it did not discommode him much. He had noticed that if he 
were careful of his digestion he had little trouble. By eating small meals, 
selecting his food with discretion and chewing carefully he kept himself in 
good shape. Should he be indiscreet he paid the penalty. 

Dr. Hemmeter, a most excellent physician of Baltimore, tells in the 



THYROID MALADIES 567 

Journal of the American Medical Association of having controlled three 
troublesome cases by attending to the digestion. Generally speaking, he keeps 
his patients, for a while at least, on a meat-free diet. He washes the lower 
bowel every day with from a pint to ,a quart of a one per cent solution of 
ichthyol. No one should try the ichthyol without having a physician to 
keep track. Some patients take sour milk and Bulgarian bacilli. 

After the symptoms had stopped he had the three patients in question 
keep up cold baths and sleep twelve hours a day, or rather stay in bed 
twelve hours a day. The colonic flushings were given about once a week. 

The people who have a slight amount of goiter can well see to it that 
they do not develop chronic constipation. If they can get their bowels in 
perfect habit they may not need enemas. But rather than allow constipation 
to continue they should take plain large enemas. 

It would be better still for them to go to their physician or a clinic 
for a course of medicated enemas. They should look to their diet and their 
method of eating with especial care. Hemmeter advises plenty of rest. 

In addition, McCarrison would take proper steps to see that the drinking 
water is not befouled by sewage or human contamination. If the water 
has been contaminated, boiling it will help. 

McCarrison, though, holds that it is not wholly satisfactory to boil 
water as a protection against goiter. He believes so thoroughly in intestinal 
disorders as the cause that he gives his cases courses of thymol somewhat 
as they treat hookworm people. That part, however, the ordinary person 
had better leave alone, at least for the present. 

This much is certain: It is not enough to know that one has a goiter. 
Before anything should be done it is advisable to analyze still further. The 
diagnosis should include the kind of goiter. Mayo, Plummer, and Wilson 
have shown plainly that there are different kinds of goiters, and what is 
required for one kind is quite different from the requirements for another 
kind. 

Some goiters start out to poison the nerves and protrude the eyes. For 
these operation is inevitable, and delay may result in the case becoming in- 
operable. 

In another group of cases the thyroid enlarges because it is necessary 
that it should do so in order that it may do the work thrown on it. 

Many goiters in women result from disease in the pelvic organs. At- 
tention to the underlying # condition brings about improvement in the goiter. 

The evidence is good that chronic infections of the nose and throat 
at times result in enlargement of the thyroid and increase in the amount 
of thyroid secretion in the blood. Dr. Beebe tells us that in goiter patients 
between sixteen and twenty-four, from 35 to 49 per cent will give a history of 
repeated attacks of tonsillitis. 

Then, if a person has goiter he should first find out whether his goiter 
belongs to the group which results from some diseases elsewhere in the body. 

If it does the search must be to find where the trouble is. In this 
search the condition of the nose and throat must be investigated. 

If the tonsils are found diseased, it is the opinion of other physicians 
as well as of Dr. Beebe, they should be removed. 

Effect of Gland Changes. — A child is bom with a large ductless gland 



568 



DUCTLESS GLANDS 



called the thymus. This gland remains large during the years of rapid 
growth. About the time the rate of growth of the young person becomes slower 
it begins to shrivel. While it is not certain it looks as if the growth impulse 
in part lies in the thymus gland. 

About puberty there is a second period of rapid growth. The shape of 
the figure changes, the bones of the face change so as to alter the expression. 
The body changes are widespread and profound. Simultaneously, there 
is activity in the ductless portions of the sex glands. The presumption is 
strong that the structural changes of adolescence are not matters of chance or 
accident but are the result of glandular activity. 

When the pituitary gland is overactive some of the bones or some parts 
of some of the bones grow large. When there is a large thyroid gland, the 
subject is dwarfed, physically and mentally. When most of the thyroid 
is removed from a young animal, the animal de- BA 

velops legs and bones so changed as to amount to 
a deformity. On the other hand, when young ani- 
mals are fed thyroid they grow large and have 
heavy bones. 

Men and women past forty begin to accumu- 
late fat — they become obese. An examination of 
the thyroid made during the same age period shows 
it is becoming senile. Thyroid, skillfully 
used, is of service in reducing obesity in cw 

this group of people. Their obesity a 
be reduced by regulating their food wit 
out giving thyroid, but the use of thyro 
permits of greater leeway in dieting. 

When the thyroid is 
markedly diseased definite 
intoxication results. The 
subject is mentally irritable 
and as the intoxication pro- 
gresses other symptoms de- 
velop. When the adrenals 
are in part destroyed low 
blood pressure and Addi- 
son's disease result. When 
there is not enough of a 
certain pancreatic secretion 
diabetes results. 

Knowing these facts 
physicians lay the founda- 
tion for much more knowledge of the effects of changes in the secretions of the 
ductless glands. Here and there in a medical society papers are being read, 
and research is being recorded. Occasionally an essayist will report a plain 
matter of fact series of observations on the effect of changes due to altered 
secretions of the ductless glands. About this report there will be nothing 
dramatic, no "story." Such a report is no sixteen story building — it is just a 
brick — but of just such plain, undramatic bricks, tested, tried, and then laid 




Fig. 196. — Thyroid Gland. Subclavian Artery (to arm) 
and Some of the Branches. Common Carotid 
Artery (to head and neck). AB, the innominate; Cc, 
the common carotid; S, the subclavian; BA, the basilar; 
MMI, the internal mammary; IS, the superior intercost- 
al; CVP, the deep cervical; TI, the inferior thyroid; CVA, 
the ascending cervical; CVS, the superficial cervical; TS, 
the suprascapular; TC, the posterior scapular. 



THYKOID MALADIES 569 

one by one, is the sixteen story building constructed. Many observations are 
needed before our knowledge of the more subtle effects of moderate duct gland 
changes will be anywhere near satisfactory. 

Enlarged Thyroid (Hands. — "A number of girls have been eagerly 
watching your articles for anything you might have to say regarding 
goiter or enlarged glands. Among a club of thirty young ladies, fourteen 
have these enlarged glands. Three are taking treatment, thus far 
without much result, and the others would if they had the money to take 
treatment. 

"Now, then, my own case, which seems to be about the same as some 
of the others, is as follows: About one year ago I noticed that if I did 
much long distance telephone talking my jaw would ache and my 
throat hurt me more or less. Many nights I would go home with a 
'jaw ache/ 

"I have a slight inclination to double chin, and I have been accustomed 
to throwing my head back while I sleep at night to overcome, in a measure, 
this tendency. I have thought there may be a slight possibility that this 
has something to do with my throat enlarging. 

"During the day my throat does not bother me, but at night, after I 
take a hot bath before retiring, my throat throbs. Would a hot bath before 
retiring have a tendency to increase the size of the goiter? 

"Can you tell us what causes these glands to enlarge at the front of 
the neck? Can you tell us of anything we can do to keep them from in- 
creasing in size? Is there not some simple remedy or some diet? 

"One of the girls has been so affected by heart trouble, which the 
doctor says is caused oy goiter, that she has had to quit work and go 
to bed. 

"Now we have heard that a doctor by the name of W. Thompson Bobo, 
M. D., a goiter specialist at Battle Creek, has a cure for goiter. Can you 
tell us anything about his claims? Do you know anything about this treat- 
ment, and would you recommend it to us as worth trying? 

"We shall eagerly watch the papers for what you have to say. Do give 
us some advice. This is an important matter to us. — A. L. M." 

Reply. — Some of these girls probably have enlarged glands due to ab- 
sorption from the gums, tonsils or nose. Such enlargements are well to 
one side and several inches higher than the thyroid gland. The thyroid 
is in front and also to the side and reaches from just 'above the breast bone 
to a point about three inches above it. 

The thyroid gland secretes a most important fluid. When the demand 
for this fluid is exceedingly great the gland secrets an extra amount, and 
in consequence it may enlarge. It is a good way from a gland moderately 
enlarged to do a moderately increased work to the goiter conditions that 
we need to be disturbed about. 

The enlargement is unsightly and causes some sense of fullness but the 
effects to be watched closely are due to the gland juice acting on far away 
organs. They are great nervousness, nervous unrest, nervous instability, 
rapid, irregular heart action, shallow breathing, diarrhea and protrusion of 
the eyes. 

I am sure that the majority of the girls in this group are unduly dis- 
turbed by their thyroid enlargement. The girl who has had trouble so bad 
that "she has had to quit work and go to bed" probably belongs in the group 
where the thyroid has got out of relation to its work. 



570 



DUCTLESS GLANDS 



Some of these cases get right back on their keels when given some form 
of antithyroid. Some need to be operated on. Just which belong in each 
group is a difficult question requiring the best judgment of medical men. 
However, that is the small group. The larger part of your friends have 
thyroids slightly enlarged because they have increased work for the thyroid 
to do. It is pretty well agreed that digestive disorders cause the thyroid to 
enlarge — where the teeth are bad and the food is badly masticated, when 

the food is of poor 
quality, when there 
is a good deal of 
fermentation, but, 
above all, when there 
is constipation. To 
remedy any of these 
conditions is to 
remedy this mild 
form of goiter. 

The old French 
writers grouped a 
lot of causes to- 
gether and called 
them causes multi- 
ples. They referred 
to such unhygienic 
conditions of life as 
defective air space, 
bad food, bad liv- 
ing rooms built on 
damp grounds. 

McCarrison has 
written a book on 
the cause of goiter 
in which he tells the 
result of years of 
study. The conclu- 
sion which he ar- 
rived at is that 
water is largely re- 
sponsible for goiter. 
The water re- 
sponsible is not 
water containing 
certain mineral in- 
gredients as was 
thought formerly. 
It is polluted water, water that has soaked through soil contaminated by 
human beings. This means that where the goiter rate of a community is 
high there is danger of much typhoid. 

Another secondary factor generally recognized is fright or any other 
form of mental strain. Prolonged mental strain such as worry and over- 
work at monotonous, grinding, mental labor may be a cause. 

Answering the question in the last paragraph of your letter, Dr. Bobo 
has been exposed in "Nostrums and Quackery." He is connected with the 
Peebles epilepsy cure and in close touch with a circle of fakers. 




Fig. 197. — Thyroid Gland ; External Carotid Artery (to 
the head and neck) and Some of Its Branches. Cc, com- 
mon carotid; Ce, external carotid; Ci, internal carotid; 
TSU, superior thyroid ; LS, superior laryngeal and crico- 
thyroid; HY, hyoid branch of the lingual; S, the sublin- 
gual; ME, the facial; SMT, the submental; LDI, the infer- 
ior labial; LDS, coronary of upper lip; SN, the a. of the 
septum narium; A, the angular; OC, the occipital; AP, the 
posterior auricular; T PS, the superficial temporal; 1, the 
tongue; 2, the genioglossus muscle; 3, the hypoglossus; 4, 
the angle of the lower jaw; 5, the hyoid bone; 6, the thyro- 
hyoid ligament; 7, the thyroid cartilage; 8, the cricothy- 
roid membrane; 9, thyroid gland. 






THYROID MALADIES 571 

Thyroid Gland. — W. P. F. writes: "1. Where is the thyroid gland? 
2. What are its functions? 3. What are one's symptoms when it is de- 
ranged? If. What should he done?" 

Reply. — 1. On the front part of the neck just above the collar line. 

2 and 3. It secretes a juice that is poured directly into the blood stream. 
This secretion has several functions. When it is deficient the child does 
not grow properly. The man who grew from childhood suffering from such 
deficiency is small, short limbed, thick skinned, and dull and heavy men- 
tally. When there is too much secretion the subject is flighty, nervous, 
and excitable. 

4. Depends on the nature of the derangement. Some cases of goiter 
yield to rest, control, and medicine; some need to be operated on. All 
cases of thyroid derangement gain from systematic, scientific medical 
control — seeing the medical advisor at proper intervals. 

Treatment of Goiter. — B. T. writes: "Will you kindly let me know 
your opinion of the value of horse or sheep serum in the treatment of 
goiter? If recommended, what dose should be taken and how long would 
it take to effect a cure? The patient has the usual symptoms of nervous- 
ness, instability, slightly bulging eyes, and palpitation of the heart. Can 
you also tell me of the relationship between goiter and marriage; also 
insanity ?" 

Reply. — Sheep serum for thyroid, called antithyroidin, has been used 
with advantage. Better reports come from the use of thyrodectin, the dried 
blood of an animal from which the thyroid has been removed. Proper 
attention must be paid to diet and water. 

Take my advice and get good medical counsel and follow it. Do not 
worry about insanity. 

Davenport says of goiter: "It is clearly inherited, as certainly as epi- 
lepsy." Not many pedigrees seem, however, to have been studied. 

See Best Surgeon. — C. B. 8. writes: "I wish advice about goiter and 
curing goiter. I have had it possibly ten or twelve years. I am 25 years 
old. Do you think it can be cured? If so, what cure would you advise? 
Does age or length of time one has had it make any difference? I have 
heard of a woman who says she can cure me in nine treatments. She gives 
three treatments each month for three months and treats in a certain time 
of the moon. What is your advice about a doctor of this kind? I know 
of cases she has cured, but want your advice" 

Reply. — 1. Go to see the best surgeon available and get his advice. 

2. Operation is generally required for cure. 

3. Yes. 

4. Do not waste your chance to get well on that kind of foolishness. 

Enlargement of the thyroid gland, called goiter, calls for skillful han- 
dling. Many cases are of no especial importance. Other cases are bad at 
the start, then get better, then slowly proceed into a condition where the 
wise surgeon will not operate. The condition is then hopeless. 

Thyroid Intoxication Case. — E. W. R. writes: "A woman, now &4 
years old, developed an exophthalmic goiter five years ago. At first there 
was violent palpitation of the heart and pain in the chest so severe that 
morphin and whisky were needed. These spells kept up for four years. 
A year and a half ago, she went on a farm, and began leading a simpler 
life. Now the symptoms are less severe, the attacks are rare, and the goiter 
is nearly gone. Two weeks ago the head got wrong. There is a tendency 



5?2 DUCTLESS GLANDS 

to fall over and a constant throbbing in the right ear. The hlood pressure 
is 200. Is this a forerunner of apoplexy? What is the trouble? Is staying 
in bed the proper course?" 

Reply. — 1. No. 

2. You have been suffering from thyroid intoxication. Within the last 
two years you have become partially accustomed to your dose of thyroid. 
It is possible that your symptoms are due to a temporary increase in 
thyroid secretion. It is probable you have some condition in your semi- 
circular canals in your right ear. Your physician should examine care- 
fully for this condition. 

3. Yes. 

May Not Need Treatment. — Mrs. S. C. E. writes: "Will you kindly 
tell me what will be helpful to know about goiter? My sister has had one 
since childhood, but it has never grown large. She is teaching school 
now, and is nervous. Would a weak back be a cause, effect, or neither, 
of a goiter? Physicians have told us an operation is the only cure, but 
our own physician, who has treated her for years, says an operation is not 
necessary. We are much alarmed about it, especially when considering 
her nervous condition. We fear such a delicate operation. Can it be cured 
in any other way?" 

Reply. — If the goiter has been present for many years and has given 
no symptoms until now it will in all probability require no treatment. 
Most school teachers work in badly ventilated schoolrooms and they get 
tired and nervous before June. Having a goiter she would get nervous 
more easily than a normal person. 

Try the effect of prolonged and thorough rest. If rest does not quiet 
her she may need an operation. 

Medical and electrical treatment sometimes succeeds. The medical 
treatment consists in the proper use of iodin and electricity locally and 
tonics and antithyroid preparations internally. Just how long it is safe 
to postpone an operation while trying rest and medicine will require the 
best judgment of your physician. 

Goiter and Children. — A. L. writes: "What, in your opinion, as far as 
children are concerned, is the danger in two people marrying when each 
has goiter? Neither was inherited, but both developed. Neither party 
has ever been incapacitated by it for work, but each is possibly more 
nervous than the ordinary person. Both persons otherwise may be termed 
fairly well. Would the child of such a marriage run a greater risk of be- 
ing a little more nervous than most children? Would the child be more 
liable to have epilepsy than any other child? Would it run any risk of 
being defective mentally? Is there any possibility that it could be up to 
par? Would the danger of childbirth, the woman being 25, be any greater 
than to anyone else?" 

Eeply. — 1. Yes. 
2 and 3. No. 

4. Yes, probably would be. 

5. Yes. 

The children of an extremely nervous couple will probably be nervous 
but if they are trained in the control of nerves they will average up well. 

Regarding Goiter. — Miss N. A. D. writes: "1. Will you please tell me 
what causes goiter? 2. Some say it is more prevalent in some localities 






THYROID MALADIES 573 

than in others, and that the drinking water causes it. 3. Does painting the 
goiter with iodin or something of the kind prevent it increasing in size? 
If.. Are operations for goiter dangerous, and what kind of goiter and under 
what conditions should they he operated on?" 

Keply. — 1. Goiter is an enlargement of a gland in the neck called the 
thyroid. Nobody knows what causes it to enlarge. 

2. It is more prevalent in some localities than in others. Boiling the 
water as a means of controlling its spread is often recommended. Whether 
it is of any value I do not think anyone knows. 

3. No. 

4. A careful examination of each case is necessary to determine. 

Graves' Disease. — J. L. T. writes: "Kindly explain what Graves' 
disease is, its cause, symptoms, and general course. Is it related to heart 
disease ? Can it be cured?" 

Keply. — Graves' disease is that form of goiter in which the eyes bulge. 
One of the important symptoms is an irregular and highly nervous heart. 
My advice to you is to consult the best available physician and abide by 
his advice. 

When to Remove Goiter. — T. R. S. writes: "Would an operation for 
goiter be considered advisable if the goiter is not only hereditary but long 
standing? Should it begin to grow rapidly, would an operation be con- 
sidered advisable? Have there been any discoveries as to causes and reme- 
dies for this trouble more recent than the study you gave some months 
ago?" 

Reply. — 1. Neither heredity nor long standing is an indication in itself 
for the removal of goiter. Rapid growth is an indication. Goiter should 
be removed when the general nervousness, heart nervousness, and other 
constitutional symptoms of thyroid intoxication indicate it. 

2. Much study is being put on goiter. The journals are filled with 
articles in connection with it. Nothing epoch making has recently ap- 
peared. 

Operation Often Necessary. — M. B. B. writes: "I am 26 and have a 
goiter. Is it incurable? I have tried electrical treatments and see no 
improvement. Would you advise an operation? Are such operations seri- 
ous? Please tell me what causes a goiter." 

Reply. — Many people are relieved of goiter symptoms due to too much 
thyroid secretion. Sometimes they get better because they get accustomed 
to their dose of thyroid secretion; sometimes the gland secretes less; 
sometimes medical treatment cures. Ofttimes nothing cures except an 
operation. Which are the cases for operation, when operation should be 
done, and when it is too late for operation are questions that can only be 
answered after a careful study of the individual case. Get the best advice 
available and abide by it. 

Goiters Grow Smaller. — Mrs. E. L. W. writes: "Will you kindly tell me 
if goiters ever disappear entirely without an operation? I have never used 
any drugs or treatment of any kind, yet mine seems to be getting 
smaller. I am just thirty years of age. Do goiters affect the heart in 
any way?" 



574 DUCTLESS GLANDS 

Reply. — 1. Goiters not infrequently cease to be troublesome ; not infre- 
quently they get materially smaller. The thyroid gland, when enlarged, is 
called a goiter. This gland is necessary. If it were to disappear entirely 
grave results would follow. Some thyroid juice is a good thing; too much 
poisons one. If one becomes accustomed to too much thyroid the goiter 
ceases to be troublesome. To decide which cases are trending to the worse 
and which to the better requires the best of judgment. 

2. The goiter heart is one of the most frequent and most troublesome 
goiter symptoms. 

Goiter. — E. W. writes: "1. Are cases of Graves' disease sometimes 
found in which the eyes do not bulge? 2. Is a woman with a goiter in 
more than ordinary danger in childbearing? 3. Is goiter cured by thyroid 
extract, or is it merely kept under control? 4. In cases of goiter which 
show a growth on the outside can anything except an operation reduce the 
enlargement?" 

Reply. — 1. There is goiter without bulging of the eyes more frequently 
than with it. 

2. Yes. 

3. Goiter is usually harmed by thyroid extract. 

4. Medication will do it sometimes, though not often. 

Goiter Not Contagious. — H. M. D. writes: "Will you kindly say whether 
there is any chance for one afflicted with goiter to communicate it to 
another through intimate association? What is the most effective treat- 
ment one can use to relieve the great suffering one experiences following a 
severe and general case of sunburn?" 

Reply. — 1. There is none. Sometimes goiter is abundant among peo- 
ple but the element of contagion is not a factor. 

2. Where the surface is not broken, wash with cold soda water; dry 
with soft cloth, and dust with talcum powder. To grease with cold cream 
is pleasant. If the surface is broken, wash with sterilized, normal salt 
solution; dry thoroughly, and dust with talcum powder, then cover with 
aseptic gauze. Sterilized vaselin makes a good application to a raw surface. 

Cause and Cure of Goiter. — S. A. writes: "Please give cause and cure 
for goiter." 

Reply. — The causes of goiter are many: 

1. Inheritance. 

2. Nervous shock. 

3. Worry. 

4. Water. 

5. Soil. 

6. Development out of relation. 
The cures vary with the cases: 

1. Operation. Most satisfactory and suited to many cases ; unnecessary 
in some; inadvisable in others. 

2. Iodin preparations. 

3. Milk from animals with small thyroid. 

4. Electricity. 

In every case high-grade medical advice based on adequate observation 
is essential. 



THYROID MALADIES 575 

Treatment for Cretinism. — A. C. A. writes: "Some weeks ago Chicago 
papers printed an article ahout a man and wife who are cretins and stated 
that their children were being treated by the city of Chicago. I have a 
friend in another city whose little girl is small for her age. Her parents 
took her to Minneapolis for examination, and the doctor there told them 
she would never grow taller than, possibly, three or four feet. On reading 
about this family of cretins, I wondered whether this case might be similar 
and, naturally, would like to bring the matter before my friend, if there 
is any chance for the child/' 

Reply. — First find out if the child is deficient in thyroid — is a cretin. 
If she is she should take one of the preparations of thyroid. There are 
many on the market. 

Thyroid must be used for a long time. It must be intelligently used. 
In young cretins treatment is fairly satisfactory. 

Life of Cretin. — J. W. D. writes: "About what age do cretins attain? 

What is the maximum age?" 

Reply. — Untreated cretins die young. It is rare for one to reach thirty 
years of age. 

I haYe neYer seen any statement as to the maximum age. 

Operation Not Dangerous. — Mrs. H. N. S. writes: "I have a small 
goiter which has been troubling me. In case I decide to have it removed 
are such operations dangerous? Also are such operations expensive, and 
how long would I be kept in bed? I am a working woman." 

Reply. — If you are in good condition, and I judge from your letter 
that you are, the operation is not dangerous. If you have a frank under- 
standing with your surgeon your bill will be in keeping with your capacity 
to pay. Such operations cost nothing for those not able to pay. They cost 
little for those able to pay little; they cost much for those able to pay 
much. 

Goiter and Medicine. — Mrs. H. P. writes: "Can a goiter be destroyed 
by medicine?" 

Reply. — The more efficacious of the goiter medicines act by neutraliz- 
ing the excess of thyroid secretions. In a certain sense they are antitoxins. 
Therefore they must be continued so long as the excessive secretion of the 
gland continues. 

In some cases goiter can be kept under control by attention to the diges- 
tion ; in others by attention to the pelvic organs or by medicine ; other cases 
require operation. 

Thymus Gland Tablets. — J. S. B. writes: "Have taken thymus gland 
tablets for rheumatism of the finger joints with some encouragement. 
Will you please state what these tablets are composed of?" 

Reply. — The thymus gland is a ductless gland located just above the 
heart. It is quite large at the time of birth ; in fact, it may reach up into 
the neck. When the young person is about ready to stop growing the 
gland shrinks. It has much to do with growth. 

Every young animal has a well developed thymus gland. The butcher 
commonly calls it "the sweetbread in the neck." The tablets are composed 
of dried thymus gland taken from pigs and calves. 



576 



DUCTLESS GLANDS 



THE ADRENAL BODIES 



If one judges by the name of these organs he concludes that they are 
related to the kidneys. They are located near the kidneys and from 
this nearness they have drawn their name, adrenal, or their other name, 

suprarenal. Though sit- 
p HR ting on the kidneys like 

an illy adjusted nightcap, 
they have no other rela- 
tion to them. Their 
work is in no way re- 
lated to the work of the 
kidneys. 

The kidneys are the 
body sewer or an impor- 
tant part of it. The work 
of the adrenal has to do 
with the distribution of 
the blood to the different 
parts of the body. As 
the adrenals are being 
formed in the body of 
the unborn child they are 
placed next to certain 
nerve cells that have to 
do with the size of the 
blood vessels. As develop- 
ment proceeds the bunch 
of adrenal tissue and the 
group of nerve cells grow 
together to form the 
adrenal body. 

When in mature life 
the adrenal cells secrete, 
a part of the secretion 
acts on the next door 
nerve cells and a part of 
it flows into the blood 
stream and is carried to 
nerve cells elsewhere 
throughout the body. 

Each of the adrenals 
is about an inch and a 
quarter by an inch and 
three-quarters in size and 
weighs about a dram. Anatomically, the adrenals are not imposing. They 
are small and inconspicuous. 

Unlike the secretion of the kidneys the secrtion of the adrenals cannot 




Fig. 198. — Adrenal Glands (or Suprarenals). Kidneys, Ab 
dominal Aorta and Some of Its Branches. Ai, common 
iliac artery; I, external iliac; H, internal iliac; SM, middle 
sacral; PHR, inferior phrenic arteries; LD, one of the 
lumbar arteries; C, the celiac; MES, the superior mesen 
teric; MEI, the inferior mesenteric; SR, the capsular; R 
the renal; SPI, the spermatic; HI, the internal hemor- 
rhoidal. 



THE ADRENAL BODIES 577 

be drawn from the living body and made the subject of study. Owing to the 
difficulty in studying the adrenal secretion it is only in recent years that 
anything had been known of its effect on the human body. We are just 
beginning to learn of the discomforts, disabilities and diseases which result 
when the adrenals go wrong. 

At a meeting of the American Medical Association Dr. Williams of 
Washington told the section on practice that he no longer recognized neuras- 
thenia as a disease; that it was a lazy, sloppy diagnosis and that there was 
always some abnormality somewhere in the body. He said when a physician 
diagnosed neurasthenia he had used the term "merely as a convenient cloak 
for failure sufficiently to investigate." 

In his experience, when these cases have been carefully and patiently 
studied, it has been possible to discover some abnormality in some organ 
somewhere. In some of them there is organic disease in the more frequently 
considered organs. After placing these cases under their appropriate heads 
he finds a large number of ordinarily considered neurasthenics whose trouble 
is with their adrenal glands. He bases his conclusions upon such experimen- 
tally proved facts as the following: 

Cannon found that after fright the vein running from the adrenal 
gland contained too much adrenal secretion. Everyone has noticed that 
fright causes the skin to pale, the amount of blood in the skin to decrease, 
and goose flesh to form. These effects are closely related to an increased 
discharge of adrenal secretion into the blood stream. Crile proved that pro- 
longed fright caused a continuously excessive secretion of adrenal secretion. 

The ordinary term for prolonged fright is anxiety. Anxiety, worry, 
and fright cause an oversecretion by this gland, and this oversecretion causes 
a train of symptoms, some of which are prominent in neurasthenia. 

There are cases of so-called neurasthenia which are purely mental. These 
divide themselves into insanities and the neurasthenias. The body is influ- 
enced by the mind. There are cases of so-called neurasthenia in which the 
mind is under the influence of the body. Among this group are some cases 
of neurasthenia in which the cause lies in the adrenals. These have the 
ordinary mental indecisions, worries, anxieties, and fears of the neurasthenic 
accompanied by low blood pressure. Sometimes the skin bronzes. 

One such man felt that he could not carry responsibility or manage 
men; he could not come to a decision. Feeling that his usefulness was at 
an end he feared he was losing his mind and in consequence was greatly 
depressed. When he was examined the only abnormality found was a low 
blood pressure. He was told that he was not losing his mind ; that his blood 
pressure was low because he did not have enough adrenal secretion; that his 
low blood pressure meant a poorly nourished brain. 

From this came his indecision, his worries, fears and anxieties. Be- 
cause he took no exercise his muscles became flabby and his flabby, soft 
muscles made him tire easily, resulting in poor circulation — a vicious circle. 
His blood pressure was 100. For a man of his years this was quite low. 

Under adrenal tablets, rest, exercise, and diet his blood pressure came 
up to 114; he became physically fit, quit worrying and got back his old decision 
and managing ability. 

Another man, fifty-seven years of age, had indecision, weakness, dizziness, 



578 DUCTLESS GLANDS 

and throbbing in the abdomen — the usual symptoms of neurasthenia — with a 
low pressure — 108. The same line of conduct plus adrenal tablets cured him. 

Another, a man of forty-four, had had headaches for six years whenever 
tired from using his eyes. A dull, aching pain at the end of his spine would 
often be so severe as to waken him at night. There was nothing the 
matter with his eyes, and he tired when he was read to as well as when he 
was reading. His blood pressure was 114. 

Another case, a woman, was low spirited, melancholy, anxious, and 
mentally depressed. Her pressure was 106. Her skin was pigmented. 

Another, a man of forty, had worried until he was run down so much 
that he had lost his self-control. He did not want to work ; he fatigued easily ; 
he had nervous indigestion and insomnia. He was due to marry in three 
weeks but the prospect horrified him and he wanted to go and hide. His 
blood pressure was 102. 

Another patient worried all the time. He said: "My mind feels as a 
shadow only and for two years nothing has seemed real." He had indigestion, 
flatulence, dizziness and headache. He had a weak, flabby feeling, especially 
in his arms. His skin was pigmented. His blood pressure was 102. In 
another case, a woman of 34, the pressure was 86. The skin was pigmented. 

Most persons have a fair knowledge of the symptoms of neurasthenia. 
From every standpoint, this is for the best. Neurasthenia is sometimes called 
Americanitis. It is also frequently referred to as "the American disease/' 
The indications are that it is on the increase. It is inheritable. The 
children of neurasthenics are somewhat liable to be neurasthenics. 

What is of more importance, neurasthenia, hysteria, insanity and 
criminality are often found jumbled up in a family strain in such a way as to 
indicate that these plants grow rather interchangeably out of a common 
soil — a nervous mental makeup in which there is lacking poise and a proper 
understanding of one's relation to one's fellow men. 

One writer, albeit only an indifferent authority, goes so far as to propose 
nation-wide intermarriage between Italians and Americans. The basis of 
his suggestion is that when the overtense, unromantic American crosses with 
the underambitious, overromantic Italian there will be progeny in which 
there will be just enough of tenseness and just enough of romance to make a 
masterful race, devoid of tendency to neurasthenia. 

This is referred to to show that the inheritance phases are being dis- 
cussed. It is for the best interest of the individual neurasthenic to have 
neurasthenia known. 

Three years ago when the neurasthenic wrote me about his symptoms, 
they were to him very important. To him they always meant organic 
disease. He was anxious; he worried. He commiserated with himself 
and he abused anyone who did not appreciate the gravity of his complaints. 

The general tone of the letters from neurasthenics has changed. They 
still have symptoms; they still worry; they are still anxious but now 
they frankly acknowledge that they are neurasthenic; that their symptoms 
do not proceed from that which they dread; that their stomach symptoms 
do not mean cancer, for instance. At the same time they are unable 
to throw them off. It is along this line that they search for help. 

To recognize that a group of symptoms means neurasthenia is the first 



THE ADKENAL BODIES 579 

step toward cure. The above list of symptoms will be recognized by neuras- 
thenics. It is for the best interests of neurasthenics that the people know 
the symptoms of neurasthenia. 

Under the old order neurasthenics were always misunderstood and were 
commonly neglected. There was a certain period in which the family shared 
the anxieties of the worried one. In this period the family's commiseration, 
added to the individual's commiseration for himself, made a combination 
that was hard on the neurasthenic. It generally landed him in a state of in- 
validism. 

This period was commonly followed by that in which everybody dis- 
regarded every complaint of the neurasthenic. Thus he was driven in on him- 
self all the more. Since nobody would pay any attention to his symptoms 
he must nurse them the more. Since time had proved that he had some 
illness of which he had complained and to which no one had listened, he 
was right in all of his complaints and his heartless associates were wrong. 
It is best from the standpoint of community life. 

Neurasthenics are not incapacitated for business. Ours, the masterful 
nation of the last five centuries, is the neurasthenic race. Not all of this 
is in spite of neurasthenics. Neurasthenics have contributed to progress. 
They engage in the keen competitions of business. 

It is wise for business competitors to understand the workings of the 
neurasthenic mind. To the average business man this is more important 
than to understand the relentless logic of the Eockefeller mind. In literature 
neurasthenics have been prominent. 

It is for the best from the standpoint of medical men. Physicians have 
had little patience with neurasthenia. They had been so often misled by the 
symptoms of neurasthenia they had fallen into the habit of disregarding 
the neurasthenic wherever they could. Like a hunting dog who, having often 
investigated promising trails and found that they led to nothing, finally be- 
came indifferent to all trails, the physician, listening to a story of symptoms 
and recognizing exaggeration and self-commiseration as earmarks of neuras- 
thenia, loses interest and worms out as easily as he can. 

The present medical tendency is to dig deeper into these cases. As the 
result of digging deeper many are found to have a physical basis. Some 
are found to have early stage Bright's disease or anemia or some other fairly 
well known disease. Some are found to have trouble with the ductless glands. 

We are just beginning to know about the relations of the ductless glands 
to health and comfort. In the discussion of Dr. Williams' paper Dr. Starkey 
said that when a patient suffers from lack of force, inefficiency, lack of decision, 
easy fatigue, melancholia, the trouble lies with the ductless glands. 

The more important of the ductless glands are the adrenals, the thyroid, 
the pituitary, the thymus and the sex glands. The secretions of these glands 
in health are in exact balance. When the balance is lost ill health, discom- 
fort, or bodily disorder of some sort results. When the disorder takes the 
bent which forms one of the varieties of neurasthenia extracts of several 
of these glands should be given. 

He made a therapeutic suggestion which embodies a rather far reaching 
thought. He said the ordinary commercial preparations of thyroid, adrenal, 
and so forth, are made from castrated animals. When an animal is unsexed 



580 DUCTLESS GLANDS 

the entire structure of that animal is changed. We know of the difference in 
the texture and flavor of the flesh, of the difference in the mind and spirit of 
altered, as compared with unaltered, animals. 

"The change from the bull to the ox and from the cock to the capon 
are conspicuous and familiar examples/' he says. "The change that takes 
place in their organs of internal secretion is just as marked, so that the 
chemical composition and the physiological action of glands obtained from 
spayed animals are very different from those derived from unspayed ones." 

ADRENALIN ^ 

Adrenalin and other preparations made from suprarenal gland have 
been known to the medical profession for a long time. They have been 
in general use for more than ten years. The remedy can be procured from 
any drug store. 

Adrenal substance and extracts of adrenal substance are powerful medi- 
cines. We strongly advise that they be not promiscuously taken. No one 
is justified in using adrenal substance until, first, careful consideration has 
proved his case a proper one, and, second, provision has been made for 
supervision during its use. 

ADDISON'S DISEASE 

Suprarenal or adrenal extract has long been in use to stop hemorrhage 
and temporarily decrease local congestions. 

Sixty years ago an English physician, Addison, reported a disease 
in which the shin turned brown, until a Caucasian became as dark as an 
Indian or mulatto and in which there was tuberculosis of the adrenal glands. 
Since that time it has been found that any cause which slowly destroyed the 
adrenals would cause Addison s disease to develop. For instance, old, neglected 
peritonitis, appendicitis which has caused extensive adhesions — either of these 
can cause it if the adrenals happen to be caught in the contracting scars. 
Nevertheless, much the most frequent cause is infection with tubercle bacilli. 

When tubercle bacilli are swallowed in milk, they may get into the blood 
and go to any part of the body. However, they usually locate and develop 
somewhere in the abdomen. Occasionally they locate first in the adrenals or 
near by whereupon the skin turns brown and Addison's disease is under way. 
The blood pressure falls to 80 and sometimes 60, the weakness is profound, 
the blood loses in richness and death finally ensues. The cause of the disease 
is that the blood does not get as much adrenal secretion as it needs. 

When the adrenals are removed or are rapidly destroyed, the blood 
pressure also drops, weakness is profound and death ensues, but pigmentation 
does not develop. This last sign results when the supply of secretion is moder- 
ately diminished, not entirely stopped. 

The treatment of Addison's disease is the use of some of the forms of 
adrenal preparations and the care of the symptoms. In a large proportion 
of the cases no treatment is satisfactory. 

There is great need for study, work and investigation on the curative side 
of Addison's disease. There is greater need for study of the relation between 
the secretions of the thyroid, thymus, sexual glands, pituitary, adrenals and 



EAYNAUD'S DISEASE 581 

possibly other ductless glands, to learn where they antagonize and where 
they complement each other* 

There are but few people who develop Addison* s disease and, from the 
standpoint of this disease, the adrenals are scarcely of interest enough to 
warrant this space. But a large part of the people are mildly adrenal plus or 
minus and the greatest need of study is that information may be made avail- 
able for these. We do not know as much as we should about high and low 
blood pressure and the relation thereto of the adrenals. 



RAYNAUD'S DISEASE 

This disease at its worst is a kind of dry gangrene, causing the loss 
of the affected member in a few weeks. A milder and more frequent form of 
the disease follows about the following course: During a cold spell, an ulcer 
appears on a finger or toe and, without being exceedingly sore or suppurating, 
the tissues crumble away until a joint {bone and all) is gone, or an entire 
finger or toe. 

Some moderately severe cases will consume a winter in developing this 
far, whereupon the wounds will heal, but the disease will recur when cold 
weather comes again. Each season will take a finger, toe, ear or nose, 
as toll. This type of the disease has little or no tendency to destroy 
life. 

Osier compares the series of phenomena in Raynaud's disease to what 
takes place when the hand freezes — the skin first flushes, then gets blue, 
then turns pale, then dead white, stiff and without feeling. This, the stage of 
local syncope, is due to spasmodic contraction of the blood vessels. 

In order to keep the blood from freezing the vessels are emptied. If 
this keeps up necrosis or local death ensues. If it is not kept up blood 
comes back into the veins. The skin becomes livid and mottled. This 
is the stage of local asphyxia. Soon arterial blood comes in, the hand be- 
comes livid and swollen, and the fingers throb with pain. This is the stage 
of active hyperemia. 

These different phenomena but with no freezing to explain them are 
what happens in Eaynaud's disease. They are logical when the vessels are 
trying to keep the blood from freezing but when they develop without an 
adequate temperature reason the mechanism of the body has gone wrong. 
Eaynaud's results from a continued spasm of the muscles which make up the 
walls of the small arteries. Why the spasm? No one knows. 

But for every typical case of Kaynaud's disease going on to the loss 
of joints there are thousands of minor manifestations of the same type but 
in a mild form. Chilblains, cold feet and even some cases of red nose and en- 
larged veins in the face are mild manifestations of the same type of dis- 
order. Perhaps persisting cold feet is also a very mild manifestation. An- 
other mild disorder somewhat akin is chilblains in which the blood supply 
oi the feet, having been low, is suddenly increased. 

As the blood comes back some fluid escapes from the vessels and blisters 
arc formed. Another form noted by Osier is the beefsteak hand — cold, 
clammy, swollen, chapped, hyperemic hands. Another is the beefsteak cheeks 



582 DUCTLESS GLANDS 

of gouty men. Another is seen in the cheeks of full-habited men with red, 
eyanosed faces and twigs of blood vessels showing here and there. 

These mild manifestations may hot, and usually do not, lead to serious 
conditions but even the mildest of them are abnormalities. If we could 
learn the underlying principles of Raynaud's disease we would know the un- 
derlying principles of less important conditions. If we could control these 
inconveniencing minor conditions it would help in the solution of the problem 
of Raynaud's disease. 

Raynaud's Disease. — Mrs. H. B. writes: "What is the cause of 'Ray- 
naud's disease' and what can be done to cure it?" 

Reply. — Nothing is known as to the cause of this disease. It is usually 
found in women between ten and thirty years old. It is worse in cold 
weather. It has some disposition to run in families. Sometimes there 
seems a relationship between it and gout and sometimes it seems related to 
goiter. No cure is known. A mild form, showing itself by frequent chil- 
blains in cold weather, with beefsteak hands, feet and hands which go to 
sleep and muscle cramps, is closely akin to gout. For this mild form the 
proper plan is to keep the hands and feet warm and to live so as to avoid 
gout. 

Symptoms of Raynaud's Disease. — N. E. B. P. writes: "What are the 
symptoms of Raynaud's disease? I have a constant numb feeling in finger 
ends of left hand, a dried out, burned feeling of entire hand." 

Reply. — Undue paleness or redness of the ringers and toes. Later, 
ulcers and sometimes gangrene affect the toes and fingers. Sometimes a 
toe or finger is destroyed by the disease. It gets worse in cold weather 
and better in warm weather. In mild cases the fingers and toes chill, pain, 
and become pale or dusky when the weather is not cold enough to war- 
rant it. 

Nails Turning Black. — N. 0. C. writes: "Kindly explain why the finger 
nails turn black. The flesh recedes from the nail, is much inflamed, and 
at times causes great pain. The nail grows in ridges and seems infected 
at the root. No pus or dirt under the nail, but at times a dry powder on 
top of nail. Have been this way over a year, starting with middle fingers, 
the inflammation often reaching the second joint. The nail becomes very 
black, turns light, then black again." 

Reply. — Have your physician see if you have Raynaud's disease. 

White Finger Ends. — J. G. K. writes: "What is the cause of dying 
finger ends? They turn white and stiff when cold. Is there any effective 
treatment?" 

Reply. — I judge you have Raynaud's disease. If so, the condition is 
not to be treated lightly. Put yourself in the hands of a physician. 



CHAPTEE XXXII 



The Spleen 



Everyone knows the location of his liver. The spleen is placed in the 
corresponding position on the left side of the body. Like the liver, it is tucked 
away just below the diaphragm under the arch of the ribs and in front of the 
kidney. Being much smaller than the liver, it is lodged up under the ribs so 
that it cannot be felt at the rib edge, but when it is enlarged enough to 

become somewhere near the liver's size 
it can be felt on the left side, just as 
the liver can be felt on the right side. 
I venture to say most people do 
not know that they have spleens. The 
spleen does not hold the center of the 
stage except when things are going 
wrong. In long continued malaria the 
spleen, called now an ague cake, large 
and heavy, is felt as a dragging mass 
in the left side of the abdomen. In 
leukemia it is so radically changed that 
any observer can feel it as a hard, tumor- 
like mass. 

The spleen is a blood gland. In a 
certain sense it is the only blood gland. 
The lung is one kind of blood gland. 
The black, venous blood flows in the 
arteries to the lungs and there meets the 
air from which it picks up oxygen and 
into which it pours out smoke or what corresponds to smoke. In that it 
changes the blood it is a blood gland. 

In a certain sense the kidney is a blood gland. Into it the blood, charged 
with waste, is carried by the arteries. The kidney cells remove urea and other 
waste materials and discharge them down the waste duct, and the purified 
blood flows in the veins back into the general circulation. 

The lungs have ducts, the bronchi, through which waste discharges. The 
kidneys have ducts through which waste discharges. The spleen has no ducts. 
Its cells act on the blood in the vessels, change it in some way or other, and 
the changed blood flows on through the vessels. 

It is easy to catch the air as it flows from the lungs and analyze it, and 
in that way get an idea as to what is the work of the lungs. It is easy to 
analyze urine and judge of the work of the kidneys. It is not impossible, 
to drain the gall-bladder, gather the bile, analyze it, and get an idea of the 
work of the liver. 

583 . 




Fig. 199. — Diagram Showing Division of 
Stomach into Two Physiological 
Parts. 



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584 



THE SPLEEN 585 

There is no spleen secretion to analyze and getting a line on the work of 
the spleen has been hard. 

The blood vessels to the spleen are large for so small an organ. They 
divide and redivide until the thick walled arteries have delivered their blood 
into their thin walled branches, called arterioles. From these the blood flows 
into thin walled tubes called capillaries, and from these right among the spleen 
cells themselves. 

The blood, after it gets among the tissues of the spleen, is in great lakes 
in which are islands of spleen cells. In these lakes the blood no longer rushes 
forward. It comes into the spleen tearing away under torrential speed. It 
begins to slow up soon after it gets in. In the capillaries it flows gently. 

In the lakes it tides back and forth like water in a lake, gradually travel- 
ing from where it enters to where it flows out, but without any inlet to outlet 
current that anybody can find. 

The water flows into Lake Michigan from the mouth of the St. Joseph. 
Some day that same water will flow out through the "Soo," but if one observed 
the direction of the flow on any given day he would be quickly liable to 
find it towards the mouth of the St. Joe Eiver. 

This lake effect gives the spleen cells a good chance to act on the blood. 
As the blood passes through the lungs it is always moving from the arteries 
to the veins. As it travels through the kidneys it keeps on the move. Yet the 
effect of these organs on the blood is important. 

How important then is the work of the spleen ? What is that work ? We 
know a part of the answer, but probably only a part. 

In those diseases where germs circulate in the blood, the spleen enlarges. 
In anthrax, about the first bacterial disease of which we knew the bacterial 
cause, the bacteria gets into the blood, and in consequence the spleen enlarges. 
In fact, one of the names for anthrax is splenic fever, while the Germans 
call it Milzbrand, or spleen disorder. 

The large rodlike bacillus is carried by the blood to the spleen, where the 
spleen cells get to work trying to destroy them. As the work required is 
prodigious, the spleen cells rapidly multiply. The spleen would get quite 
large in anthrax if the patient lived long enough, but anthrax is rapidly fatal. 

In typhoid fever the typhoid bacillus circulates in the blood. The spleen 
rallies to the rescue. The extra work calls for extra cells. The spleen enlarges 
in typhoid. It often becomes large enough to be felt below the border of 
the ribs. 

In pneumonia the coccus gets into the blood. It circulates everywhere. 
At once the spleen knuckles down to work. Before the work is over the 
swollen, tender spleen can be felt at the border of the ribs. 

In syphilis the spirochetes get into the blood. They circulate widely. 
There is fever and a skin rash. The spleen gets to work. It swells. Within 
a few weeks the secondaries have passed. The spirochetes are no longer in the 
blood ; they are out in the tissues. The spleen is not under strain ; it goes 
back to normal size. After that, as long as the spirochetes keep out of the 
blood, the spleen keeps down ; whenever they get in the spleen enlarges. 

In septicemia and pyemia, or blood poisoning, the pus cocci are circulating 
in the blood and the spleen increases rapidly in size. 

This evidence is enough to convince us that one of the functions of the 



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THE SPLEEN" 587 

•pleen is to remove from the blood the bacteria that get in it. As long as 
the number is small the spleen removes and destroys them and gives no sign 
to indicate that it is on earth. 

In olden times, when everything about the body was speculative, it was 
claimed that the spleen was the seat of ill humor. In consequence, the term 
spleen was used as synonymous with anger. We spoke of ill tempered men 
as "having the spleen" or being "splenetic." How it came about one can 
scarcely understand, since the origin is so free from ways of speaking. 

There are several conditions that cause the spleen slowly to enlarge and 
to remain large for a long time. In chronic malaria the abdomen enlarges 
and one can feel a large, firm spleen pushing from under the ribs. This is the 
fever or ague cake. 

The malarial parasite passes through two forms. In one form the organ- 
ism causes regular, periodic chills and fever. In this stage it is easily killed by 
quinin. In this stage the spleen is also busy killing the parasite, but it is 
not exceedingly adept at the job, and in consequence this organ swells less in 
three weeks of malaria than it does in three weeks of typhoid, or in ten days 
of pneumonia. 

The malarial parasite, after about sixteen days, begins turning to the 
sexual form. In this stage chills and fever are irregular. The parasite is not 
so easily killed by quinin. The spleen does the best it can to rid the body of the 
parasites. In consequence it enlarges, though slowly. 

Whenever a person has ague cake, two things may be taken as certain. 
The first is that the malarial parasites in that man's blood are in just exactly 
the right stage to infect mosquitoes. The second is that it will take consid- 
erable time to rid him of malaria, for the parasites in that stage are not easily 
killed. 

If a community cannot afford to do all the things necessary to rid it of 
malaria it can cut the disease in half or decrease it even more than that by 
doing one thing — providing care until completely cured for every person having 
an ague cake. 

In leukemia there is a great enlargement of the spleen. The large, firm, 
notched tumor can be easily felt. We know little about the cause of leukemia. 
We know that it is a slow disease; that at times the forces defending the 
body are able to hold the invaders at a standstill for years; that the cause, 
whatever it may be, is combated by the one-nuclear, white blood cells, for 
these are found present in great excess ; that the multi-nuclear white cells, the 
best fighters of the blood cells, are of no service in the fight, and that the 
quality of the blood is lowered until it is exceedingly watery. 

This group of facts makes it plain that leukemia is due to a mild infection 
with some parasite; that the parasite is a blood parasite, though it may have 
its principal holdout in the spleen, as does chronic malaria. Probably the 
parasite is not a coccus, but is more nearly like the malarial parasite or the 
syphilis parasite. Some day somehody will identify this parasite and then 
the research to find a cure will start on a scientific basis. 

The spleen gets large in ordinary consumption, because the blood is 
poisoned for months by the large number of germs that absorb from the 
cavities* in the lung ; in suppurative pleurisy from the same cause ; in inherited 
syphilis because the spirochetes are in and out of the blood. 



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588 



THE SPLEEN 589 

It may occur to some readers that the spleen should be removed when 
it gets in the way. In ague cake, in leukemia, and in a few other conditions 
the great, heavy organ is as much in the way in the abdomen as any large 
abdominal tumor would be. Surgeons remove these other tumors, why not the 
heavy spleens? 

The answer is this : Usually the spleen is large because it has extra work 
to do. If the number of germs to be removed is small it can be done by the 
liver or some other organ, in which event the spleen could be removed without 
harm. But when the spleen is big because it has big work to do, it would be 
most unwise to remove it. Therefore, the surgeons do not remove ague cakes 
or leukemic spleens 



CHAPTER XXXIII 



Heart Disease 



In this country school inspectors are not allowed to remove the cloth- 
ing in examining school children. Therefore in order to learn how much 
heart disease there is among school children and what effect such disease 
has on their health it is necessary to go to reports from the old country. 

The Medical Officer for May, 1911, has an interesting study of heart 
disease among school children of a small town in Scotland. Of 2,380 chil- 
dren examined, 131 had leaking heart valves and 55 had nervous hearts. 

Those having organic heart disease — leak- 
ing valves — on an average were 55 per 
cent below height, 52 per cent below 
average weight, and increased in weight 
at a rate which was 60 per cent below the 
average. 

A crippled heart valve causing a leak, 
ordinarily called heart disease, results 
from bacterial destruction. Rheumatism 
is that bacterial disease which is the usual 
cause of heart disease, though in scarlet 
fever, pneumonia, diphtheria, and even in 
hard colds, the needed germs can enter 
the blood and become attached to the 
valves. 

If there were no heart disease rheu- 
matism would not amount to much. If 
there were no rheumatism, life insurance 
would be 10 per cent cheaper, for heart 
disease would not amount to much. 

Engineers know it to be good econ- 
omy to put in a 1,000 horse power boiler 
for a 500 horse power plant. They 
learned that by experience. Had they 
asked what the human heart had to say 
about it they would have had an answer. The human heart does its work 
with three-quarters of its horse power held in reserve. When rheumatism 
has crippled a valve the heart compensates by using a little of the reserve 
horse power. 

Ordinarily we say a man has heart disease when his compensation fails. 
It would be truer to say he has a failing heart compensation, the result 
of heart disease. The real heart disease was in existence when during 
rheumatism his joints creaked and, over the heart a soft, blowing mur- 

590 




Fig. 203. — Heart and the Great 
Vessels which Lead into and 
out from the heart. coronary 
Arteries which Supply the Head 
Muscles with Blood. The left 
ventricle makes up the apex. The 
right ventricle is not so prominent. 



THROBBING AND BEATING 



591 



mur was heard. When his acute disease subsided his rheumatic joint was 
a little stiff and his heart valve leaked. In a certain sense he had heart 
disease at that stage, though he would have resented being told so, for he 
felt equal to anything. Twenty — perhaps forty — years later his heart muscle 
lost some of its tone, compensation failed and he finds out a fact that had 
been a fact since his childhood — he has heart disease. 



THROBBING AND BEATING 

As the heart beats the force of the contraction runs instantly down 
the arteries and loses itself in the capillaries. The blood runs in the 
same direction but it runs slowly as compared with the force that we call 
the pulse. We see the same 
thing where a pump is send- 
ing water through an iron 
tube. When we watch the end 
of the pipe we notice that at 
the instant the piston strikes, 
the water spurts. The water 
took several minutes to flow 
from the pump to the nozzle 
but the spurt arrived in a 
fraction of a second. 

In the case of an iron 
pipe the throb is just as plain 
a few hundred feet away as it 
is at the pump. In the pulse 
the throb disappears in the 
capillaries — in no case more 
than six feet from the pump, 
the heart. The water in the 
iron pipe had a wall in which 
there was no give and in con- 
sequence all the forces of the 
piston carried on the water 
stream. 

In the arteries the blood 
vessels have walls nearly as 
elastic as rubber. Some part 
of the force of the heart is 
used in stretching the vessel. 

After a flow of a few feet the blood moves smoothly and evenly and without any 
j erhs or spurts. The blood in the capillaries and veins Hows smoothly and 
evenly — there is no pulse. That is the way when things are right. 

In old people the arterial walls are stiffened. Some of the rubber ig 
gone. Their vessels are more like iron pipe in that they have not much 
give. The larger blood vessels are generally placed so that they can swell 
without pressing on anything. The smaller blood vessels are not infrequently 




Fig. 204. — Diagrammatic Section of Heart Showing 
Cavities and Vessels. LV, Left Ventricle; LA, 
Left Auricle; PV, Pulmonary Veins; MV, Mitral 
Valves; a, Aortic Valves; Aa, Aorta; RV, Right Ven- 
tricle; SRA, Right Auricle; SVC, Superior Vena Ca- 
va (vein carrying blood from head, neck and arms). 
IVC, Inferior VenaJ Cava (vein carrying blood from 
trunk and legs) ; TV, Tricuspid Valves; Pa, Pulmo- 
nary Arteries. 



592 HEART DISEASE 

packed in tighter. In an old person the stiff arteries continue the pulse im- 
pulse into some of these smaller vessels. Here the pulsing presses on delicate 
nerves. 

Old people not infrequently complain of thumping in the ears and 
disagreeable pulse beats elsewhere throughout the body. It causes nothing 
more than annoyance and is not worthy of the worry that it usually occasions. 

When a limb is swollen and sore the pain sometimes comes in throbs. 
The pulse beats can be felt and they hurt. The tissues are filled with an 
excess of fluid, the skin is stretched tight; as the pulse beats the small 
nerves cannot roll out of the way — they get pinched and pain results. 
Again, the inflammation throws the muscles of the small vessels out of 
service, the vessels dilate their walls and cannot give further. They are 
somewhat similar in physics to the iron wall pipe, and the pulse beat, instead 
of stopping where it should, is carried on into the smallest blood vessels. 

If a man has a sore foot and would be rid of the throbbing he can 
usually succeed by raising it. If the foot vessels can be rid of gravity 
they come near enough handling the situation to stop the throbbing. 

In no part of the body is throbbing so much in evidence as in the teeth. 
Nowhere else do blood vessels and nerves pass through such narrow quarters, 
such canons between solid, bony walls. 

Throbbing pains are then the result of mechanical conditions. Some of 
these can be changed and the condition remedied^ some must be endured. 



THE HEART AND EXERCISE 

Should a man be afraid to exercise because of his heart? How should 
a well man decide this question? How should a man with a nervous heart 
decide it? How should a man with disabled heart valves decide it? 

To some it would seem silly to ask whether well men can harm 
their hearts. Yet a good deal has been written about acute dilatation of the 
heart and some office men with very soft muscles are afraid to exercise. 

Occasionally there is a report of the results of close, careful examina- 
tion of a group of athletes who have just finished a marathon or similar 
contest which states that dilatation of the heart has been the rule. 

As to persons with sick hearts the Schotts of Nauheim and those of 
their school have written forcibly and often of the great danger of dilata- 
tion of sick hearts from what they hold to be overexercise. 

The heart is a bag. Or, rather, it is two bags, for there is one bag, 
the right, to get blood to the lungs, and another, the left, to get it to the 
rest of the body. The wall of this bag is elastic. It is composed of muscle 
which expands and contracts alternately. 

The blood returning from the veins pours into this bag. This blood 
is under pressure. It balloons the bag. The muscle of the wall responds by 
contracting. It collapses the bag driving all of the blood into the arteries. 
There is, therefore, a constant opposition between the ballooning force of 
the blood in the heart and the collapsing force of the heart muscle. 

In the period extending from heartbeat to heartbeat there is a time in 
which the inflowing blood is ballooning the heart and another time in which 



THE HEAET AXD EXERCISE 



593 



the muscle is collapsing the bag. In this antagonism of forces things are 
going well if the muscle force is easily holding its superiority over the bal- 
looning force. Other tilings being equal the good heart is the one which 
does not balloon out and dilate unduly. 

Dr. Williamson, assisted by Drs. Hartung, Moore and Mosser, has 
attempted an answer to the 
questions asked above by ac- 
curately measuring with x-ray 
apparatus the hearts of a large 
number of persons. Some 
were healthy young men with 
sound hearts. Some had heart 
disease, but compensation was 
fully established. Some had 
no heart diseases but were af- 
flicted with other diseases the 
nature of which would lessen 
the tone of the heart muscle. 
Others had heart disease with 
a failure of compensation. 

The hearts of these per- 
sons were measured. They 
then climbed stairs until their 
pulsebeat was around 160 and 
the beating was rapid and 
"panty." 

The hearts of the well peo- 
ple were less ballooned after 
this violent exercise than be- 
fore. The answer for that 
group is that exercise is good 
for the heart immediately and 
ultimately. 

In the case of the sick per- 
sons with good compensation 
one-half of the hearts ballooned less than before the exercise. In the case of 
the sick persons with poor compensation nearly one-half ballooned less after 
as compared with before the exercise. This violent exercise was of momentary 
benefit even in heart cases. 

The answer then to the last question is that persons with sick hearts 
under proper direction can exercise with immediate benefit and also with 
ultimate good. Finally, people with nervous hearts need exercise above all 
else. 

Valvular Trouble Symptoms. — E. K. A. writes: "What is a leaking 
heart valve f How does it affect a person? Does it cause the nose to 
bleed? What are the symptoms?" 




Fig. 205. — Sketch Showing Approximate Location 
of Gall Bladder (gb), Appendix (a), Navel (N), 
Crest of Ilium — hip bone — (H), and Rib Bor- 
der (R). 



Reply. — A heart valve is like a pump valve. When the blood is going 
in the right direction it gets out of the way. When the blood starts in the 
wrong direction the valve gets in the way, closes the opening, and stops 



594 HEAET DISEASE 

the backward flow. If the valve is shriveled as the result of disease or is 
not large enough to stop the backward flow, it leaks. 

If the heart muscle works hard enough to repump the leakage there 
are no symptoms. A physician listening to the heart will detect a blowing 
sound which he knows means a leaking valve. 

When the heart muscle has lost some of its power and can no longer 
repump the leakage then symptoms appear. 

The more frequent symptoms are swelling of the feet, short breath and 
palpitation. There may be nosebleed. 

Care with Heart Murmur. — J. W. writes: "A gentleman friend, of 
mine, 26 years old, is troubled with a soreness in the left side which has 
been described by a physician as a 'heart murmur.' He has been in the 
habit of taking a cool bath every morning and evening. Don't you think 
this too often, and that the shock to the heart is too great? Wouldn't just 
the evening bath be sufficient?" 

Eeply. — A man with a heart murmur must be extra careful to keep 
up his general muscle tone. If he gets a good reaction after a cold bath 
his muscle tone will be benefited. If not he will be harmed. If he can 
take one he can take two. 

See Heart Specialist. — "Thankful" writes: "Would you kindly tell me 
if there is any hope in leakage of the heart for a man of 1+6? He is a 
tailor. Once in a while he has to lift about 300 pounds of goods. Does 
smoking hurt him? Would you suggest something for him?" 

Reply. — If you have an injured valve and that is the reason of the leak 
you cannot hope to restore the valve to what it was. But you can hope 
to live reasonably comfortably and be able to work for many years, pos- 
sibly for as many years as is the lot of the average man of 46. 

To do this you must so regulate your life as to keep your muscles in 
good tone and you must always be careful not to overstrain your heart. 

In lifting 300 pounds of goods, divide it into "takes" that do not make 
you pant. 

You should stop smoking. 

Ask your physician to go with, you to a heart specialist. Have them 
together lay out a plan for you — how much work, what kind of work, how 
much exercise, what kind of exercise and similar advice in detail. Then 
follow directions. 

Nervous Heart. — J. C. W. writes: "1. What is a nervous heart? 
2. What are the symptoms? 3. What are the causes of nervous heart? 
If. How may the condition called 'nervous heart' be corrected or cured? 
5. What are the consequences of neglecting it?" 

Reply. — 1. A heart that is easily made to beat too fast, or too slowly, or 
irregularly in speed, or too hard, or too feebly, or irregularly in force, or 
to skip. 

2. Variation in speed, or force, or rhythm without adequate cause; 
rapid, irregular pulse, pounding heart beat, or skipping pulse are 
symptoms. 

3. Tobacco, excesses of various kinds, general nervousness. 

4. Remove the cause — e. g., stop tobacco. Practice simple, plain, 
hygienic, sane living through nervous poise. 

5. A nervous heart may and does frequently nourish itself poorly and 



THE HEART AND EXERCISE 595 

in consequence the heart muscle loses power. Irregular heart action may 
contribute to angina pectoris. Generally speaking, a nervous heart is not 
so serious a matter as the affected person thinks. 

Nervous Heart Evidence. — J. W. writes: "Please give the symptoms 
of a nervous heart and the best remedy for it. Is it dangerous?" 

Reply. — A nervous heart is one that under any form of excitement or 
under the strain of physical exertion beats very rapidly or irregularly. 
We expect the heart to beat faster when one exerts himself but if the 
increase is much greater than that of the average person the heart is 
nervous. 

The way to find out is to feel the pulse. 

The most frequent form of nervous heart is the tobacco heart. That 
is seldom dangerous, but is annoying. 

The remedy is to stop the use of whatever is causing the nervous 
heart if it is some drug like tobacco or coffee. 

The heart is frequently nervous when the thyroid gland is enlarged or 
overactive. Finally, remember that watching the pulse can cause it to 
beat fast and sometimes can cause it to become irregular. 

Nervous Heart Not Serious. — E. G. N. writes : "If consistent will you 
kindly advise me as soon as possible whether or not a 'nervous heart' is a 
serious condition; or will lead to serious conditions if neglected?" 

Reply. — A person with a nervous heart usually thinks it more serious 
than it is. Nothing is more alarming to a man than to feel his heart 
cutting up. Upon regular beating of the heart depends not only general 
nutrition but the nutrition of the heart muscle itself. Therefore a 
nervous heart in time results in some organic trouble — in the main, flabby 
heart muscle. If the nervous heart results from tobacco habit or any 
other removable cause, no man is justified in not removing it. 

Heart Trouble. — A. B. B. writes: "Would you advise a heart stimu- 
lant in the case of a woman 88 years of age, married and the mother of 
two children almost grown? She is seldom sick, and never complains, but 
her heart bothers her. It beats hard, often missing a beat, and her pulse 
beats often 100 and seldom less than 85. She is not a big eater, but her 
heart is always worse after meals. I have had her examined by several 
doctors, who say she has no leakage." 

Reply. — Do not give her a heart stimulant. Her heart is now over- 
stimulated. Evidently her heart is nervous from some cause located else- 
where in her body. It may be that her thyroid is secreting too freely. It 
may be her stomach is the seat of trouble. It may be purely mental. Of 
itself the condition is of little consequence. If it is the result of too much 
thyroid, that should be looked after. If of the stomach trouble that should 
be looked after. 

Heart and Altitude. — Constant Reader writes: "What effect does the 
high altitude of the West have on one who has heart trouble? Would it 
be safe and beneficial for one 35 years of age who has heart trouble, is 
under weight, and whose general health needs building up to live at an 
altitude of 1^,000 feet or so in New Mexico or Colorado? Which would be 
better, the mountainous regions of the South or the southern part of New 
Mexico for one in such condition?" 



696 



HEART DISEASE 



Reply. — 1. Generally speaking, an altitude of 4,000 feet has no effect 
on the heart. There are some exceptions. 2. Whichever makes you happier. 

Find Cause. — A. H. F. writes: "Will you kindly state what it meant 
~by a tremor of the heart? Can anything be done to cure it?" 

Reply. — I judge that by tremor you mean that you have palpitation 
of the heart at times. If so, you should find the cause and correct it if you 
can. It may indicate a condition of great gravity, and it may mean some- 



HEAD""> UPPER 
EXTQEM. 

CYANOSIS OF FACE 

Cl UBBED FINGERS 

SYSTOLIC JUGULAR 

PULSE, 



L UA/GS. 

COUGH. 

DYSPNOEA. 

FREQUENT BRONCHITIS* 

OEDEMA. 

HYDRO THORAX. 

HAEMOPTYSIS. 

BROWN INDUR, 

ATHEROMATOUS 

VESSELS. 



CEREBRAL ANAEMIA. 

VERTIGO,, 
EAINTNESS, 

a" 
S YNCOPE. 



VEOGflS. 




OEDEMA, LOINER 
EXTREMITIES. 



INTESTINAL CATARRH, 
OBSTINATE DIARRHOEA. 

OR r^~ 

CONSTIPATION^ 
ASCITES, 



LIAC ARTS* 



Fig. 206. — Scheme Showing Circulation of the Blood. Systemic circulation: arteries 
shown on the right, veins on the left. Pulmonary circulation arteries shown on left, veins 
on the right. In brackets are stated the effects of certain disturbances of circulation. 
Examples: Obstruction of return of blood from legs results in edema of lower extremities 
(lower left bracket). Obstruction to return of blood through innominate vein results in 
cyanosis of face, clubbed fingers, pulse in jugular veins (upper left bracket). Insufficient 
force in carotid artery results in vertigo, faintness, syncope (upper right bracket). 



THE HEART AND EXERCISE 



597 



tHng that can be easily remedied. It may be caused by smoking, over- 
eating, indigestion, constipation, high arterial pressure, lime plates in the 
arteries, a weakening 
heart muscle, a diseased 
valve, etc. You will note 
that most of these causes 
can be remedied. 

Chronic Myocarditis — 
F. J. writes: "Will you 
describe the symptoms of 
chronic myocarditis, cure 
if any, and effect of hard 
work on one suffering 
from it? Advise what 
precaution to take, and if 
a complete rest from 
mental or physical strain 
will help." 

Reply. — In chronic 
myocarditis there may be 
very few symptoms. A 
weak, rapid pulse, a weak 
apex sound and a low 
blood pressure are fairly . 
good signs. But do not 
put thought on the diag- 
nosis. A diagnosis re- 
quires good diagnostic 
ability. Have an exam- 
ination by a capable diag- 
nostician and accept his 
opinion. One with 
chronic myocarditis 
should devote his care 
and control to efforts to 
make his disabled organ 
equal to the tasks im- 
posed. Temperance in 
work and worry, in eat- 
ing and drinking is the 
proper plan. 

Nothing Out of the 
Way. -B. F. M. writes : 
"I hear sounds with 
heartbeats, though not 
constantly. I have con- 
sulted physicians with no 
results. I am perfectly 
well at 65. The sound is 
sometimes a whir, a chug, 
or a peep, and more trou- 
blesome at night/' 




Fig. 207. — Femoral Artery and Its Branches. 
CFI, common femoral ; ESF, superficial epigastric; 
CIS, superficial circumflex iliac ; PUE, external pudic; 
PRF, deep femoral; CFL, external circumflex of 
thigh; PF 1 , first perforating a. of the thigh; PF 2 , 
second perforating a.; PF 3 , third perforating a.; AGS, 
arteria anastomotica magna; SF, superficial femoral. 



598 



HEART DISEASE 



CUI 



Reply. — In certain positions it is easy- 
enough for one to hear his heartbeats. To 
him they may sound like a whir or a chug 
or a peep according to how he happens to 
hear them. A heart murmur loud enough 
for you to hear could not escape an exam- 
ining physician. You can therefore feel 
certain that what you heard were the nor- 
mal heart sounds. 

Have Your Heart Examined.*— A. C. 

writes : "In a man of 73, in apparent good 
health, whose normal pulse had been 60 per 
minute, what causes it to drop to 50 and 
55, with sometimes an intermittent pulse?" 
Reply. — It may not be of any signifi- 
cance. It may mean some lime plates in the 
arteries. You had better have your heart 
examined and your blood pressure taken. 

Irregular Beat of Heart. — D. A. writes: 
"1. I was examined recently by a physician 
who told me I was in good condition. He 
said my heart had a catch in it, but he did 
not consider this of any consequence. 
Would you consider this a disease of the 
heart? If so, can it be cured or remedied? 
2. Will tobacco contribute to this if the 
smoke is not inhaled? 3. Could indigestion 
cause this irregularity of the heart?" 

Reply. — 1. I suppose by "catch" you 
mean your heart interrupts or skips a beat 
occasionally. Skipping a beat may result 
from disease in the heart. It usually re- 
sults from causes outside the heart. It can 
usually be cured. 2. Yes. 3. Yes; a man 
with a heart that skips should find out 
what he is doing wrongly (e. g., worrying, 
smoking, or digesting poorly) and change it. 

Has Years to Live.— E. L. writes: 
"What are the possibilities of living for a 
man of JfO with a mitral lesion? Is it pos- 
sible for a man so afflicted to live to 60 or 
70? Does such a condition have any 
marked symptoms, such as swelling of 
limbs, nosebleed, or fainting spells?" 

Fig. 210. — Brachial Artery (arm) and Its 
mvp Branches. B, brachial; R, radial; U, ulnar; 

CLS, arteria deltoidea; CLI, profunda radial; 

PB, superior profunda; CM, arteria collateralia 
media; CUI, anastomotic a. of arm; RR, anterior radial recurrent; RV, anterior ulnar 
recurrent; ICO, common interosseous; I A, anterior interosseous; IP, posterior inter- 
osseous; IR, posterior interosseous recurrent; IAV, arteria interossea anterior volaris; 
IAD, arteria interossea anterior dorsalis; M, median; CVR, anterior radiocarpal; CVU, 
anterior ulnocarpal; CDR, posterior radiocarpal; MDU, posterior ulnocarpal; MVS, 
superficial volar; MVP, ulnar portion of deep palmar arch; DC, first palmar digital. 



SKI 



DC 



flfll/O /Wl/S 



THE HEAET AND EXERCISE 599 

Reply. — 1. If lie is wise, has good muscles and has a good compensa- 
tion he is nearly as likely to reach 70 as the average person of 40. 

2. When there is a break in compensation these symptoms appear. A 
break in compensation means that the heart muscle is straining to do the 
extra work and not succeeding well. To avoid this keep fit, especially 
keep your muscle tone good, live hygienically and do not overdo. 

Heart Trouble. — B. L. R. writes: "I am engaged to a young lady who 
has heart trouble and has had several attacks of inflammatory rheumatism 
during the last ten years, the last being three years ago. Her physical 
development is perfect, height about 5 feet 6 inches and weight about lJfi. 

"I am over 6 feet tall, weigh 180, have never been sick, and free from 
anything of a contagious nature. My fiancee feels well, although she has 
shortness of breath on going upstairs rapidly. Do you think it safe for us 
to marry? I know she is not able to do much work, hut I am in position 
to let her have all of the help she needs. I also realize that she will need 
better care than many men give their wives/' 

Reply. — Her heart disease is evidently the result of rheumatism; her 
rheumatism the result of a bacterial infection. She did not inherit either 
nor can she transmit either. The question, then, is limited to how long 
her heart will be able to do the extra work which its leaking valves throw 
on it. If you are in a position to make her married life easier than her 
single life has been her compensation will be maintained longer married 
than single; otherwise not. Judgment as to permanence of her heart com- 
pensation must be based on (a) amount of damage to the heart valve, (b) 
state of heart muscle tone, (c) state of general muscle tone, (d) whether or 
not rheumatism germs are continuing to find entrance to the blood, joints, 
and heart. The opinion of those who have seen her, examined her, and 
know her is much better than mine or that of any other stranger. 

Probably Angina Pectoris. — M. A. L. writes: "What is the cause of 
pain in the chest, beginning at the oreast bone and passing into the collar 
bones and shoulders? The pain seems to be in the bones rather than inside 
the chest walls, and is intense for a few minutes, then passes away." 

Reply. — My guess is that this is angina pectoris. The pain of the con- 
dition does not start in the breast bone. It starts behind the bone and 
shoots into the arm. See your physician about it. 

Don't Try "Remedy." — B. F. M. writes: "For the last few years I have 
had a leaky valve which I acquired through rheumatism. It is in the artery 
going out of the heart to the body (the aorta). 

"According to an article recently printed, it is claimed that a treatment 
of hammering on the seventh cervical vertebra will contract the aorta. 

"Will such treatment by a physician do any good to the leaky valve, as 
it is claimed it will contract the artery f 

Reply. — It will do absolutely no good. The aorta is made up of dense 
fibrous tissue like gristle and some elastic tissue like rubber. It contains 
no muscle. It cannot contract and dilate as do small arteries. It cannot 
be stimulated to contract. Its limited power to change size is similar to 
that of a rubber tube. Therefore pounding on a vertebra is foolishness. 
When people study and know more about such things it will no longer be 
possible to make foolish claims for treatments and get away with it. A 



6,00 HEAET DISEASE 

leaking aorta can be made to do satisfactory work if the heart muscles are 
kept strong enough to do the extra work thrown on them by the leak. In 
building up the general muscles the heart muscle will be built up. 

Heart Trouble in Son. — J. S. C. writes: "What can I do that will he 
test for my son? He is 16 years old and has a touch of heart trouble. He 
has had it for five years and it is now worse and more dreaded by him than 
ever. He weighs 95 pounds and is 5 feet 1 inch in height." 

Keply. — The first thing for him to do is to quit dreading it. Dread 
will make it twice as bad. It should be no trouble for a 16 year old boy to 
keep his heart equal to its work. A fair percentage of 10 year old boys 
have heart leaks but the heart muscle is so strong during those years that no 
symptoms result. The symptoms come when the adults begin to let their 
muscles get flabby. Your boy should be watched over by a good physician. 
Under his direction the boy should exercise enough to build up his mus- 
cles. As he gets stronger he should exercise more. His heart muscle will 
get strong as his other muscles get strong. Let him forget his heart and 
watch his calf, his thigh and his biceps. 

Quick Heart. — W. A. D. writes: "The insurance examiners say I have 
a nervous heart. It beats 80 standing, 6Jf lying down, and 96 after walking 
upstairs, and misses a beat now and then. I am 1+3, general health good, 
sleep and eat well, and am gaining flesh, although weight is somewhat below 
normal — 1^5 pounds, 5 feet 8 inches tall. I work hard mentally and get 
tired easily. Can a man over JfO do more than conserve his nervous energy? 
How can he increase it?" 

Reply. — A heart which is sixteen beats faster when standing than when 
lying down, which increases another sixteen on walking upstairs, and which 
skips a beat occasionally may or may not be structurally sound. Have your 
physician find out if the valves are sound and the muscle not degenerated. 
If everything is organically all right cut out tobacco and all other bad 
habits, take some muscle exercise and get yourself in hand. 

Doctor Should Superintend. — B. T. W. writes: "I am a man 53 years 
old. I weigh 180 pounds, am 5 feet 10 inches in height. I was recently 
examined for life insurance and was refused, I have since learned, on the 
following account: 'High blood pressure and slight murmuring of the 
heart.' Can you suggest what exercise and diet to follow to remedy these 
defects as much as possible?" 

Keply. — If your blood pressure and heart condition was bad enough to 
cause your rejection by the life insurance company you had better have 
your physician superintend your efforts. The general principle of such 
efforts should be as follows: 

A — When a heart valve leaks the heart muscle is called upon to do 
extra work. If the heart muscle is in good tone it does the extra work 
and there are no symptoms from the leaky valve. If the muscle tone is 
lost we say compensation is broken and we expect symptoms to ensue. 
The plan of treatment then is to build up muscle tone. This is done by 
carefully graduated general muscle exercise. To be right the exercise 
must almost reach the point of making the heart beat fast and hard but 
must not quite do so. You must work almost to the point of tire but not 
quite. You must persist. 



THE HEART AND EXEECISE 



601 




Fig. 209. — Veins, 
Showing (A) 
Valves Open 
when Blood is 
Flowing; (B) 
Closed When 
Blood Starts to 
Flow in Wrong 
Direction. 



B — When the blood pressure gets high the elastic tissue of the blood 
vessel walls has been worn out and been replaced by inelastic tissue. It 
is therefore late to begin. The best you can do is to eat fruit enough to 
keep your bowels regular and to live abstemiously. No tobacco, no alcohol, 
no heavy meals; in fact, light meals consisting largely of cheese, milk, 
buttermilk, bread and fruit are advised. 

Have Heart Examined. — A. B. C. writes: "I am a man 35 years of age, 
and up to six months ago drank almost every day regularly. I stopped 
drinking suddenly; just made up my mind to stop for 
ever, and did. Shortly after doing so I would become 
nervous at the least provocation and my digestion has 
been bad off and on of late. Almost constantly for the 
last few months my heart has bothered me greatly by 
its thumping at night, when I lie down in bed to sleep. 
Sometimes it thumps so fast that I imagine it will 
jump out of my mouth, and then it will get so slow 
that I am in dread it will stop. Most of the time my 
pulse is 60 to 66, when calm, and under any excitement 
it jumps away up to 100. I sometimes get so dizzy that 
I imagine I am going to drop dead. I wish you would 
tell me what you think is the matter and advise me 
what to do, as I am becoming a wreck worrying about 
myself. Is a pulse of, say, below 72 a sign of a weak 
heart or a bad one? Is 60 to 66 too slow for mef The 
beat is a light one, but seems regular/' 

Reply. — The condition described is much more sug- 
gestive of tobacco poisoning than of alcohol poisoning, 
and you do not tell your tobacco habits. A pulse beat below 72 is not a sign 
of a weak heart or a bad one. Have a physician examine you to find out if 
you have a heart leak. If you have not but have a nervous heart instead 
he will tell you how to end that. He will start by telling you to quit wor- 
rying, to quit watching your heart and counting your pulse. 

Blood Pressure in Hardening of Arteries. — C. G. R. writes : "Can there 
be high blood pressure without hardening of the arteries? What is the 
average blood pressure? What would blood pressure of 150 indicate?" 

Reply. — 1. The pressure rises temporarily from many causes. If it 
persistently remains high it means hardened arteries. 

2. Varies with age. In childhood, under 100; in early adult life, 120 
to 130; after 50, 150 to 160. 

3. Hardening of the arteries in anyone under 50. 

Prevention of Hardening of Arteries. — M. writes: "What is the treat- 
ment proposed by a Russian scientist to prevent premature arterial harden- 
ing? What can be done to reduce blood pressure?" 

Reply. — 1. The Metchnikoff plan is to prevent the growth of putrefac- 
tive bacteria in the large intestine by infecting the contents thereof with 
an acid secreting bacillus. He makes use of a certain lactic bacillus which 
makes a great deal of acid and is not killed thereby. This bacillus can 
stand acid four times as strong as ordinary lactic bacilli. To help out, 
this bacillus should be given with much sugar. The treatment is not get- 
ting a fair trial, since many of the commercial preparations are composed of 
germs easily killed by acid. 



602 HEAET DISEASE 

2. Not much can be done. The horse is out; what good to lock the 
stable door? Eat lightly, live temperately, and avoid constipation. 

Tissue Change in Hardening of Arteries. — C. J. D. writes: "What 
causes hardening of the arteries? Is it curable? By what general meth- 
ods, baths , or medicine? How is this trouble prevented?" 

Eeply. — The tissues of young people are exceedingly elastic. The more 
elastic fibers of the tissues wear out more rapidly than other tissues. As 
they wear they are replaced by a harder, less elastic tissue, called fibrous 
tissue. It happens that the change from elastic to fibrous tissue in the 
arteries can be measured in a rough way by measuring the blood pressure. 
There is no satisfactory way to measure senility in the other tissues. 

When a man's blood pressure indicates that his arteries are old as 
measured by wear his other tissues are also worn, though it cannot be 
proved. 

The papers tell us of cures by radium. Maybe so, but I doubt it. To 
change one's method of living is more rational. While cures have a small 
field the field of prevention is large. 

The method? Eight living; temperance in eating, drinking, working, 
worrying; avoiding infections and subinfections, especially avoiding rheu- 
matism and gout. 

Cause of Hardening of Arteries. — W. H. S. writes: "1. What causes 
hardening of arteries and high blood pressure in a middle-aged man? 2. 
What can be done for a person who is said to be neurasthenic?" 

Eeply. — 1. Overeating, drinking stimulants, constipation, a tobacco 
heart, Bright's disease. There are other causes but these five are the most 
important. 

2. Exercise in the open air, a natural life, taking an interest in others, 
optimism. Many mild cases cure themselves by reading books on nerves. 
In these they learn that "there are others," that their experiences are no 
worse than thousands of others have had, that the condition in the main 
is due to bad mental inheritance or bad mental training or both, and that 
it yields to patient efforts at nerve control. 

Water in Hardening of Arteries. — A. F. writes: "I am a woman, near- 
ing 60. Have hardening of arteries, and b. p. much above normal. What 
effect would hard water {very hard) have upon me, in my condition? 
Would boiling the water, and pouring off for use after the white deposit 
settles, make it less injurious?" 

Eeply. — Hard water will not harm you. Boiling it will make no dif- 
ference so far as your arteries are concerned. Back of the existing condi- 
tion in your arteries lies the cause. You used up the strength and elas- 
ticity of your arterial walls when you were young. As long as Nature 
could she repaired the wear with the best materials, elastic and fibrous 
tissues. 

Now she must stop it with the best available material and this is lowly 
organized tissue and lime salts. 

The lime salts are not to blame. In fact, were they not available the 
wall would give worse than it does. 

An excess of salts taken in as hard water is passed right out by the 
kidneys and bowels. The mineral may hurt these organs a little but it 
will not harm the arterial walls or the tissues generally. 



THE HEART AND EXEECISE 603 

Premature Hardening of the Arteries. — J. W. writes: "1. In the case 
of an individual about J+0 suffering from premature hardening of the ar- 
teries, not in any marked degree, but where the hardening is perhaps ten 
years in advance of his years, can it be arrested? 2. Would or does this 
condition necessarily lead to or cause bodily discomfort, disability to per- 
form manual labor, illness, or shortening of life? 3. Are fat, well nour- 
ished people usually those whose arteries are in prime condition? .4. 
What is considered the normal blood pressure?" 

Reply. — 1. Yes, by eating in moderation, living temperately and hy- 
gienically. 

2. No, as to all except the last and even that can be avoided. 

3. No. Fat people usually have pressure a little higher than normal. 

4. 110 to 140, but what is normal at one age is high at another. It is 
lowest in infancy, rapidly heightens during childhood and adolescence, 
then slowly until 70 to 80, after which it may be somewhat lower. The 
force of the heart beat is a contributory factor and that goes off a little 
in old age. 

Simple Life Only Avails. — Southerner writes: "Will you please tell 
me what causes arteriosclerosis and what, in your opinion, is a sensible 
treatment? My husband has been told by a physician that he is suffering 
from it. He complains of nothing, save of a tingling in the tips of the 
fingers of his left hand, and all the left arm is almost continually in the 
condition popularly described as 'asleep.' What would you advise and also 
what is the span of life after a case of arteriosclerosis reaches the condi- 
tion of being well defined? My husband is 52 years of age, weighs 180, 
and is intensely nervous. I have been much given over to the idea of 
calomel, and you have turned me from this faith/' 

Reply. — 1. Arteriosclerosis is due to the wear and tear of life. The 
processes of senility begin in a baby at birth. The child ages most rapidly. 
Senility progresses much more slowly in middle life but its effects are 
more generally recognized. At no other period does one age so slowly as 
in old age. 

The process is one of wear. Wear is greatest when the wheels are turn- 
ing fastest. Worry, whisky, and improper eating increase the wear. The 
other tissues wear as do the artery walls, but in the artery walls scar tissue 
grows to take the place of the worn muscle. 

A way to measure the vessel wall change mathematically has been 
found. That is why we hear so much about high blood pressure and 
arteriosclerosis. 

Arteriosclerosis having been diagnosed, follow the simple life. Noth- 
ing else avails. Of course, the time to have locked the stable was before 
the horse escaped. 

2. People who live in a warm climate and eat heavily have swollen 
livers. Calomel purges them and makes them more comfortable. So would 
any other purge. But why go on swelling one's liver and purging to get it 
down again? Is there sense in that? 

Treatment of Hardening of the Arteries. — C. T. O. writes : "1. Is olive 
oil beneficial in cases of hardening of the arteries? 2. Will massage relieve 
pain in such cases? 3. Is there any remedy for enlarged liver? 4. What 
will prevent accumulation of gas in the stomach?" 



604 HEAET DISEASE 

Eeply. — 1. No. 

2. Massage will help many kinds of pain. 

3. Depends on what causes the enlargement. The enlargement of the 
liver which comes in summer can be cured by eating less. 

4. Gas is not formed in the stomach in any considerable amount. Much 
gas is swallowed. Slower eating limits this. Belching, if that is what you 
mean, nine times out of ten is a sign of nervousness and is to be so treated. 

Symptoms of Hardening of Arteries. — Florida writes: "Please state 
what some of the symptoms are of hardening of the arteries." 

Keply. — High blood pressure, large quantity of urine, enlarged heart, 
dizziness, vertigo. 



CHAPTER XXXIV 

Blood Pressure 



HIGH 

PRESSURE 



: i 

L INE 5\ i 



VENTRICULAR SYSTOLE 



/IRTERIES 

[curved double lines : 
represent the dis - 
tcntion and length- 
ening or the . 

arteries) 



BLOOD PRESSURE RECORDS 

We begin to get old when we begin to live. When we are young we 
get old rapidly. When we are old we get old slowly. The tissues of a baby 
age rapidly. The tissues of 
a man of seventy age slowly. 
A baby is a great energy 
waster. He has a surplus 
of energy and he spends it 
like a drunken sailor. An 
old man makes his efforts 
count. 

Repair never leaves the 
cell quite as it was before 
the waste. Some vitality is 
gone even when everything 
' seems absolutely normal. 
After a few decades the dif- 
ference between the cells as 
they are and as they were at 
the beginning becomes rec- 
ognizable by certain tests. 
The only test that is reduci- 
ble to a mathematical basis 
is blood pressure. 

Blood pressure is a test 
of two tissues only — the 
blood vessel wall and the 
heart muscle. Therefore, it 
is only a partial test but at 
that it is a better test than 
the years lived. 

The insurance compan- 
ies pay out most of their 
money for wear and tear 
diseases. The most promis- 
ing way of lessening the 
wear and tear diseases is by 

changing some of the popular customs. To this end the life insurance com- 
panies spend money on efforts for public education. 

605 




/IRTERIOL 



oKrras 3 ®!!® 



iYiTEM 



ttAim 



Tiyn§is. 



RESISTANCE 

(triction in 
capillaries, 

MAINLY.) 



VEINS 

!L©W 



(D 



Fig. 210. — Diagram Explanatory of Arterial. Ten- 
sion. 



606 



BLOOD PKESSUKE 



The Northwestern Life has been studying blood pressure. It has 
observations on about 3,000 people, some of whom had been insured five years. 
The average blood pressure of those who passed was 143. The 525 with 
highest blood pressure among those passed had an average of 153. Seven 

hundred and twenty- 
three persons rejected 
had an average pressure 
of 171. 

In another group 
of cases the average 
blood pressure of those 
under 40 accepted was 
125. The average of 
accepted risks at 40 to 
44 had an average pres- 
sure of 128; 45 to 49, 
130; 50 to 54, 132; 55 
to 60, 134. 

When a life insur- 
ance company insures a 
man it counts upon his 
living out a certain ex- 
pectancy. The actual 
death rate among a 
group of insured who had a blood pressure of 143 was but 47 per cent of 
the expected death rate. In the group with a pressure of 150 and over, the 
death rate was 70 per cent of the expectancy. Of those rejected and having 
a pressure of 171, the death rate was 153 per cent of the expectancy. Those 
having a high pressure, 171, and some organic disease had a rate of 161 per 
cent of the expectancy. 

The causes of death in the high blood pressure cases were apoplexy, 13; 
Bright 's disease, 10; heart disease, 8; arteriosclerosis, 6; remainder, scat- 
tering. In the cases in which the blood pressure averaged 152, apoplexy and 
heart disease led but the lead was not so great. 




Fig. 211. — Method of Taking Blood Pressure. 



PROTECTING THE BLOOD 



The blood runs from the heart through the arteries to the capillaries 
and then back through the veins to the heart. The blood is always inside a 
closed tube. When the structure of man was planned it was seen at once 
that the important fluid — the blood — must be protected against infection. 
On the other hand, it was seen to be necessary, in order that the tissues be 
nourished, that the liquids ooze out of the vessels so that the cells of the body 
might soak in them. Therefore the small blood stream was so arranged that 
food could easily soak out but that harmful things could not soak in. 

Now, whenever any arrangement for soaking out is provided an ar- 
rangement for soaking in must also be provided; else presently everything 
will be out and nothing will be in. 



PROTECTING THE BLOOD 



607 



The arrangement provided was that whatever had got out could get 
back in again by flowing into certain spaces and then flowing along certain 
tubes and through certain filters and finally back into the blood stream. 

This especial arrangement for getting the tissue juices back into the blood 
stream is known as the lymphatic system. It is an adjunct to the blood system 
especially provided to make it safe for the blood fluids to do their work. 

A properly arranged lymphatic system must have open mouths. It must 
be easy for anything to get in. Therefore the lymph vessels start as open 




Fig. 212. — The band B is fastened around the arm; air is pumped by the bulb C through the 
tube D until the inflated band B pressing the artery against the bone stops the pulse at the 
wrist. The air pressure in B and D is registered on the column of mercury A. 

mouthed tubes lying everywhere around the cells and any liquid or solid 
that gets under the skin or through the mucous membrane can get at once 
into a lymph vessel. 

Disaster, however, would wait around every corner unless a way was 
provided to filter the lymph and thus keep dangerous substances out of 
the blood. These filters are called lymph glands. It is impossible for the 
lymph to get into the blood until it has gone through several of these lymph 
glands. 

The little kernels that appear here and there under the skin are lymph 
glands. So long as their work is not too great they are small, in fact usually 
too small to he felt. 

When they grow large enough to be felt it means something. It means 
that they are being called upon to do an excessive amount of work and they 
are striving hard to do it. 

If they get tender and painful it means that the job is more than they 
can stand up under. The gland is straining out the germs and saving the 
blood stream from pollution but the poison is proving too much for the filter. 

A swollen, tender, inflamed gland is in a bad condition but it is better 
that the gland should suppurate than that the blood stream should be polluted. 



608 BLOOD PRESSURE 

Blood Pressure. — Mrs. S. G. writes: "1. Will you kindly state whether 
150 m. m. is normal hlood pressure for a man of 59 years'? He is slightly 
pigeon breasted, and has had a hard winter cough — bronchitis — since child- 
hood. He gets red in the face and neck at times, with no great throbbing 
of arteries. The physician calls it a vasomotor disturbance. 2. What is 
meant by 'vasomotor disturbance'? 8. After an operation for chronic 
appendicitis the colitis ceased, and last summer there was no recurrence of 
the trouble. He has been using a good deal of buttermilk {creamery). 
Can the ordinary lactic acid germ have given him relief? Jf. How much 
credence should be given to the theory that buttermilk will stop putrefac- 
tion in the bowels and prevent arteriosclerosis? 5. Can vaccinating for 
'colds' do any good? 6. Kindly tell those who cannot go to bed how to 
stop a cold." 

Reply. — 1. It is a little too high. 

2. Blushing is a vasomotor disturbance. A vasomotor disturbance is 
a lack of proper automatic control over the size of the smaller blood 
vessels. 

3. My guess is that his intestines were irritable from the appendicitis; 
therefore that the operation cured the intestinal trouble indirectly. 

4. A little, not much. 

5. Yes. 

6. A purge, light diet, and a few doses of aspirin. 

High Blood Pressure. — L. H. writes: "1. Would a blood pressure of 
200 and over — at times 230 — be dangerous for one of Jf9 years who has a 
nervous heart, but otherwise is in good health? 2. What is apt to be the 
result from such a condition? 3. How high can the blood pressure run 
without causing paralysis at 50 or 60 years?" 

Reply. — 1. Blood pressure of 230 at forty-nine is about the limit. It 
indicates a bad condition. 

2. Bright's disease, apoplexy, the tissue changes of arteriosclerosis. 

3. The pressure does not cause paralysis. A high pressure may accom- 
pany brittle arteries and one of these may break, causing paralysis. You 
had better quit smoking, eat less, change your habits, and get your pressure 
down. 

Temperate Living Urged. — Mrs. I. S. K. writes: "A friend of mine 
suffers from too high blood pressure and hardening of the arteries. Her 
age is 65 years. Has been taking nitroglycerin tablets for six months 
four times daily, but so far has derived no benefit. Would you advise 
to continue the use or is there anything you could suggest?" 

Reply. — Many people use nitroglycerin. I do not think it does any 
good. Prevent constipation. Eat, drink, and in all other ways live tem- 
perately. 

No Great Danger. — W. A. writes: "Is a blood pressure of 170 to be 
considered dangerous for a woman of 65, living under conditions almost 
ideally sanitary and hygienic?" 

Reply. — 170 is high for that age. That does not mean you are in great 
danger. 

The Northwestern Life has found that the death rate among people 
with a blood pressure of 170 is 138 as compared with a normal for that 



PROTECTING THE BLOOD 609 

age of 100. In other words, you are in no great danger but your life ex- 
pectancy is somewhat lower than normal for your age. 

Altitude Effect Exaggerated. — E. W. S. writes: "What precautions 
should a person take who is going to Colorado or some other point in the 
west of a high altitude, and who has 'leakage of the heart/ or valvular 
trouble of the heart? Is there any relation between 'leakage of the heart' 
and inflammatory rheumatism? Could one be said to be the cause or fore- 
runner of the other; if so, which? What are the first symptoms of dia- 
betes? What would you say was the cause of one requiring a great deal 
of drink (nothing stronger than water) especially in the evening after 
dinner?" 

Reply. — 1. Let him be careful about exercising. After a few weeks he 
will find that he has adjusted himself to the new atmospheric pressure. 
The effect of altitude on the heart is greatly exaggerated in the public 
mind. 

2. Yes, inflammatory rheumatism is the cause or forerunner of much of 
the heart disease. 

3. Generally an increased amount of urine and increased thirst. Some- 
times a crop of boils or a carbuncle first calls attention to the existence of 
diabetes. 

4. May be due to an overfull meal or to inactivity after eating. It is a 
good idea to drink a good deal of water after a full meal. 

On High Blood Pressure. — M. J. B. writes: "Will you please tell me 
what is the cause of high pressure of the blood and are there any serious 
results from too high pressure? What should the treatment be?" 

Reply. — A high blood pressure means that (1) the heart is beating too 
strongly; (2) the blood vessels walls are thickened and inelastic; (3) 
the person is obese; or any two or all of these combined. Of these 
much the most important is the second. Naturally the blood vessels are 
large enough and smooth enough for the blood to flow through with very 
little friction. They are elastic enough to stretch like a rubber tube every 
time the heart beats. As age comes on the elasticity diminishes, the walls 
thicken, and the inside width of the tube gets less. In consequence the 
blood in the tubes is under too much pressure. High blood pressure is 
of importance, more because it is an indicator of senile changes in the 
tissues rather than on account of itself. For instance, it usually goes hand 
in hand with chronic Bright's disease — senile kidneys. About all that can 
be done is to live "slimmer." 

Treatment of High Blood Pressure. — L. C. R. writes : "I have what they 
call hardening of the arteries. About one year ago I was working in my 
yard and it was awfully hot. I got dizzy and fell and since then my right 
leg has been numb and I have dizziness when I walk. I am a man of 6Jf 
years old and my blood pressure at the present time is 172. Can you sug- 
gest where I could go or what is best for me to do?" 

Reply. — People generally start to work on high blood pressure about 
twenty years too late. Eat lightly, eat simply, chew your food well, drink 
plenty of water, attend to your bowels, exercise moderately, keep happy, 
do not worry and you will be doing all you can do for high blood pressure. 

Blood Pressure at Forty. — A. M. writes: "The writer, age Ifi, recently 
applied for life insurance, and, though the application was granted, the 



610 BLOOD PRESSURE 

examining physician expressed dissatisfaction with the blood pressure, say- 
ing it was 138, or within two degrees of 'the limit' for that age. Will you 
kindly say (1) how serious this record should be thought to be? (2) 
Whether medical advice should be sought? (3) Whether one may hope to 
reduce such a record of blood pressure, or only to prevent it increasing too 
rapidly? The writer s health is good, and he is commonly thought to be 
much younger than he is, but he has congenitally poor circulation, being 
troubled with hot head, cold extremities, etc." 

Reply. — 1. For 40 years of age 138 is high. In the sense of immediate 
danger the condition is not serious. If one maps out a plan of proper living 
and follows it the condition may never be serious. I know a man whose 
blood pressure was found high twelve years ago. He was frightened and 
agitated about it for a while. Since then his first wife has died; he mar- 
ried a second time and that wife died. He married a third time and that 
wife is living. 

2. Yes. 

3. A sensible hygienic life may result in some lowering. It will surely 
result in a lower rate of increase. 

High Blood Pressure Symptoms. — J. B. W. -writes: "Will you please 
state the cause of a high blood pressure, and also what are the symptoms?" 

Reply. — A high blood pressure means that the elastic fibers of the walls 
of the blood vessels have been worn out and replaced by inelastic fibers. The 
cause is "wear and tear." "Wear and tear" may result from syphilis, lead 
poisoning, alcoholic addiction, overeating, overworking, worrying, and con- 
stipation. The symptoms are many. In a given case any symptom may 
be absent. There is an instrument for measuring pressure. Symptoms 
which suggest the need of this examination are dizziness, cold extremities, 
albumin in the urine, irritable heart. 

Blood Pressure at 23. — A. R. writes: "1. What is the normal blood 
pressure of an unmarried woman, 23 years old? 2. In a person who is 
anemic, what does a blood pressure higher than normal indicate? 3. What 
would it indicate should the blood pressure be lower than normal?" 

Reply.— 1. About 105 to 110. 

2. If the person concerned is the woman referred to in the first ques- 
tion I doubt if her blood pressure would go above normal for long. 

3. Probably a weak, flabby muscle and general lack of tone. 

Leave the Bed. — C. B. A. writes: "Kindly give me your opinion of a 
case of high blood pressure. Can it be cured, and how? Is there danger to 
a woman of about lfl years, who has had good health, as a rule, and looks 
well? The weight is about 150 and the height about 5 feet 7 inches. The 
patient has been in bed three months on a strict sweet milk diet. Should 
there be a diet, and of what, after giving up the milk diet? Is the condition 
critical at this time or later? Is traveling safe?" 

Reply. — High blood pressure indicates long continued wear. The wear 
may be from overwork, or worry, lead poisoning, venereal diseases, stimu- 
lants or tobacco. Unless there is some special occasion for it there is.no 
sense in going to bed for high blood pressure. A "one hoss shay" may be 
somewhat creaky but why have it if you do not use it? Get out of bed, 
go about your affairs, change whatever in your habits should be changed 
and you will do about all you can do for high blood pressure. 



PROTECTING THE BLOOD 611 

Milk, eggs and meat should not make up any considerable part of your 
diet. Eat lightly. You have been a sinner for forty years. You are now 
trying to escape your sins by being good and, as usually happens, you are 
too good. 

Hemophilia. — J. E. R. writes: "Please tell me why the daughters of 
bleeders should not have children. Where can I procure agar and what is 
a dose? Is there danger of its becoming impacted in the bowel f 

Reply. — 1. The sons of the daughters and sisters of bleeders are apt to 
be bleeders. Hemophilia [tendency to bleed] is inherited. It is an in- 
heritance limited by sex. While only men have it it is transmitted only by 
women. 

2. Your druggist can get it for you. You may eat a handful a day if 
you wish. 

Nosebleed. — G. A. C. writes: "I am troubled with nosebleed a great 
deal. My left nostril has bothered me the most. The secretions form a clot 
at the upper end of the nostril and it is necessary to remove it 
upon getting out of bed. The clot is about one-quarter of an inch across 
and quite thick. When I remove it the nostril always bleeds. It is 
very easily stopped by snuffing a little cold water up the nostril. Lately 
the right nostril has taken to bleeding, but it is hardly ever stopped up, 
and it is very hard to get it stopped. The right nostril bleeds very 
freely and the left very slowly. I find it necessary to pack the left 
nostril with cotton, sometimes two or three times. The blood seems to be 
of a good bright color. It bleeds at all hours — just starts itself. I am a 
locomotive engineer, and work nights. Have for years smoked a great deal, 
and drink lots of coffee. I do not use intoxicants." 

Reply. — If the cause of the bleeding is of a local nature then local 
treatment is all that is necessary. Such treatment consists in cleansing the 
nose thoroughly at night with a solution of warm salt water in the propor- 
tion of one teaspoonful of salt to one quart of water followed by a free 
application of boracic acid and lanolin. 

The nose should not be blown hard at any time and picking is positively 
forbidden. Where crusts of scales form and it is desired to dislodge and 
remove them do this by first softening with warm water, vaselin or oil. 

When nose bleeding persists it is usually advisable to have a physician 
or nose specialist if one is available. 



CHAPTEE XXXV 

Apoplexy 

APOPLEXY IS CEREBRAL HEMORRHAGE 

Apoplexy stands near the top as a cause of death in old people. It gen- 
erally disables for several years before it produces death; therefore, it stands 
near the top as a cause of disablement. After the blood vessel breaks and the 
blood pours into the brain, there is about a week in which the patient runs 
fever and is worse than immediately after the stroke. Then the paralysis 
of the tongue, face, arm, and leg slowly gets better. 

The improvement is exceedingly slow, because a new set of nerve cells and 
fibers must be trained to do the work formerly done by those destroyed by the 
hemorrhage. 

There are two phases of the subject worthy of some thought. The first 
is that there is usually a history of vertigo and nausea for a few hours preced- 
ing the attack. 

Apoplexy runs in families. Therefore, if a man is of an apoplectic fam- 
ily and has arrived at the apoplectic age, he will be wise to watch his digestion 
closely, to live carefully, especially avoiding intemperance in eating and 
drinking, and, if he finds himself giddy and a little nauseated, to take a dose 
of saline water without delay. 

The second point is this : After the fever stage has been passed a man 
can do a great deal to improve his condition. Eegular massage to keep up the 
tone of his muscles will be of great service. When a man is learning to walk 
again he can be helped by experts in the training of his nerve cells and fibers 
to the new duties. 

Careful watching will prevent the development of cystitis and Bright's 
disease, so destructive to the life of people of this group. 

Apoplexy produces paralysis — but it is not a nerve or brain disease. It 
is the result of disease of the blood vessels in the brain. In the evolution 
of apoplexy the order of events is as follows: Eheumatism, gout, venereal 
disease, alcohol, lead poisoning, resulting in weakened patches in the brain 
arteries; a brittle area in a brain artery breaking under strain; outpoured 
blood tearing brain substance to pieces; paralysis from injured brain tissue. 

The effective prevention of apoplexy lies in shielding the arterial walls 
from infection and mild poisons during the earlier years of life. Therefore 
the apoplectic looking for the cause of his condition must have his mind run 
back to the social history of his childhood, youth, and early manhood. 

The usual story told by one who has had a stroke is as follows: For 
several days he had been feeling tense, with some tendency to vertigo, and 
possibly a little nausea. The blood in his vessels and the tissues under his skin 

612 



CAUSE OF APOPLEXY 613 

were under about as much pressure as they could withstand. There came a 
little change in position, a stooping, a little extra exertion, a vomiting spell, 
and — the weak place snapped. 

If those having brittle arteries would recognize these tension warnings 
and take a laxative, eat lightly, and keep quiet until the vertigo and "bilious- 
ness" had passed, they would prevent the break — at least many would. 

It takes nothing from the force of the first statement to say that a man 
who has lived wrongly and finds himself with brittle arteries can still be fairly 
successful in warding off apoplexy by temperance in emotion, excitement, 
work, straining, eating, and drinking. Nor does it make any difference that 
a tendency to gout and rheumatism runs in families; that some men are of 
apoplectic strain and others not. The man of a consumptive strain can afford 
to take chances by gormandizing; the man of a gouty or rheumatic strain 
cannot. 

CAUSE OF APOPLEXY 

The blood vessels of young people are very elastic. Their walls are 
largely composed of tissue having the quality of rubber. Such vessels do not 
break easily. 

The wear and tear of life consumes this elastic tissue and causes it to be 
replaced by inelastic tissue. The "give" is lost, but the result is not a 
tendency to break. The worn man tires easily, is short winded, does not re- 
cuperate easily, has less than the normal reserve strength; but he does not 
have apoplexy. 

The deacon's one hoss shay was as good in one place as in another. When 
it broke, it went all to pieces. 

The man subject to apoplexy is not like the deacon's one hoss shay; he is 
bad in spots. 

In his blood vessels are islands in which the live tissue of the vessel wall 
has been destroyed and removed and replaced by lime stones, called lime plates. 
Around the edge of these plates is an "easily broken" zone. 

"Miscondition," the doctors call atheroma. Whenever in a man with 
atheroma the blood pressure exceeds the breaking point in these weak areas, 
a break occurs. If the break is in a brain blood vessel the result is apoplexy. 
Sneezing sometimes acts as a cause. A sudden jump in pressure and the 
vessel breaks. Straining from any cause is liable to produce the same effect. 

However, apoplexy induced by coughing, sneezing, stooping, violent emo- 
tion, and so forth is the exception. The blood vessels are well protected from 
outside influences. 

The rule is that the stroke comes in times of physical and mental calm. 
Usually there is a history of several days of slight disturbance of digestion 
and slight vertigo preceding the stroke. 

Many who know their family tendency to apoplexy accept these signs as 
premonition and take a purgative. Some stop eating as a precautionary 
measure. These are proper procedures. 

The trouble is not with the digestion primarily. Observations on blood 
pressure have shown that there is a progressive rise in blood pressure. The 
indigestion and vertigo are the direct effects of the high pressure. 



614 APOPLEXY 

To take a laxative and refrain temporarily from eating is both right and 
wrong. 

It is right in that it gives temporary relief. It is wrong in that it em- 
phasizes the digestion unduly. The moderation in eating for a day or two 
will probably be followed by systematic overeating. 



WARNINGS AND PREVENTION OF APOPLEXY 

What can a man who belongs to an apoplectic family do to prevent a 
stroke ? 

What can a man who has had one stroke do to prevent a second? 

As a man who belongs to an apoplectic family approaches the apoplexy 
age, he should have his blood pressure taken once a year. If he finds that 
his blood pressure is more than 20 per cent above the normal for his age, he 
should map out his life in accordance with the facts. Thereafter he should 
go to a physician for a physical examination, including a blood pressure test, 
at least twice a year. 

If the pressure warrants it, he should purchase a blood pressure apparatus 
and take his pressure at periodic intervals. A pressure apparatus is inex- 
pensive. It is not difficult to use. No great technical skill is needed. A man 
of fair intelligence can learn to use it in two lessons. 

Apoplexy is preceded by two warning signs. One of these is dizziness; 
the other is rise in blood pressure. Ability to use a blood pressure apparatus 
makes the second of these warning symptoms available. 

An apoplexy warning having been recognized, the indications are clear. A 
saline purge should be taken at once. This should be followed by a dose of oil 
or calomel. The reason for reversing the usual order is that quick action is 
needed, and salines act quickly. A person with whom a saline does not act 
quickly should take an enema. 

The diet should be very light for several days. The digestive organs 
should be given a partial rest. The system should have an opportunity to use 
up some of the excess nourishment stored up in the liver and elsewhere. 

No tobacco should be used. Tobacco raises blood pressure. Even heavy 
tobacco users should "lay off the weed" until the vertigo period has passed. 



FORMS OF PSEUDO-APOPLEXY 

A number of years ago Weir Mitchell wrote about nocturnal hemiplegia. 
This disease is not apoplexy, but those who have it are usually much afraid 
of apoplexy. The patient wakes up at night to find that one leg and one 
arm or both legs are numb and cannot be moved. After a few minutes of 
rubbing, the symptoms pass away. 

To prevent the attacks from coming back two things must be done : Take 
a purge and afterwards carefully regulate the diet, especially the evening 
meal. The amount of coffee and tobacco should be lessened. The second is to 
get a better bed. If the mattress has been hard, get a softer one. If an 
exceedingly soft mattress was used, get a harder one. Certain nerves have 



FORMS OF PSEUDO-APOPLEXY 615 

gone to sleep because of pressure. This, however, is much more liable to 
happen in one who has been eating improperly. 

Another condition which frightens people who are dreading apoplexy 
is night cramps in the calves. Night cramps are not related to apoplexy. 
They are not forerunners of apoplexy. 

One who has night cramps should regulate his diet. Especially should he 
cut down on tobacco and coffee. He should also change his mattress so that 
he will not suffer from pressure. Night cramps are the result of lowered 
blood supply to the cramping muscles. 

Not Apoplexy Sign. — M . H. W. writes : "What should one do to avoid 
cerebral hemorrhage? I have had an ache at the base of my brain for 
some time. When I turn my head suddenly it causes pain there. I 
understand the symptoms are those that -precede cerebral hemorrhage, and, 
if possible, I wish to avoid having it." 

Reply. — To avoid cerebral hemorrhage, keep the bowels open well, eat 
lightly, refrain from vomiting, or any other physical act or any emotion 
which increases blood pressure in the arteries of the brain. These precau- 
tions are for those whose arteries are brittle, and liable to break under 
strain. Pain at the base of the head increased by suddenly turning the 
head is not a sign of threatened apoplexy. It bears no particular relation 
to apoplexy. 

Due to Apoplexy. — 8. R. T. writes: "1. What is paralysis? 2. What 
causes it? 3. Can it be prevented? k- Is it hereditary? 5. Can a man 
survive four strokes? I am troubled with dull pains in my lower limbs, 
numbness in my hands and feet, cold shin, dizziness at times, especially 
when stooping, dull pain at times in bach of neck." 

Reply. — 1. I judge from question 5 that you have in mind the most 
frequent kind of paralysis — that which is due to apoplexy. In apoplexy a 
blood vessel in the brain breaks and blood flows out — a clot forms. This 
hemorrhage destroys certain nerve centers. The nerve centers usually 
destroyed are those of motion for a hand and leg. These limbs immediately 
become paralyzed and remain so until they come under the partial control 
of other nerve centers. 

2. The arteries are made brittle by contagion in childhood, or rheu- 
matism, or venereal disease, or lead poisoning, or overeating. They break 
from high pressure. 

3. Yes, by preventing the cause. To prevent it, care must start in 
childhood. 

4. In a certain sense — yes. There are "apoplexy'' families. These are 
families in which members like to live high or have a tendency to heart 
disease, Bright's disease, or sclerosis. 

5. Yes, he can, for there is no magic in numbers. But when a man's 
arteries have broken four times, the inference is that they are about worn 
out. Numbness and pains in the legs do not mean impending apoplexy. 

Meat and Apoplexy. — J. E. B. writes: "Does the eating of beef, pork, 
or mutton induce paralysis? Should one eat much after Ifi years of age? 
Why are the sanitaria eliminating the use of meat with the paralytics?" 

Reply. — Eating large quantities of pork, mutton, or beef has some 
tendency to produce apoplexy. Apoplexy follows a break in one of the 



616 BLOOD PRESSURE 

arteries of the brain. The arterial wall does not break until it is first 
diseased. 

The most important cause of disease in the arterial wall is syphilis. I 
should say that lead poisoning is second. Alcohol and tobacco operate 
somewhat in injuring the wall and somewhat by increasing the blood 
pressure. A high protein diet is a factor and a prominent one. That 
means habitually eating heavily of meats. Habitual overeating of foods 
in general also causes it. Dr. Wedekind holds that eating foods that con- 
tain too much sodium chlorid (common salt) and other salts and drinking 
hard waters is another cause. 

I have the impression that you are going off on a tangent. Excessive 
meat eating is an important cause, but you may exaggerate its importance. 






CHAPTER XXXVI 



Bright's Disease 



A hundred years ago an English physician, Dr. Bright, discovered that 
albumin was present in the urine of certain patients who had dropsy. He 
came to the conclusion that the cause of dropsy was an inflammation of the 
kidneys which caused albumin in the urine. The disease came to be known as 
Bright's disease. Since that time every form 
of inflammation of the kidney has been loosely 
called by that name. In some of these inflam- 
mations there is a high percentage of albumin 
in the urine ; in some there is none at all. 

Ordinarily men judge of their condition 
by symptoms. If they have aches or pains or 
fever or cough or difficult breathing they think 
they are sick. If they have none of these they 
think they are well. When Bright wrote about 
the disease which bears his name he had in 
mind the people who had the symptom dropsy. 
But when the name came to be applied to all 
forms of inflammation of the kidney it was 
found that in some of them there were no symp- 
toms except albumin in the urine, and people 
generally never thought of that as a symptom. 

In no other disease is the unreliability of 
symptoms as a guide better shown than in 
Bright's. Most of the people who have Bright' s 
disease have none of the ordinary symptoms 
which cause us to think ourselves sick.' To this 
statement another should be added. There is 
no way to be on guard against Bright's disease 
except to have the urine examined once or twice 
a year. 

When people began to hear about Bright' s 
disease most of them learned of it as a disease 

which steadily grew worse and invariably caused death. There is variety in 
Bright' s disease. There are varieties in which there are few symptoms and, 
especially worth noting, in which there is little tendency toward a fatal ter- 
mination. 

The object of this article is to teach people that when one case called 

617 




Fig. 213. — Method of Collect- 
ing a Sample of Urine from 
a Male Baby. 



618 



BRIGHT'S DISEASE 



Bright's disease does not act like some other case the doctor has not made a 
mistake in diagnosis. The diseases are different, though they go by the same 
name. 

With it there goes another lesson. There are no kidney cures. The so- 
called "cures" have no power to cure inflamed kidney tubes. 

Then why do people buy and take medicines of this sort? Often it is 
because they have heard of some case which had Bright's disease, or thought 
he had it or was told he had it, and took one of them and got better. 

While there are no patent medicines or domestic roots and teas which 
cure Bright's, there is no other disease in which carefully regulated 
living accomplishes so much. Most cases of Bright's get well. Many go 
through life fairly efficient and fairly safe. In a proper sense Bright's disease 
is a curable disease. The cure is early diagnosis, followed by right living. 



WARNING OF BRIGHT'S 



The Human Factor informs us that in 1914 100,000 people died of 
Bright's disease in the United States; that the death rate from this disease is 
increasing rapidly, 72 per cent in the last twenty years and 23 per cent in 

the last ten. The greatest rate of increase noted was 106 

per cent in Richmond; the 

smallest, 16 per cent in San 

Francisco. Some increases in 

percentages were: Boston, 22; 

Chicago, 47; Memphis, 50; 

Denver, 36. 

Human Factor says that 

60,000 of these 100,000 lives 

could have been prolonged sev- 
eral years, and many thousands 

could have been saved had the 

disease been discovered in its 

early stages. 

The increase for a state 

was highest in New York, 132, 

and lowest in Montana, 52. 

This refers to the registration 

area. The states not in the 

registration area have no way 

of knowing what is happening 
The Tcidney is an exceedingly vulnerable organ, 
hind is nearly certain to cause some Bright's disease. This is especially 
true of pneumonia, scarlet fever, diphtheria, and rheumatism. In addition, 
overeating, overdrinking, and overworking put the kidneys under great 
strain. 

Whatever the nature of the overload, the organ carries it as best it can. 
When the strain is too great and the kidney gives down under it there is no 
pain, no ache, no complaint of any character. Albumin and casts appear in 




Fig. 214. — Test 
Tube Used in 
Testing Urine 
for Sugar and 
Albumin. 



Fig. 215. — Half a Kidney 
Showing Suprarenal 
(or adrenal) Kidney 
Structure, Pelvis of 
Kidney and Ureter. 



to their people. 
Severe illness of any 



ACUTE BKIGHT'S DISEASE 



619 



the urine, but a laboratory examination is required to snow it. Swelling of 
the feet, puffiness under the eyes, short wind — these speak for the kidneys, but 
the disease has progressed far before they show themselves. The kidneys do 
not complain. 

To warn their people in time one life insurance company will make an 
examination of the urine once a year for any person who has been insured 
with it three years. If the party insured is in one of the company's central 
points a physical examination also will be made. 

This type of service was begun by another company a year or two ago. 
It is spreading. Other companies are adopting it. A life extension institute 
has been organized to make the same sort of service available for any life in- 
surance company or any organization desiring it. Treatment is not the object 
of this service. Its object is to discover organic diseases in their beginning 
stage. 

The man who thus discovers that he has an organic disease in its early 
stage may be able so to change his habits as to cure his disease. In the great 
majority of cases he can prolong his life five years or more by changing to a 
thoroughly hygienic method of living. Medical service can promise much 
when the trouble is just unfolding. 

The insurance companies feel that people past middle life are neglected. 
Health departments have not been mucli interested in the welfare of this 
group. The work inaugurated by the companies for their policy holders will 
eventually be furnished by health departments to all the people. 



ACUTE BRIGHT 'S DISEASE 



Acute Bright' 's disease frequently results from an infection. The effect 
elsewhere in the body may be slight, yet the poison may set up an inflamma- 
tion of the Tcidneys. On the 
other hand, the infection may 
be profound in its effect on 
other parts of the body, yet the 
kidneys may escape. 

While any type of infec- 
tion may cause acute Bright's 
disease, some are much more 
prone to do so than others. 
Scarlet fever and pneumonia 
infections are trying on the 
kidneys; common colds and 
typhoid fever are not. Acute 
rheumatism, though it is ac- 
companied by highly acid, 
highly colored, and greatly con- 
centrated urine, is not likely FlQ - 216.— Bed Grapple. 
to set up an acute Bright's. 

Occasionally an acute Bright* s disease is spoken of as being apoplecti- 
form, meaning a person previously well is suddenly and violently stricken by 




620 



BRIGHT'S DISEASE 



unconsciousness or convulsions, or both, as the result of an acute developed 
Bright's. That way of oncoming is exceptional. The usual method is subtle : 
A child sick with scarlet fever is not doing so well as it should; it is difficult 
to see just what is the trouble; a chemical and microscopic examination of 
the urine shows albumin, casts and probably blood present. 

The teaching of all this is that in any condition which throws a strain 
upon the kidneys the urine should be examined as a matter of routine. It 
should be done as systematically as taking temperature, counting of the 
pulse, or looking at the tongue now is. 

I do not mean that it should be done several times a day. The frequency 
should be determined by the disease and by the other indications — in scarlet 
fever and pneumonia every day, in typhoid once a week, in tuberculosis (and 
pregnancy) once a month. 

It should be done for the same reason that a trackwalker walks a rail- 
road track or a man comes around and taps the car wheels at every division 
point. In cold weather the greater the need that the trackwalker watch 
closely for broken rails, the greater the need that the wheel tapper listen well 
for cracked wheels. The wheel tapper usually finds the wheels all right, and 
not every broken rail causes an accident. These results are arguments for 
and not against track inspection and wheel tapping. 



INFECTION OF THE KIDNEYS 



The kidneys are loosely connected with the tissues which surround them. 
In consequence infection of the spine (Pott's disease), or of the muscles 

(psoas abscess), or the peritoneum (peri- 
tonitis) — all near-by structures — seldom 
spreads directly to the kidneys. Around 
each kidney is a tense, almost impene- 
trable capsule which shields it from the in- 
fections of its neighbors. 

Infection can travel to the kidney by 
the blood stream and up the ureters from 
the bladder. The most frequently infect- 
ing organism is the colon bacillus, the or- 
ganism which, so long as it stays in the 
large intestine, is nearly harmless. An- 
other one frequently found is the proteus, 
a germ which of itself is quite harmless 
but which ferments the urine and manu- 
factures a lot of ammonia which irritates 
and harms the kidney. 

Another important group is the 
ordinary pus cocci, which may have 
traveled to the kidney in the blood, 
but which usually have traveled from the 
bladder, in cases of cystitis, up to the kidney. Another of some importance is 
the tubercle bacillus. The Phipps Institute found Bright's disease frequently 




Fig. 217. A Human Kidney a Little 
More Than One Half Natural 
Size in an Adult. 



CHRONIC BRIGHT'S DISEASE 621 

present in the later stages of consumption, but that is a different matter from 
infection of the kidney with tubercle bacilli. Tuberculosis of the kidney is 
usually unassociated with consumption. 

Gonococcus infection rarely travels to the kidney. Sometimes it does, but 
in most infections of the kidney, following a gonococcal infection elsewhere, 
complicating bacteria are responsible. 

Whether or not a person is to get an infection of his kidney depends 
largely on himself, and that is the reason for this article. A large group 
of the cases is due to the use of dirty catheters and other dirty instruments — 
not dirty in the sense that a garbage can is dirty, but laden with enough 
bacterial life to infect the bladder or the urine in the bladder, whence the 
infection travels to the kidney. Especially are men with enlarged prostates 
liable to forget at times 
the necessary precau- 
tions during the years 




of continuance of the 
condition. Eternal vigi- 
lance is difficult when 
the need is drawn out Fig. 218.— Head Coil. 

for ten to thirty years. 

Osier's " System" says : "It is advisable to give plenty of water in severe 
febrile diseases, in pregnancy, and in the latter case to insist upon a certain 
amount of rest in the prone position, and in addition to this, as in all other 
conditions, to build up the patient's general health, avoiding above all things 
constipation. ... It is therefore important to avoid all irritating drugs, to 
use the greatest care in the use of instruments, to avoid introducing infection 
or producing trauma, to treat with care and promptness all cases of cystitis and 
gonorrhea, to remove if possible all causes of stasis, such as strictures, prostatic 
enlargements, and stone ; ... to use large quantities of water." 

The quack medicines so widely advertised and so widely used for a certain 
infection can be classified as irritating drugs, such as copaiba, cubebs, sandal- 
wood, and turpentine. 



CHRONIC BRIGHT S DISEASE 

The man who has gouty kidneys suffers no pain and does not feel very 
different from the ordinary man. He is a little short winded, but to him that 
does not mean much, because most of those who have it are old enough to be 
slowing up. It follows that the condition is frequently discovered by accident 
— a urine examination for life insurance, for an operation, or for some pur- 
pose and, presto ! albumin and casts are found. A few years ago a famous 
teacher in Tulane, demonstrating to his class, discovered that he had ad- 
vanced and advancing Bright's disease. 

" Bright' s disease of the kidneys" is 'about as indefinitely used as "catarrh 
of the head." It includes an acute inflammation of the kidney due to an acute 
infection of the kidney, which, like a pneumonia infection, runs a short, sharp 
course and terminates in death or in recovery. A progressive form is one in 
which there is much dropsy, while the chronic, or gouty, form, which causes 



622 



BKIGHT'S DISEASE 



few symptoms, but does not improve, has little tendency to kill. Where it 
causes death, it makes a fatal disease out of an otherwise mild infection, such 
as colds, bronchitis, pneumonia, typhoid fever. It is insidious. It is the pun- 
ishment for years of wrong living. It shows full meals, nutrition out of bal- 
ance, constipation, lead poisoning, venereal disease; bad colds, pneumonias, 
contagious diseases. Neglect before fifty means Bright' s disease afterward. 

A great many people are interested in how to live with Bright' s disease, 
for it is a condition, not a disease. 

Osier, writing of some cases of chronic Bright's disease of which he had 




Fig. 219. — Cold Water Coil Applied to Abdomen. 



known as living twenty years with the condition, sums it up by saying that 
the man with chronic Bright' s disease is no longer No. 999 drawing the Em- 
pire State Express, but is a dinky switch engine. If he will allow the Bright's 
disease to teach him temperance it will be an advantage and not a disad- 
vantage. 

The man who keeps his shin warm, eats temperately , avoids excesses, 
avoids colds and other infections, will live to a comfortable old age in spite of 
his crippled kidneys. 

Some day it will be the custom for men who think themselves well to have 
a complete examination at stated intervals — to take stock— and then govern 
their lives in accordance with the findings. This means efficiency as well as 
security. Efficiency and security are the watchwords of the health movement. 



CHRONIC BKIGHTS DISEASE WITH MUCH ALBUMIN 623 



CHRONIC BRIGHT'S DISEASE WITH MUCH ALBUMIN 



There is a form of Bright' s disease characterized by much albumin, many 
casts in the urine, and by a marked dropsy. The dropsy in Bright's disease 
usually shows itself by puffiness under the eyes. This puffiness comes on before 
swelling of the feet appears. From the loose tissues under the eyes the water 
logging process extends, first involving other loose tissues and finally becoming 
universal. 

Frequently this kind of Bright's disease goes hand in hand with related 
changes in the heart 
and liver. The heart 
muscle becomes weak 
and flabby and the 
liver swollen and pale. 
This group of moder- 
ately progressive cases 
acts as if some fairly 
active cause were car- 
ried around the body 
by the blood, poisoning 
all of the delicate tis- 
sues with which it 
came in contact and 
slowly destroying some 
of the most necessary 
of the body tissues. 

Many causes oper- 
ate to bring about this 
disease. Drink is one 
of them; others are 
lead and mercury pois- 
oning and the differ- 
ent varieties of vene- 
real disease. Bakers, 
butchers, and icemen 
have more than their 
share of it, because 
they work in damp 
places, some of which 

are too hot and some too cold. Underground and cellar workers of every 
sort get more than their share. But the most important cause is consump- 
tion. About one-fourth of all the cases occur in connection with consump- 
tion. 

Within the last few years it has been the custom to restrict the amount 
of salt given patients with this form of Bright's disease. 

A few years ago Fischer wrote an interesting book on the reasons why 
water sometimes soaks into the tissues in too great quantity. In other words, 
why dropsy occurs. His conclusion was that in such cases there was too much 




Fig. 



220 — Arrangements for Prolonged Bath. 
used in sunstroke, fevers and alcoholism. 



To be 



624 BEIGHT'S DISEASE 

acid waste or ash in the tissues; that the tissues, instead of burning com- 
pletely, as they should, made slag or something corresponding thereto, and if 
there were plenty of oxygen this was not so liable to happen. 

One of the practical applications of this discovery of Fischer's is that we 
decrease the amount of swelling in the milder conditions of dropsy if we give 
the patient plenty of fresh air. This is why these patients do so much better 
in the open air than in tightly closed, badly ventilated hospital wards — those 
of the old type. For the same reason in part these patients do better when 
they go South for the winter, assuming that they stay out of doors when they 
get there. 

Another practical suggestion is that, by the use of a solution of salt and 
soda, the edema can be materially reduced. However, this last is not of much 
importance since it strikes at the effect rather than the cause. 

We do not know how to strike at the cause after the disease is estab- 
lished. About all we can do is to protect and shelter the vital forces, keeping 
the patient as comfortable as possible, meanwhile hoping that this particular 
case may be one of those relatively few when nature seems to be able to arrest 
the progress of the disease. 



VERY SLOW BRIGHT 'S DISEASE 

Brault speaks of this form of Bright's disease as nephritis from slow 
poisoning. It is the kind that develops in people at and after middle life. 
That form causes but little dropsy. There may be some puffiness around the 
eyes and, later, a little swelling of the feet, but there is seldom much dropsy. 
The urine is pale in color, copious in quantity, low in gravity, contains but a 
trace of albumin and only a few casts. Sometimes there will be long intervals 
during which there is no albumin and no casts. 

It is caused by gout, alcohol, overwork, worry, overeating, lead poisoning, 
and venereal disease. It is the disease of the bon vivant. Usually the cause 
is some mild poison scarcely detectable as a poison, some chemical substance 
which wears just a little more than the average but which just keeps on wear- 
ing until a condition is brought about at fifty which would be about normal 
at eighty. 

Water falling drop by drop on a stone will wear a hole, yet if one were to 
judge from the force of the fall of any one drop, he would say so insignificant 
a force could never channel through solid rock. But mild irritations, long 
continued, bring senility a few decades before it is due. 

Another group of cases stands for the scars of acute infections, especially 
in childhood — such infections as scarlet fever, diphtheria, and pneumonia. At 
the time of the original illness kidney cells were destroyed and scar tissue 
started to grow. This scar tissue did no particular harm until, having grown 
old and firm, it contracted and thus puckered and squeezed the kidney sub- 
stance. 

Several years ago Osier wrote an article on "The Advantage of a Few 
Casts and a Little Albumin." A Canadian statesman who had been pro- 
nounced incurably sick with Bright's lived a useful life, though a very tern- 



KIDNEY OF PKEGNANCY 625 

perate one, for twenty years after Osier pronounced his sentence. Several 
other cases were cited. 

A man in good health whose tissues have the spring of youth can overeat 
or overdrink or work in lead and not feel the effect for a long time, possibly 
never. There is about it a certain element of gamble. A man with a chronic 
Bright's must behave himself. He has no option. For him to play the game 
is about the same thing as sitting in where the other fellow has the cards 
marked. There isn't even a gambler's chance. 



KIDNEY OF PREGNANCY 

Women with Bright's disease are liable to become pregnant. The progress 
of the changes in the kidney when Bright's disease was present before preg- 
nancy occurred is different from that when the kidneys were in good condition 
at the beginning of pregnancy. 

Pregnancy occurring in a woman with a preexisting Bright's disease is to 
be watched more closely than where the kidneys were normal to begin with. 
But, watched closely, there is an excellent chance that the woman can be car- 
ried through without accident. Of course, albumin and casts in the urine of 
a woman with a preexisting Bright's disease does not indicate that she is being 
harmed by her pregnancy, as does this sign when Bright's disease was not 
present to begin with. When the pregnancy has caused the albuminuria, it 
means that the task on the kidneys is too great. If the albuminuria existed 
first, the kidneys may be standing the strain without trouble. 

Every woman should have a urinalysis made soon after pregnancy is de- 
termined to discover whether she has Bright's disease or not. At that early 
stage one can be certain that sound kidneys are equal to the extra burden of the 
pregnancy. If albumin and casts be found and further examination confirm 
the existence of a Bright's disease, during the rest of the pregnancy the woman 
must be watched closely for evidence that her kidneys are not failing to do 
their work, and everything possible must be done to lighten the kidney load. 

Women who start out with good kidneys not infrequently develop what is 
known as the kidney of pregnancy. Some writers think the great change from 
the usual routine in the machinery within the abdomen causes bacteria to be 
absorbed from the intestines and that these, being excreted by the kidneys, 
cause the kidney of pregnancy. Some think the pressure of the heavy uterus, 
supplemented by the weight of the child, is responsible for the kidney con- 
dition. 

The great Virchow, the father of pathology, brought prominently forward 
the theory generally accepted now. It was that pregnancy put a fearful strain 
on the kidneys of the mother. There is the waste of the baby — and rapid 
growth means much waste — the waste of the rapid pregnancy changes in the 
mother and the usual daily waste — all to be got rid of, and much of it by 
the kidneys. This theory is that the toxins overload the organs and the kidney 
of pregnancy develops. 

Usually the first suggestion that the condition is present comes in the 
shape of a laboratory report. Albumin and casts have been found where no 
particular symptoms suggested things were not going right. Sometimes head- 



626 BBIGHT'S DISEASE 

ache, dizziness, sleeplessness suggests that something is wrong, and urinalysis 
shows what the trouble is. Sometimes there is but little albumin and casts are 
quite abundant — so abundant that they will not be overlooked by even the 
most superficial examination. In fact, many families provide themselves with 
a test tube and some nitric acid and do their own routine testing. 



ALBUMINURIA IN PREGNANCY 

When albumin is discovered in the urine during pregnancy the woman 
must be watched closely. In the first place an effort should be made to decide 
whether the kidneys were sound when the pregnancy began. The history, the 
condition of the heart and blood vessels, and the presence or absence of changes 
in the retina will usually settle this question. 

If it be found that Bright's disease preceded the pregnancy, then one must 
judge of the ability of the diseased organ to withstand the strain. The evi- 
dence of albumin in the urine does not mean that the kidney is not standing 
up. If it be found that the albuminuria has developed after the pregnancy, 
then its presence means that the kidneys are not wholly up to the demand, and 
the question then to decide is whether they can be nursed along. 

This question cannot be decided at once. It must be held open and close 
watch be kept on the quantity of urine, the amount of albumin, casts and blood, 
and the evidence of intoxication in the patient — headache, dizziness, sleepless- 
ness, and dimness of vision. The degree of dropsy must be closely watched. 
If the mother can escape convulsions the chance, that both she and her baby 
will escape is great. If she gets convulsions the mother will recover three 
times out of four, but the baby will not fare so well. 

The later kidney effects do not seem to be especially bad. If the woman 
recovers there does not seem to be the same trail of chronic Bright' s disease 
that we get after scarlet fever and rheumatism. 

The preventive treatment is much a matter of being on guard — watching 
for a little puffiness of the eyes or feet, a little albumin or casts, headache, rest- 
lessness. 

Dr. Herrick says, in Osier's "System," "The prejudice of even the civilized 
woman against ordinary cleanliness of the skin because of fear of catching 
cold, her aversion to exercise, particularly in the later months of pregnancy, 
and especially in the open air, the frequent obstinate constipation, the faulty 
performance of function on the part of the stomach, sluggish action of the 
kidneys — these are some of the explanations offered for the accumulation of 
an undue amount of toxic material in the blood of the pregnant woman, which 
substance may harm the delicate renal parenchyma." 

The items embodied in the above collection suggest measures for the pre- 
ventive treatment of the kidney of pregnancy. Of greatest importance is the 
prevention of constipation. It is a little too much to ask the kidneys, already 
doing work for mother and child, to take up the work of the bowels in ad- 
dition. 






BKIGHT'S AND DIABETES 627 

TO TEST URINE FOR BRIGHT 'S DISEASE 

There are needed : 

A test tube, 

An alcohol lamp, • 

Some strong nitric acid (white), 
A medicine dropper. 

About a half-inch of nitric acid is placed in a test tube. The acid is gently 
warmed over the lamp. It must not be boiled. With the medicine dropper 
a half -inch of urine is carefully run on top of the warm acid. If a white band 
forms at the junction line of the two fluids, albumin is present. If albumin 
is found its presence should be verified by a laboratory. 

This test does not show casts. Albumin may be present from some cause 
other than Bright's disease. Bright's disease may be present where there is 
no albumin in the urine. These are the exceptions. The rule is that albumin 
in the urine means Bright's disease. 



BRIGHT'S AND DIABETES 

Most chautauquas give personal and public hygiene a place on their pro- 
grams. Many arrange for a daily talk on some phase of personal hygiene, 
since personal hygiene is of interest to so large a group of people. Becently, 
I attended one of these chautauqua talks on personal hygiene. The subject 
announced was "Diet in Belation to Disease." When the bell rang the audi- 
ence gathered from all parts of the grounds. It was a late afternoon hour 
and the proportion of women to men was about four to one. More than half 
the audience had notebooks, and they used them. 

When the lecture was finished, questions were fired at the lecturer from 
all parts of the hall. The questions showed that the audience had a fair 
grasp of the subject. The speaker had been trained in a low protein school 
and her teaching was based upon the theories which prevail there. Neverthe- 
less her first subject was the tea and toast meal of the unmarried woman. 

She told of calories ; what a calory is ; how many calories the body needs, 
and how toast fails to supply fully the need, while tea is used to whip the 
underfed, fatigued cells to do their work. 

However, the theme on which the lecturer especially dwelt was overeating. 
She emphasized the folly of taking more calories than the machine needs. Not 
only is it wasteful, but in time it brings about obesity, Bright's disease and 
diabetes. 

She told her audience of the insidious onset of both Bright's disease and 
diabetes. Neither had a single outstanding symptom, one capable of halting a 
careless person. But each had a symptom capable of arresting the attention 
of a careful person. The symptom of Bright's was albumin in the urine; of 
diabetes, sugar. 

The lecturer advised her hearers to make the simple tests required at 



628 BRIGHT'S DISEASE 

least twice a year. The only equipment needed is an alcohol lamp, a test tube, 
a little nitric acid and a little Haines' solution. 

To test for albumin an inch of urine is placed in the test tube, and 
brought to a boil. If the urine becomes cloudy on boiling, three drops of 
nitric acid is added. If the cloudy urine remains cloudy, it is due to albumin, 
and Bright's disease is present. 

To test for sugar, an inch of Haines' solution is placed in the test tube 
and brought to a boil. Then ten drops of urine are added. If the deep blue 
solution changes to a muddy yellow or reddish yellow, sugar is present, and 
the patient has diabetes. If either test indicates anything wrong, the person 
should seek medical advice. 

KIDNEY CURES 

The kidney cures have been popular frauds for years. The reason these 
compounds have sold is because they have traded on a popular belief. Our 
forefathers grew up on the idea that certain drugs were "good for the kid- 
neys." They thought asparagus and onions were good for the kidneys because 
of the odor of the urine after these vegetables had been eaten. They thought 
gin and juniper berries were good because of the large quantity of clear urine 
after one had tanked up on gin. Niter and sweet spirits of niter are other 
compounds that have had reputations as "good for the kidneys." 

Along came the patent medicine man and he traded on these old-fashioned 
notions. He called his medicine kidney cure and kidney medicine. He usu- 
ally advertised that his medicine contained juniper berries, asparagus, and 
other "yarbs" of repute. 

Probably the medicine did contain them. There must be some flavor, 
and these different roots and herbs are as cheap as anything. Gin is as good 
a solvent as other forms of alcohol, and the cost is not prohibitive. There- 
fore, why not make use of the advertising values of these traditional kidney 
remedies ? 

Now, what are the facts? Much the best kidney stimulant is water, just 
plain tap water. The amount of urine can be increased by digitalis, or niter, or 
gin, but it can be increased more and in a better way by talcing a few extra 
glasses of plain water. 

If one should drink gin and stimulate the kidneys to take an excess of 
water from the blood, he would be worse off therefrom until he had filled up 
the deficiency of blood by drinking water. 

Another excellent way to stimulate the kidneys is to permit the skin to 
get cold. If a man has any reason to feel that his kidneys should secrete more 
freely, he does not need to take a tablespoonful of kidney cure. Let him walk 
out of the office without his overcoat on any cold day; let him stroll a few 
blocks leisurely or stand on a corner until he gets chilled through. This 
"medicine" he will find much more effective than kidney medicine taken from 
a spoon. 

Of these two suggestions, the first is much to be preferred. The sug- 
gestions are offered those who take kidney medicine for "pain in the back," 
"heavy feelings" or "scant kidney secretion." 

If a person has any form of Bright's disease, it is because of some error in 



BRIGHT'S DISEASE TREATMENT 629 

his way of living, or because somewhere his machine is slipping a cog. Most 
cases of Bright's disease get well, at least for a time. Of those that are not 
recovered from, most are of such a nature that they can be lived with for 
years. 

A sensible person can usually round out a full life in spite of Bright's 
disease. The only cases of Bright's that are cured by these remedies are those 
that were cured in spite of the remedies. 

The treatment of Bright's that gets results is right living under intelligent 
medical control. 

BRIGHT'S DISEASE TREATMENT 

Some time ago we published (in the Chicago Tribune) a letter from J. E. 
Hardy in which he said that he had cured himself of Bright's disease. Many 
wrote asking for Mr. Hardy's address. We adhered to our rule and declined 
to give this information. However, we wrote to Mr. Hardy, requesting him 
to write out his method, that we might publish it for the benefit of many who 
had written. We have been compelled to abridge his letter. 

He writes, however, that he is willing to answer letters and submits his 
address. Letters sent to him must include stamped envelope; otherwise the 
burden would be unreasonable. Mr. Hardy resides at Victor, Colorado. 

Many cases of Bright's disease get well ; others live to a ripe old age. We 
are always liable to fall into errors when we draw conclusions as to all man- 
kind from one experience with one man. Mr. Hardy's temperance and right 
living are right. With some of his food ideas I cannot agree. 

J. E. Hardy writes : "About twenty years ago I was informed by a phy- 
sician who has since died of Bright's disease that I had that much dreaded 
malady and that I had only six months to live. There is no doubt that this 
diagnosis was correct because I had it confirmed by several physicians. The fact 
that I am alive and enjoying life, although I am past 54 years of age, speaks 
volumes for the methods I have used. 

"Dear reader, this article will mean little to you if you are unwilling to 
deny yourself. If you are determined to eat and drink various articles just 
because you enjoy their taste and you do eat these articles just to gratify your 
appetite, although you know they are injurious, then these suggestions are of 
little worth to you. Your health and future happiness depend on what you 
eat and drink and what you do not eat and drink, together with your manner 
of living. 

"Do not drink milk, cream, tea, coffee, cocoa, chocolate, beer, whisky, wine, 
hard cider, soda water, mineral water, or any fancy drink sold at a drug store 
or over a bar. Avoid all hard waters and waters impregnated with minerals 
and alkalis. Drink nothing but soft water. Eat all kinds of grains, such as 
wheat, oats (oatmeal), corn (cornmeal mush, corn bread), rice, barley, rye, 
flaxseed, boiled whole wheat, whole wheat mush, parched whole wheat mixed 
with flaxseed and ground. Whole wheat bread should be eaten at every meal. 
Whole wheat can be purchased at all seed stores and at most of the feed 
stores. 

"You can make your own whole wheat meal or flour by grinding whole 
wheat in your coffee mill, after having thoroughly washed the wheat and 



630 BEIGHT'S DISEASE 

letting it dry. This whole wheat meal makes excellent gems or bread. When 
prepared like oatmeal mush it makes an excellent and inexpensive breakfast 
food and is beneficial to those who are troubled with constipation. 

"Take equal parts of whole wheat and flaxseed. Parch this combination 
in a pan on the stove. When slightly parched grind in a coffee mill. Eat 
freely at your regular meals and you will have no more trouble with con- 
stipation. 

"Eat potatoes and all legumes, viz., beans, peas, lentils. Avoid canned 
beans; Mexican beans are preferable. Eat apples freely, uncooked principally. 
Eat figs if they agree with you. Nuts are permissible, provided they do not 
produce constipation. 

"Avoid all forms of animal foods, such as milk, butter, eggs, grease, 
oysters, meats, fats, glands, thymus, liver, sausage, cheese, gelatin, fish, calves' 
foot jelly, and similar dishes. 

"By avoiding the following articles of food, which contain oxalic acid, you 
will escape uremic poisoning and those sick spells: Spinach, sorrel, lettuce, 
rhubarb, cabbage, turnips, olives, gooseberries, currants, plums, strawberries, 
raspberries, grapes, cranberries, apricots, peaches, horseradish, olive oil. 
Avoid sugar and all sweets. If you must have some sweets experiment with 
pure maple syrup or saccharin as a substitute for sugar. Bananas should be 
avoided by most persons. 

"Avoid the use of pepper, salt, mustard, pickles, essential oils, spices, 
ice cream, flavoring extracts, catsup, and all condiments ; also all rich and indi- 
gestible pastries and cake. Avoid the use of tobacco in every form. 

"'Drink a glass of lemonade once or twice a week. When the kidneys are 
sluggish, drink corn water, which is made by boiling one cupful of common 
field corn in two or three quarts of water for five or six hours. 

"An absolute fast for one, two, or three days will correct these sick spells 
by giving nature a chance to throw off the accumulated poison in the system. 

"Eat three regular meals per day. Do not overeat. Eat at the same 
hour every day. Do not eat between meals. Do not eat late suppers. Eat 
slowly and masticate your food thoroughly. Do not drink more water than 
your natural thirst demands. 

"Keep the pores of your skin open by frequent baths, say two per week. 
One of these should be a hot steam bath, if possible. Bathe your feet fre- 
quently. 

"Sleep with your bedroom windows open every night during the year. 

"Keep your living rooms well supplied with fresh air. 

"Take plenty of outdoor exercise. Walk several miles each day. Com- 
mence your walking exercise gradually. 

"If you are dropsical I suggest that you live in a high, dry climate. 

"One who lives on milk and vegetables is not living on a strict vegetarian 
diet. I cut out milk many years ago. 

"Eice as an article of diet cannot be too highly recommended. Boiled rice 
is easily digested, and as it contains less alkaline salt than any other food, it 
does not overtax the kidneys. Be careful to use the unpolished rice, because 
the polished rice is coated with paraffin and talc, and, like white flour, has 
been robbed of its most health giving and nourishing qualities. 

"You may think this treatment is a strenuous dose. Well, possibly it. is 



BRIGHT'S DISEASE TREATMENT 631 

somewhat heroic, but remember you are playing for big stakes — life, health, 
and happiness. Is it not worth while? Give it a trial." 

Water and Bright's. — L. C. R. writes: "You have written a series of 
articles on the spring waters in this country. I would like to know whether 
you could tell me what is the best water for Bright's disease." 

Reply. — People with milder forms of Bright's disease generally get help 
from the free use of waters containing very little mineral matter, such 
as Chippewa, Poland, Waukesha, and Mountain Valley. People with the 
acute forms of Bright's disease are sometimes helped by the bitter purgative 
mineral waters. 

No water is a specific for Bright's disease or any other disease. The 
composition of the water is of minor importance as compared with the 
method of use of the water. We have better waters than those of the 
famous cures of Europe. Our hope of developing cures equal to those of 
Europe lies in the possibility that we shall learn that it is the method of 
use and not the chemical constitution of a mineral water which counts. 

Bright's Disease Diets. — C. R. writes: "Will you kindly let me know 
what to eat? I have Bright's disease. Will Hot Springs, Arkansas, 
cure me?" 

Reply. — I wish I could answer your question in detail and not mislead 
you a bit. I am afraid to try. 

Bright's disease is of several varieties, and the diet good for one is not 
good for another. If you have acute Bright's disease you should go on a 
very limited diet. The skim milk cure has helped some. If you have a 
form of chronic Bright's you must eat more in order to nourish your body, 
but still you must eat much less than does the average well man. Yon 
Noorden has a valuable little book on diet in Bright's disease. Suppose 
you get that. 

No spring water will cure you. The waters of some springs are of great 
service in the treatment of certain forms of Bright's, particularly the cases 
that have a good deal of albumin in the urine. Mountain Valley and 
Potash- Alum Springs, near Hot Springs, are good. 

Bright's Disease Ration. — 8. I. K. writes: "What diet should one take 
who has albumin, a symptom of Bright's disease? What is the best section 
of the country for one having Bright's disease, or endangered with the 
malady, to live in? Is it harmful for one having this disease to work 
indoors?" 

Reply. — 1. Eat what you please, but not so much as you please. Cut in 
half the amount of meat in your daily ration. Reduce the quantity of 
food other than meats one-third. Take no whisky nor beer. Be temperate 
in all things. Avoid getting wet or cold. Avoid infections of every kind. 

2. A warm, even climate, such as southern Florida, California, the 
Gulf coast. 

3. Not especially. 

Interstitial Nephritis. — L. C. M. writes: "1. What is interstitial 
nephritis? 2. Does blood pressure above normal and arteriosclerosis usually 
accompany this disease? 3. Is it slow or rapid in developing? Jf. Is 
apoplexy liable to occur from this disease if arteriosclerosis is present also? 
5. What are usually the last stages?" 



632 BRIGHT'S DISEASE 

Reply. — 1. The slowest form of Bright's disease. It is a mild, chroni« 
inflammation of the kidneys. 

2. Yes. 

3. It develops very slowly. While it is incurable, ofttimes it is without 
symptoms. Sometimes the symptoms are very mild. Often people with 
this disease live long and comfortable lives. 

4. Apoplexy in people with high blood pressure and chronic Bright's 
disease is rather frequent. 

5. Death is generally brought about by some intercurrent, acute disease, 
such as pneumonia or acute Bright's disease. The symptoms in that event 
would be those of the intercurrent disease. Death frequently is from 
uremic coma. Sometimes it comes with the symptoms of an advanced 
arteriosclerosis. 

To Avoid Uremia. — E. L. L. writes: "What foods should be avoided 
if there is a tendency to uremia?" 

Reply. — Overeating is much more important than anything else. A 
low protein diet is advised, one consisting largely of milk, buttermilk, 
cheese, fruits, and vegetables. The amount of meat and bread in a low 
protein diet is not over half that usually taken. 

Symptoms of Bright's Disease. — M. E. S. writes: "What are the symp- 
toms of Bright's disease? Is there a swelling of the kidneys, face, and 
eyes? Also the feet? Is there a certain diet for it? The person in ques- 
tion is only 18 years of age. For a time she seemed to be doing very well, 
but is now in a very serious condition. Probably it is not Bright's disease, 
but that is what we think it is. A doctor at one time said it was kidney 
trouble." 

Reply. — Examination of the urine shows the presence of albumin and 
casts. This is the best sign. Pumness around the eyes is often due to some 
other cause. At the same time it is one sign of Bright's disease. The 
same is true of swelling of the feet. 

Most cases of Bright's disease respond to change in living habits. 
In fact, right living is the only treatment needed in a fair proportion of 
the cases of Bright's. 

Dieting is an important feature of right living. The first essential of 
dieting for Bright's disease is never to overeat. The second is to eat 
simple foods. The third is to decrease materially one's consumption of 
savory meats — juicy steaks. The fourth is to cut the amount of protein 
eaten about in half. 

Try Dieting and Exercise. — H. E. B. writes: "What causes the albumin 
to go into the urine? Is it a sure sign of Bright's? What articles of food 
should be excluded? What is the best medicine to take? When the blood 
is poor from malaria and taking quinin, what is the best thing to take?" 

Reply. — 1. The albumin is held in the blood by the kidney cells when 
they are normal. When they are diseased some of the blood albumin passes 
through the diseased cells into the urine. 

2. No; it is, however, reasonably sure, and that is about' as much as 
we can say of anything. Sometimes albumin is present when there is no 
Bright's, and sometimes Bright's is present when there is no albumin. 

3. In chronic Bright's disease, be sure to eat enough nutritious food, 
but be sure not to eat too much. In acute Bright's eat lightly of meats 



BRIGHT'S DISEASE TREATMENT 633 

for, say, a month. Don't stop eating meat entirely in acute Bright's, and 
certainly not in chronic Bright's. 

4. Instead of relying on medicine, have your physician outline a plan 
of eating, exercise, and personal hygiene, and follow it. If you put your 
dependence on kidney cures, you for the scrap heap. 

5. Iron tonic, good food, and exercise in the open air. 

Loss of One Kidney. — H. J. C. writes as follows: "1, My brother, a boy 
of 18, has had one of his kidneys removed by a recent operation. Does this 
lessen the chance of his ever becoming strong and robust again? 

"2. A. C, aged 37, has for years been annoyed by a cough which comes 
on suddenly if he should sit in a draft or at an open window, or even out 
of doors at night, regardless of how warm the weather. During the winter 
months bedroom windows cannot be left open at night or he will cough 
most of the night. It is only at these stated times, however, that said 
cough puts in an appearance. From this information what would you say 
it was caused by? 

"3. What is glycerin made of? Have been using it on hands and lips 
at night, and have been told it is drying. Would it hurt a person if he 
took any quantity of it?" 

Reply. — 1. If the remaining kidney is sound, he should get as strong 
as the next man. A normal man has a great excess of kidney capacity. 
One healthy kidney is more than ample. 

2. A. C. coughs when, by reason of chilling of his skin, his outside 
blood pressure is lowered and his internal blood pressure is increased. If he 
will use more cover on his bed and wear more clothes when exposed to 
chilling, he will not have the coughing spells. In some way or other, the 
increased internal pressure on the skin reflexes irritate his bronchial tubes. 
In some cases it is thought the irritation comes from enlarged bronchial 
lymph glands which swell when the skin is chilled. 

3. I think usually from alcohol. It dries. By itself it is not good to 
take nor to put on the hands. In Arizona it is wise to grease the skin fre- 
quently with a grease gum mixture to which some but not much glycerin 
can be advantageously added. 

Tubercular Kidneys. — L. A. T. writes: "1. What is the cause of tuber- 
cular kidneys? 2. Would 'dope' produce a condition leading to this con- 
dition or an appearance of this condition?" 

Reply. — 1. Tubercle bacilli cause tuberculosis in the kidneys as else- 
where. Sometimes the bacilli get into the blood and are carried in that 
way to the kidneys. In this condition the tuberculosis is not limited to the 
kidneys, but is everywhere throughout the body. Sometimes the bacilli are 
carried to the lining of the kidney by the lymphatic tubes. In this variety 
of tubercular kidney no other organ is involved except those of the urinary 
tract. Ofttimes the disease involves but one kidney, the other being 
healthy. 

2. I should say no to each half of this question. 

Case Is Incurable. — New Subscriber writes: "I have a friend, J+6 years 
old, weighing 200 pounds. He has a good appetite, can eat anything cooked 
for him. He has suffered from Bright's disease for seven or eight years. 
His doctor ordered him to take Epsom salts or cream of tartar every fore- 
noon. He got tired of it and can't take it any more. He is constipated 



634 BRIGHT'S DISEASE 

all the time and has pain in the head and frequently in the back of his 
neck. He is restless at night and finds it hard to get his breath at times. 
He is always dull and sleepy. Would you tell me if his case is incurable, 
or what would you suggest?" 

Reply. — If his Bright's disease has lasted seven or eight years, he is 
incurable. At the same time by intelligent care and watchfulness you may 
succeed in keeping him alive and fairly comfortable for several years. 
The symptoms stated in your letter do not indicate that he is doing well 
now. You must keep his bowels and skin working well. As he can no 
longer take what he has been taking, use something more simple. Find 
something the effect of which he will like. 

Danger in Overeating. — A. B. S. writes: "I weigh 220 pounds and am 
about 5 feet 8 inches in height. At times I feel dumpish, am heavy eater, 
and work inside, drink some and smoke. At times I think I am troubled 
with liver, then again I think it might be Bright's disease; have large puffs 
under my eyes at times. What do they indicate ?" 

Reply. — Puffs under the eyes may mean Bright's disease. Urinalysis 
repeated in case the first is negative will tell you. A heavy eater who works 
inside is certain to overtax his liver or his kidneys or both sooner or later. 
Why not reform now ? 

Use of the Kidneys. — Constant Reader asks: "Why was the elaborate 
pumping machinery (the kidneys) put in the body, when, seemingly, all 
possible fluid is needed for flushing the colon?" 

Reply. — If all of the water separated from the blood by the kidneys 
was excreted into the colon conditions would be intolerable. The average 
man would be better off if he had a few ounces of additional water in his 
colon, but the pints excreted by the kidney would overdo things. The 
human machine, as nature makes it, is a very good article. That it goes 
wrong when man tampers with the works does not argue that it should 
have been made different. 

Stone in the Kidney. — N. L. G. writes: "Can stone in the kidney be 
cured? My doctor tells me I have one, and suggests an operation. To 
avoid this, what would you advise?" 

Reply. — Stone in the kidney cannot be cured, in the sense of removal 
of the stone, in any way except by surgical operation. Sometimes the 
symptoms disappear because the stone settles down quietly in a pouch or 
because an infection which accompanied the stone subsided. But the stone 
is there just the same. Follow your physician's advice. 

Gravel in the Urine. — M. A. C. writes: "1. What is the cause of gravel 
in the urine in a young woman 27 years old? She also has severe head- 
aches by spells. 2. Is the gall-bladder working all right? She has to take 
pills all the time to move the bowels. 3. What kind of diet should she 
follow to help her? She has pain in the bladder for quite a while now." 

Reply. — 1. Gravel in the urine is precipitated urates. After normal 
urine has stood for a while in the cold it precipitates urates. Some call 
this gravel. This phenomenon indicates nothing. When urates precipi- 
tate while the urine is in the kidney or the bladder the condition is called 
gravel. That is of consequence. If that is the condition drink more water 



BRIGHT'S DISEASE TREATMENT 635 

— several times as much as you now drink — and go to your physician for 
counsel. 

2. You do not give any symptoms referring to your gall-bladder. 

3. Eat an abundance of fruit and vegetables. Eat bran bread. Drink 
plenty of water. Exercise in the open air. 

Salt and Bright's Disease. — P. writes: "An article by an M. D. in a 

recent issue of The Cooking Club on the salt eating habit stated that the 
use of salt in the human system is deleterious, producing diabetes, Bright's 
disease, and heart troubles. He protested against its use in cooking. Is 
there any considerable school opposed to the use of salt? What is your 
own view of meat eating, as opposed to a strictly vegetarian diet?" 

Reply. — I do not think there is any considerable school opposed to the 
use of salt. In Bright's disease it is best to decrease the amount of salt 
taken with the food. Many physicians think so. My opinion is that a 
moderate amount of salt is a necessity. I believe in a mixed diet — one 
containing meat, bread, vegetables, and fruit. However, adults doing 
mental work require little meat. In summer little meat is required. 

Concerning Floating Kidney. — Subscriber writes: "Will you kindly 
answer the following: 1. What causes floating kidney in child of Ik, not 
adolescent? 2. Will this interfere in any way with periods? 3. Can float- 
ing kidney cause intense pain in kidney region, nausea, weakness? If.. Is 
it advisable to use X-ray to determine cause of pain, if it is felt that the 
kidney is not causing all trouble? 5. Is not use of X-ray a bad idea? I 
know, of course, it has value, but are not the effects on the individual 
deleterious? Have heard prominent physician decry use of it and wish 
to know. 6. Is gymnastic dancing advisable for one who has had two 
severe attacks of appendicitis?" 

Reply. — 1. Probably she was born that way. The tissue that holds the 
kidney against the back sometimes is so arranged as to permit that organ 
to move about. Movable kidney may be due to accident, to pressure from 
a corset, or to loss of flesh. 

2. No. 

3. Yes. The displaced organ sometimes kinks the ureter, causing pain. 

4. I don't think X-rays will give you any information. Physical exam- 
ination and urinalysis ought to be satisfactory. If not, a catheter can be 
passed up the ureter to the kidney. It is possible that X-ray of the ureters 
with the catheters in them might help. 

5. There are no bad effects unless there is a burn. Burns are exceed- 
ingly rare now. 

6. Yes. 

Osier on Floating Kidney. — G. W. writes: "My daughter has been 
troubled with a floating kidney. Will you kindly advise whether an opera- 
tion is necessary, and, if so, whether it is dangerous?" 

Reply. — Sometimes floating kidney calls for an operation. The opera- 
tion consists in fastening it to the back. Ninety-nine times out of one hun- 
dred it calls for nothing. Osier says people with floating kidney should 
never be told about it, since they thereupon commence having aches and 
pains, imaginary in character. 

Dropsy. — A. B. Z. writes: "1. What is the cause of dropsy? 2. Is 
there a permanent cure when a young person has had an attack where feet, 



636 BRIGHT'S DISEASE 

hands, and face were swollen? 3. Should a person marry who has had an 
attach of dropsy? J/.. Does it run in a family and can children inherit it?" 

Reply. — 1. Dropsy may be due to any one of several causes, the most 
important being kidney disease, heart disease, and liver disease. 

2. Probably, in the case suggested, the cause was kidney disease. Many 
such conditions pass away and there are no symptoms for years, sometimes 
never. The dropsy is a detail. The answer must depend on the condition 
of the kidneys. 

3. If the kidneys get in good condition, yes. However, the person af- 
fected should be frank with the intended. 

4. No. 

Kidney "Dopes." — K. M. S. writes: "I have been talcing kidney dopes 
for several years, with no good results. I always have a full feeling in the 
top of my head and a ringing sensation in my ears for several hours every 
evening, also my hair persists in falling out steadily. I am not lazy, but I 
find it so hard to take the least interest in anything." 

Reply. — Kidney dopes cannot possibly help you. If you have kidney 
disease, regulation of your life will help you, but kidney medicine certainly 
will not. You may have kidney disease. Find out through urinalysis. 
You may have profound anemia. Find out by blood examination. 

Blight's and Diabetes. — A. L. N. writes: "You state a warm climate, 
as in Tucson, San Antonio, and El Paso, is excellent for Bright's disease. 
Several specialists in this country claim there is no such thing as Bright's 
disease; that sugar sickness, called diabetes, is not a kidney disease. There 
must be some mistake. Diabetes, called sugar sickness, is certainly a kid- 
ney disease; it is not a stomach, liver, gall, or an intestinal malady. Dia- 
betes at a certain age is fatal, no matter what climate or what remedies are 
used; but after a certain age patients keeping a prescribed diet can live an 
unlimited time. A few years ago a friend of mine suffering from diabetes 
visited Europe, consulting Professor Erd in Germany, a prominent spe- 
cialist, who, after making an examination and telling him no medicine 
would be given, gave him a printed book informing him about his diet — 
what to eat and drink, and what not to eat and drink. In parting the pro- 
fessor told him that the cause of diabetes was unknown and that there is 
no cure for it. My wife had diabetes for about twenty-five years and lived 
strictly as to her diet, staying for many years at Waukesha drinking the 
water. She died here at 73. Still, a good deal depends upon the constitu- 
tion and good care patients receive." 

Reply. — The term "Bright's disease" is used loosely to designate inflam- 
mation of the kidneys. There are several different kinds of Bright's dis- 
ease, due to several different causes. They vary greatly in their symptoms 
and in the rapidity of their progress. 

Diabetes is a disease in which there is sugar in the urine. It may be 
due to brain or nerve disease, to disease of the pancreas, or to the eating of 
more starches than the body can burn up. 

It is not a kidney disease. The kidneys are simply doing the best they 
can to rid the body of sugar. Sometimes the hard work causes the kidneys 
to break down under the strain, but that is secondary. 

The disease is usually rapidly fatal in the young. In the old it is very 
mild. From the philosophical standpoint, it is about on a plane with 
obesity and is not much more serious. 



CHAPTEE XXXVII 



Digestion 



IMPORTANCE OF CHEWING FOOD 



Digestion begins in the mouth. It is essential to know that when 
the food has been retained in the month long enough to become thoroughly 
incorporated with the mouth juices an important part of digestion has 
already taken place. When the food is well chewed it becomes well mixed 
with the saliva and other mouth juices and this is one of the reasons why 
complete mastication of the food is necessary. 

Starch, for instance, is converted into sugar by 
the action of the saliva and this is one of the steps 
of digestion. If food be thrust into the stomach 
without being emulsified by chewing and the starchy 
substances of the diet converted into sugar before 
being swallowed the stomach is compelled to take on 
a duty for which it was not intended. 

That the stomach can and does take on and 
perform the functions of the teeth and the mouth 
for years without complaint does not refute the ar- 
gument in favor of chewing. It only indicates that 
the stomach is an organ of wonderful power and 
adaptability. It can and will for a time in addition 
to its other duties perform the function of the teeth 
and the mouth; but at last it gives out and the 
owner finds himself a victim of one of the forms of 
indigestion. 

There are other reasons why thorough mastica- 
tion is necessary. The longer the food is retained in the mouth and the 
longer it is chewed the more chance the taste nerves have to come in contact 
with it ; and when the palate is satiated the appetite is appeased and the desire 
for food is gone. The same mouthful of food retained in the mouth sixty 
seconds will go nearly as far toward satisfying the taste nerves as two mouth- 
ful s retained in the mouth thirty seconds each. 

Hence it follows that thorough mastication of food is a preventive of 
overeating and it may be said that overeating is one of the dietary sins of 
the age. 

The savory taste of food in addition to the motion of the jaws and 
cheeks facilitates the flow of saliva. It is necessary that the mouth juices 
be incorporated with the food while it is still in the mouth. 

All chewing of gum or other substances between meals creates an undue 

637 




Fig. 221. — Section of a 
Tooth Showing En- 
amel, Dentin and 
Pulp. 



638 



DIGESTION 



flow of saliva at a time when the salivary glands should be at rest. The 
result is a shortage of that necessary fluid when the next meal time arrives. 



PROCESS OF DIGESTION 

A man from whom the entire stomach has been removed can digest 
lean meat. The digestive and assimilative apparatus can convert lean meat 
into sugar. It can convert lean meat into fax. But muscle cannot be made 
from sugar and starch foods or from fatty food. 

When proteids whether from animal or vegetable sources are eaten 
digestion begins in the stomach. The mouth breaks the food up and the 

saliva moistens it ; but it is not 
until the gastric juice strikes 
it that digestion begins. 

The stomach is powerful 
as a mechanical mixer. Its 
juice converts proteids into 
acid albumin or syntonin, then 
into proteose; then some of it 
is changed to peptone. Then 
the mixture of syntonin, pro- 
teose and peptone is passed 
into the small intestine. The 
pancreatic juice changes the 
syntonin and proteose to pep- 
tones. This action is so power- 
ful that it has been found that 
the pancreas can wholly take 
the place and digest lean meat 
in a person who has no stomach. 
We have known for a long time that the stomach was not so important 
as it was thought to be in olden times. Its most important function is its 
gizzard function — its work as a mixing machine. Most people who think 
they have dyspepsia and stomach trouble have something else. 

The intestinal juice converts the peptones into amino acids. Now the 
work of digestion of albumin has been completed. The next step is absorp- 
tion. 

The amino acids are absorbed from the intestines and pass into the 
blood bound for the liver. They are carried from the liver to the different 
portions of the body. 

The different cells of the body in need of material for repair pick up 
what amino acid they need and use it to replace the tissue that has been 
worn out. 

The worn out tissue is changed into an amino body whereupon it dis- 
solves, enters the blood stream, travels to the liver and from there to the 
organs of excretion, principally the kidneys. 

On the way it is converted first into ammonia and then into urea. The 
conversion occurs in the blood and somewhat in the body cells. The con- 




Fig. 222. — The Three Salivary Glands. 



DIGESTIVE TEOUBLES 



639 



The filtration of the 




version of the ammonia into urea occurs in the liver, 
urea from the blood occurs in the kidney. 

This is what happens in the body 
of the cell. Every cell has a nucleus 
— the small directing head for the cell 
body. When the aminoacids replace 
the waste in the nucleus ferments con- 
vert the waste through several steps 
to form uric acid. 

This uric acid is carried by the 
blood to the muscles, the liver and 
the kidneys. A good part of it is 
burned up, destroyed by the muscles 
and the liver. 

The part not destroyed by these 
structures reaches the kidneys which 
filter it out of the blood. In the urine 
it may exist as uric acid or urates or 
substances closely related to uric acid. 



DIGESTIVE TROUBLES 



If one is afflicted with pain in Fig. 223. — The Jaws and the Teeth. 

the Stomach, distention, belching or 1, 2 incisors; 3, canines; 4 5, bicuspids; 

-,. , & 6, 7, 8, molars; a, vein; 0, artery; c, nerve; 

gas, colicky pains, SOUr stomach, SO- d, vein, artery, and nerve. 

called heartburn, or like maladies, 

the cause is usually some form of indigestion and is due to improper feeding. 
Few of these symptoms occur in the underfed but all of them may occur 

in those who are overfed. Too much 
food for one person may not be too 
much for some other person, as diges- 
tion is wholly an individual affair. It 
naturally follows that a food that has 
helped or harmed one individual may 
not so affect his neighbor. 

It is irrational to be careless in 
eating or to eat too much and then 
to take medicine or spirits to aid diges- 
tion. If a food cannot be digested 
without artificial aid it should not be 
eaten at all, or if eaten the quantity 
should be small enough to be within 
the digestive power of the diner. 

Some persons have lived to old age 
without any appreciable illness from 

indigestion; but they were persons of equable temperament, were robust to 

start with and practiced few indiscretions in eating or otherwise. 

Such instances are extremely rare, for most persons have more or less 




Fig. 224. — Baby Teeth, Except the Six- 
Year Molars. The six-year molars be- 
long to the permanent teeth 



640 DIGESTION 

trouble some time in their lives and very many have digestive troubles 
all their lives. Many ailments have their origin in faulty nutrition. Indeed, 
physicians know that most of those who consult them have no organic disease 
but suffer from the evil effects of errors of diet, overwork or bad habits 
of life. 

Different kinds of food produce different kinds of trouble but the first 
requisite bearing upon relief is to reduce the total quantity of food taken 
while the trouble lasts and to endeavor to determine the kind of food and the 
quantity that can be best borne with freedom from discomfort. 

Those suffering from a feeling of distention and the eructation of 
gas may have excessive fermentation in the digestive process. As sugar is the 
chief factor in fermentation it should be discarded or the quantity greatly 
reduced. As bread, potatoes and beans are rich in starch and the mouth 
and stomach juices convert starch into sugar they should be eaten sparingly. 
But most of the gas belched has been swallowed as air. 



EXERCISE AND THE STOMACH 

The stomach muscles move in waves somewhat similar to those of the 
heart muscle. When the muscle is contracted down we call the stage systole. 
When the muscle is relaxed the stage is called diastole. Exactly these same 
terms are used for the movement of heart muscle. The muscular contraction 
starts when the food enters the part of the stomach called the cardiac end 
and moves toward the end where the food leaves the stomach called the 
pyloric end. 

Each muscular contraction is called a cycle. A cycle takes three seconds. 
In other words we might say that the stomach beats twenty times a minute. 
The heart beats about four times as fast. 

Sometimes a wave travels from one end of the stomach to the other. 
More frequently it travels a quarter way, then breaks, then starts up, travels 
another quarter, then breaks and so on until it gets to the emptying 
end. 

Now, during all of this churning chemical action is taking place. The 
point is that the churning is more important than the chemical action. 
When the mixed food has been pushed into the first part of the small intestine 
the chemical work can and does keep up but if the churning has not accom- 
plished its part of the work it will not be done. As a large part of the 
chemical work of the stomach is done outside of the stomach the muscular 
work must be done in the stomach and by the stomach. 

These few facts lay the foundation for some highly important practical 
conclusions. The diagnosis of cancer of the stomach is difficult. Operations 
based on the old symptoms such as tumors, hemorrhage, rapid emaciation 
and chemical tests do no good. A test suggested by Abderhalden is being 
tried out. It may prove able to demonstrate cancer of the stomach in the 
early stages. Let us hope. 

X-ray examination of the bismuth-lined stomach shows cancer at an earlier 
stage than did the old methods. 

The second is this: When the digestion is poor the most important 



DIETING FOR FERMENTATION 



641 



j Salivary glana\ 



thing to do is to build up the stomach's muscle. When one builds up his 
general muscular tone he builds up his heart muscle tone and his stomach 
muscle tone. 

Exercise in the open air well planned and persistently carried out is 
better for dyspepsia than pepsin or soda or 
tablets or several of these combined. 

In one of Dr. Cole's articles on the radio- 
graphic examination of the stomach he says: 

"The gastric cycle is governed somewhat 
by respiration through the vagus, which sup- 
plies impulse both to the diaphragm and to the 
stomach. This suggests a method by which 
gastric peristalsis may be stimulated." 

An extremely important nerve called the 
pneumogastric or vagus runs down the neck 
into the chest to the abdomen. It stimulates 
the lungs to do their work and the stomach to 
do its work. The stomach, lungs and heart 
being hooked on the same wire, what affects 
one may have some effect on the others. 

The exercise that causes one to breathe 
well stimulates the stomach to work well. Per- 
haps the old fellows who sniffed snuff were 
wiser than those who took pepsin. 

To give the statements "punch" let us 
summarize as follows: 

1. The most important work of the stom- 
ach is that done by its muscle. 

2. Muscle exercise which builds up the 
general muscle system prevents and cures dys- 
pepsia by improving the tone of the stomach 
muscle. 

3. Since the same nerve which supplies the stomach muscle supplies 
the heart and lungs anything which stimulates breathing and heart function 
stimulates the stomach. 

4. An X-ray study of the stomach movements is about the best method 
for diagnosing early stage stomach cancer now known. 




Agm* 



Jpfiefl<f/x. 



Fig. 225. — Diagram Illustrat- 
ing Digestive Organs. 



DIETING FOR FERMENTATION 



Many people complain of intestinal fermentation. Dr. Ashford of 
Porto Rico gives three methods of dieting to overcome this trouble. 

1. Stop all food except milk for a period of forty days. Take eight 
ounces of milk every two hours for four days. Nine feedings a day should 
be taken. The milk should be consumed cold. It should be slowly sucked 
through a straw. A half tube of Bulgarian lactic bacillus from a good 
manufacturer should be added to each feeding just before taking. On the 
fifth day and for three days thereafter take nine ounces at a feeding. On 



642 DIGESTION 

the ninth day take ten ounces. Increase the feeding one ounce every 
fourth day until thirteen ounces constitute the size of the meal. When 
thirteen ounces as a portion has been taken for four days reduce the dose 
of milk to twelve ounces nine times a day and add one banana a day. 
After four days of this reduce the dose of milk to eleven ounces nine times a 
day and eat two bananas a day. From this point on gradually decrease 
the milk, indulging instead in eggs, fruits, and vegetables. Avoid potatoes, 
beans, apples and underripe fruit. 

2. Stop all the usual foods for one week. Take two pounds of chopped or 
roasted meat a day. Divide it into six feedings. The meals are to be taken 
at three hour intervals. Few people can stand this diet for more than a 
week. After the expiration of the week reduce the amount of meat and add 
vegetables, fruit and eggs. 

3. Take a simple fruit diet in which bananas form the principal in- 




Fig. 226. — The Pancreas, Partly Cut Away, so as to Show the Duct which Collects the 
Pancreatic Juice and Empties it into the Duodenum. 

gredient. The fruits must be fully ripe. Apples and fruit containing a good 
deal of starch should be avoided. 

Dr. Ashford's advice relates particularly to intestinal fermentation in 
a form of tropical disease called sprue. This disease, he thinks, is due to 
a yeast-like body belonging to the monilia. Monilia is liable to grow in 
yeast as a contamination. When bread is made with yeast containing monilia 
the mold may not be killed by the heat. Ashford thinks that this mold 
carried into the intestines by bread is the cause of sprue. 

By withdrawing bread, potatoes, sugars and sweets wholly from the 
diet for from one to six weeks he starves out the molds in the digestive tract. 
Of course care must be taken with bread and potatoes thereafter, else the 
disease will return. 

People in this country are not interested in sprue but thousands of 
them are interested in intestinal fermentation. The custom is to take char- 
coal or soda every day and a purge about every so often. 

The plan above outlined should help these cases. They will not stay 
cured if they go back to a diet rich in bread, beer, potatoes, apples, pastries, 
cakes and desserts. 

SUGAR EATING 

Dr. Kuhnert offers some suggestions to the German people for im- 
proving their chances in the Great War. He advises them to cut their acreage 



SUGAK EATING 643 

of beets in half. The land released from beets is to be devoted to grain. Before 
the war the German law required that the flour mills grind 70 per cent of the 
wheat berry into the flour. At present the requirement is that 82 per cent 
shall go into flour. This requirement prevents waste and, what is more 
important, it increases the protein and the mineral matter in the flour. 

Dr. Kuhnert advises that all of the berry go into the flour, that none 
of the bran be discarded. 

Now for a most subtle suggestion. He advises that the Germans export 
as much beet sugar to England as possible. The Chicago Medical Recorder 
quotes him as saying that by fairly flooding the English people with sugar 
their vitality would be lessened, the plain inference being that they would 
thus become less powerful opponents of the Germans. 

The basis of this novel proposal is as follows : Sugar is absorbed by the 
digestive apparatus without having to be changed. It is burned quickly 
into energy and heat. People in need of a great deal of heat and energy 
can get it by eating sugars and sweets. Men exposed to great cold, children 
playing very hard and men leading very active lives can get what they need 
of attractive flavors in convenient form and in a generally satisfactory way 
by using chocolate, candies, sugars and sweets. 

However, let us not forget that alcohol in moderate doses furnishes heat 
and energy quickly and effectively. Yet the disadvantages of alcohol far 
outweigh its advantages. Sugar has not the poisonous effects of alcohol but 
it has some of its other disadvantages. It is a one-sided diet. It satiates 
the appetite without furnishing the proteins and the minerals needed for a 
good physical development. People who eat much sugar are fat and flabby. 

The eating of sugar requires no work by the digestive organs. There- 
fore, the digestive organs of heavy sugar eaters are apt to balk at digesting 
meat, bread and vegetables. Sugar eaters generally have no particular appe- 
tite for heavier, coarser foods. 

Dr. Beck says that sugar eating children get very hungry, are quickly 
satisfied with a little food and in a short while are very hungry again. 

Finally, sugar eaters develop a lot of lactic acid in their tissues. To 
neutralize this lime is absorbed from other tissues. In consequence sugar 
eaters have poor teeth. Sometimes in the case of children they develop 
rickets — they are fat but soft. 

Dr. Kuhnert would give the German soldiers sugars, chocolates and 
sweets whenever they are very tired or very cold. But for a steady ration — no. 
On the other hand, he would advise flooding England with German beet 
sugar with a view to promoting its daily use by the British soldier and by 
the people at home. 

Indigestion the Cause. — H. W. ivrites that he has an irregular pulse, 
especially at night. Physicians have failed to find any organic heart dis- 
ease. He takes strychnin tablets or digitalis as a stimulant frequently. He 
wishes to know if an irregular pidse is dangerous and if the talcing of 
strychnin and digitalis is harmful. He takes a half teaspoonful of car- 
bonate of soda each evening and has done so for two years, and wishes to 
know if this is doing harm. 

Reply. — Functional heart trouble resulting in an irregular pulse sug- 
gests the need of proper medical care. The heart can be as much a source 



644 



DIGESTION 



of danger by reason of disturbance of its nervous mechanism as it can be 

from leaky valves. 

It appears that H. W. has indigestion which he patches up with soda; 

that the indigestion causes a 
disturbance of the heart on its 
nerve side and this he patches 
up with digitalis. 

No man is justified in con- 
tinuing the use of a half tea- 
spoonful of soda for two years. 
He should change his eating 
habits and get at the reason 
for his stomach disturbance 
rather than use soda. His use 
of digitalis is also to be con- 
demned. 

Nerves of Taste.— A. T. D. 

writes: "1. Why does the tem- 
perature of any article taken 
into the mouth affect the sense 
of taste? 2. Will not the taste 
discover where the chemist will 
fail? 3. Is it not possible to get 
an infection through eating or 
drinking something that is very 
cold, and if taken at a warmer 
temperature are not the chances 
minimized by the sense of taste 
in discovering the infection? 
Jf. What is the construction of 
the tongue and palate?" 

Eeply. — 1. The endings of 
the nerves of taste are delicate. 
If a substance is hot or cold 
the temperature will numb the 
nerve endings. If the tempera- 
ture is within the limit of this 
numbing effect of temperature 
will be on the substance tasted. 
Most substances dissolve better 
in warm water. Taste will be 
more acute if the solution is a 
little warm. If the substance 
gives off an aroma when warm 
the nerves of smell aid the 
nerves of taste. 

2. No. I think without exception for each substance there is a chem- 
ical test more reliable and more trustworthy than a taste test. 

3. No. Taste is of no service in guarding against poisoning. For in- 
stance, many food poisons do not change the taste of the food in which 
they have developed. 

4. Taste lies in the tongue. The palate has no taste nerves. The taste 




a, esopha- 
d, pylorus; 



Fig. 227. — Digestive Apparatus. 
gus; b, stomach; c, cardiae orifice 
e, small intestine;/, biliary duct and gall-blad- 
der; g, pancreatic duct; h, i, j, k, large intes- 
tine; h, ascending colon; i, transverse colon; j, 
descending colon; k, rectum. At junction of e 
and h is ileocecal valve, below which is vermi- 
form appendix. 



SUGAR EATING 645 

nerves end in delicate bulbs. These little bulbs contain nerve endings 
sensitized so as to be irritated by substances in solution having tastes. 
These nerve endings are not capable of appreciating slight changes in 
temperature or touch and they are not capable of registering pain. 

Eat Bulkier Food. — C. K. twites: "What can a woman of 75 do whose 
head is one mass of acute neuralgia, who works mure than she ought to, 
and patches more quilts than is necessary, hut cannot be made to shake off 
work habit? Ordinary relief, as she understands it, does not suffice. What 
about the sand cure? Will one-half a teaspoonful a day of sterilized sand 
be beneficial to the average person? How and upon what organs does it 
act, and is there liable to be damage resulting from continued use? How 
often would it be advantageous to use it?" 

Reply. — As I have frequently written the cure for ordinary cases of 
constipation is to eat bulkier food, particularly food containing a good deal 
of roughening. I especially advise wheat, bran, unbolted corn meal, 
breakfast foods which contain a good deal of bran or fiber, the stringy, 
fibrous parts of meat, the peelings of apples, pears, peaches and apricots 
and the hulls and seeds of grapes. 

The receipt of this letter and several others indicates that the use of 
sand for constipation is somewhat widespread. The first thought is that 
it would be liable to cause intestinal stones. Yet intestinal stones are rare, 
harm from them is so much rarer and we eat so much dirt with our food 
and drink so much with our water that the danger cannot amount to- much. 
If sand is used it should be free from clay and ordinary dirt. Possibly 
it is best to bake it to make it sterile. 

Even though we are careless about eating bacteria in milk it is just 
as well to be careful about eating them in sand. It is probably better to 
use peelings, bran and hulls than to use sand. But sand is better than 
purgatives, oils, salts or ordinary constipation cures. 

Breath of Dyspeptic. — W. E. H. writes : "Is there anything known that 
will neutralize, deodorize or alleviate the breath of a chronic dyspeptic? 
Mr. Howells, in a novel, alludes to the dyspeptic's breath in New England, 
which might mean that it is hopeless; but is it entirely so?" 

Reply. — The odor when not from the nose and throat is due to intes- 
tinal putrefaction and the absorption into the blood of the gases that 
result. The blood throws these gases into the air in the lungs. Nothing 
neutralizes or deodorizes these gases. 

To cure constipation and to prevent putrefaction use a diet composed 
in large part of cheese, milk, buttermilk and sour milk. 

Dr. Hawk of the University of Illinois in conjunction with several of 
his colleagues has written a series of papers on water drinking. Among 
other conclusions he says that drinking one pint to one quart of water 
with each meal will decrease intestinal putrefaction and afford "many 
other desirable and no undesirable features." 

Cut Down Starches. — W. I. J. writes: "What is the meaning of 'intes- 
tinal indigestion ? Am I right in understanding that all starchy foods are 
digested in the small intestine? If so, isn't it best to eliminate such food 
from the diet of one who is afflicted in that way? Kindly give me the diet 
one should follow with this complaint. Is it curable? Is it the cause of 
weak heart action, poor circulation, and cramps in the feet, as well as the 
hands going Ho sleep' when in a lying position? What is your idea of fruit 
eating under such conditions? Is deep breathing of any material benefit?" 



646 



DIGESTION 



Reply. — "Intestinal indigestion" is a rather loose term, which most 
people use as meaning intestinal fermentation, and some as meaning 
what nsed to be termed "biliousness." Some of it occurs in the small 
intestine and some of it in the large. Starch digestion starts in 
the mouth and keeps up under one kind of a change or another 
until the starch is used for energy. The work which the stomach does in 
digesting it is not of great importance. 

If there is excessive fermentation it is an indication to cut in half 

bread, potatoes, cere- 
als, sugar and other 
starches and to in- 
crease meat and fats 
enough to compensate. 
Fruit eating is al- 
ways advised. So is 
deep breathing. 

Intestines overdis- 
tended with gas can 
give a train of nervous 
symptoms such as 
"weak heart," "poor 
circulation," "cramps," 
"hands going to sleep," 
and the like. 

Sugar.— 0. C. B. 
ivrites: "In your arti- 
cle, 'To Live During a 
Ripe Old Age/ you 
speak of the 'lactic 
bacilli of buttermilk 
finding in the digestive 
tube the ' sugary mate- 
rial' required for their 
subsistence. In a re- 
cent newspaper item 
Professor Metchnikojf 
is said to have discov- 
ered that the poisons 
which produce old age 
are 'nullified by sugar 
and a 'bacillus living 
in the human intes- 
tines/ But my doctor 
. warns me against the 
use of sugar, saying it clogs the liver and harms the kidneys. (1) What 
is the truth about the use of sugar? And what about the lactic bacilli 
that live on 'sugar and 'sugary material'? I have been using buttermilk 
for months, and find it a great deterrent of putrefaction. (2) In the use 
of sugar, which is the more healthful, the brown or the refined white?" 
Reply. — 1. Sugar is an excellent fuel and energy producer. It is all 
right to use it in moderation but used beyond the capacity of the liver 
to convert it it brings about glycosuria — or a variety of diabetes. 
2. There is no difference from the health standpoint. 




Fig. 228. — Position of Abdominal Contents. (1, 2, 4), 
Liver; (3), Gall-bladder; (7), Stomach; (12), Small In- 
testines; (13, 16), Large Intestines; (14), Appendix; (9), 
Spleen. 



SUGAK EATING 647 

Indigestion. — L. L. L. writes: "At times I have a heavy pressing feel- 
ing just to the left of my heart. A doctor told me it was indigestion and 
gave me some drops, but it does not seem to cure me. It makes me feel 
nervous at times. Is it dangerous? Can it be cured? What is good food 
to make one gain flesh?" 

Reply. — Don't try to cure indigestion with drops. The cure for indi- 
gestion is freedom from worry, mental calm, proper bowel habits, eating 
small meals well chewed, never overeating and plenty of exercise in the 
open air. Indigestion is not dangerous. Simple indigestion can be cured. 
To put on flesh stop worrying. Drink milk and eat cheese and bread. 

Catarrh of Stomach. — G. 0. D. writes: "What state or locality would 
be the most helpful to one suffering from nasal and stomach catarrh? Is 
there any relation between nasal catarrh and catarrh of the stomach, and 
are climatic conditions a factor in catarrh of the stomach? Are gastritis 
and catarrh of the stomach the same?" 

Reply. — 1. Climate makes no great difference. 

2. No. 

3. One form of gastritis is sometimes called catarrh of the stomach. 
If the term catarrh were abandoned we should get ahead faster. It is 
loosely used to cover a lot of conditions. "The treatment for so-called 
nasal catarrh is to have the particular disease diagnosed and then treated 
properly. The treatment of catarrh of the stomach is to overcome con- 
stipation, do physical work in the open air, quit worrying and pay a 
decent regard to what is eaten and how it is eaten. 

Intestinal Indigestion. — M. J. M. writes: "Will you kindly tell me what 
kind of food and drink it is best to give one who is troubled with intestinal 



Reply. — It is difficult to answer your question because it is not certain 
what you term "intestinal indigestion." Most of the conditions called in- 
testinal indigestion are food fermentations or putrefactions. Many of 
these cases are the old condition called biliousness. 

Now, to call them intestinal indigestion is getting somewhat nearer the 
truth than biliousness but the cases require much closer analysis. 

Suppose you decrease the amount of your food, increase your eating 
time to three times what it now is and chew much more thoroughly. 

If this does not give you relief you should have your condition studied 
individually and find out just what your indigestion is and change 
your habits accordingly. 

Meaning of Proteid. — J. B. writes: "What is the meaning of proteid? 
What is it obtained from? What is its use in the practice of medicine?" 

Reply. — Proteid is albumin. There are different kinds of albumins, so 
the term proteid is commonly used as standing for the group. We say 
that milk is composed of water, fat (meaning cream), carbohydrates (mean- 
ing milk sugar), proteid (meaning the albumins or curd part of the milk) 
and salts. 

We say that meat contains 20 per cent, proteid, meaning that if a 
pound of meat is eaten the person eating gets one-fifth of a pound of 
albumin. Proteids are food. It is that food element which is especially 
needed for growing children and adults doing physical labor. 



648 DIGESTION 

Salt Meat Diet. — W. J. T. writes: "Do salt meats as a diet allow 
blood to become impoverished and produce, a bad complexion when the 
digestion is good? Would you advise a fresh and salt meat diet for an 
overstout person of middle age, whose bowels and circulation are sluggish?" 

Reply. — Salt meat in ordinary quantities and not as an exclusive diet 
will cause no harm. Too much salt meat and no green vegetables causes 
scurvy. Salt or fresh meat as such has no particular effect on the bowels. 
Eat salt or fresh meat but add plenty of roughening. 

Exercise More; Eat Less. — A. B. writes: "Kindly advise me as to the 
proper treatment for a bad liver. I have been affected for five years with 
what seems to be sluggish action of that organ. At times I become de- 
jected, dissatisfied with everything, including my food, and know that in a 
few days I will have an attach of biliousness. It usually takes two or three 
days then to get straightened up again, and for a time afterwards I will be 
myself. A jaundice-like complexion and a desire for use of stimulants 
and food to excess always accompany, or rather precede, these attacks. 
Although I do not get much exercise, I take good care of myself, except at 
these times, and my bowels always move regularly." 

Reply. — Your attacks are a modified migraine or a gouty manifestation. 
Although you are not constipated a saline purge will straighten you out. 
The only permanent cure is to exercise more and eat less. 

Don't Eat Apples. — E. F. G. writes: "Is there anything I can do to 
overcome acid in stomach from eating apples? I am very fond of them 
and they are almost a necessity to me, but if I eat three or four a day they 
put my stomach on edge." 

Reply. — If eating apples sets your stomach on edge don't eat them. 
They are doing you more harm than good. 

Onions and Health. — J. and K. write: "We ask you to please enlighten 
us about the nutritive qualities (if any) of the onion. A says it is one 
of the most healthful of foods, eaten either raw or cooked. He bases his 
theory on tradition, and because so many well and healthy people eat 
onions. He says they are conducive to sleep. B says they are indigestible 
because they are belched back hours after having been eaten and their odor 
is too strong." 

Reply. — Onions have little food value. It is well to eat them in winter 
for the same reason that we eat other vegetables and fruits of low food 
value — for example, turnips, beets, celery, radishes, and oranges. It is not 
because the odor is bad that onions are healthy. On the other hand the 
fact that the taste and odor are appreciated when one belches does not 
prove that they are hard to digest. Any strong odored food such as onions 
or coffee flavors the gas belched. Odorless foods do not thus reveal 
themselves. That is all there is to it. 

Ptomain Poisoning Protection. — Mrs. T. N. writes: "Will you please 
advise what precautions should be taken in using canned goods to prevent 
ptomain poison? Would thorough heating make food safe? What home 
medicine could one take if ptomain poisoning exists?" 

Reply. — 1. Patronize reliable grocers. Select cans that are fresh look- 
ing, unrusted and not swollen and that have but one soldered puncture hole. 



SUGAR EATING 64S 

I am informed that two holes are always present in a salmon can. See 
that the food when emptied from the can tastes, smells and looks right. 

2. Some food poisons are destroyed by thorough heating. Some are not. 
The risk is decreased more than half. 

3. Produce vomiting by tickling the throat. Hot mustard water pro- 
duces vomiting. Produce purging with salines. If there is much shock 
use blankets and hot water bottles. 

Unfortunately many of the food poisons develop without any change 
in the taste, odor or appearance of the food. Inspection at the source, 
dating and care in selecting one's grocer are about the only safeguards 
against the tasteless poisons. 

Appendicitis. — A reader writes: "1. What articles of food should he 
rejected hy a young adult afflicted with chronic appendicitis and also chronic 
constipation? 2. Should fruit he peeled, and are heans harmful? 3. Is 
there any help in such a case outside of surgery?" 

Reply. — 1. None. 

2. Fruit should not be peeled except bananas, oranges, pineapples and 
others with highly objectionable peeling. Grapes, apples, peaches, plums 
and prunes should be eaten peeling and all. Beans are not harmful. 

3. Chronic constipation can usually be relieved by eating bulkier food 
and drinking more water. Nothing heals chronic appendicitis much except 
operation. Some cases get well spontaneously. Prevention of constipation 
is of some service. 

How to Cure Heartburn. — Violet writes: "Will you kindly advise me 
what to do for severe heartburn and helching immediately after eating? 
I have heen troubled with it for ten years." 

Reply. — Belching immediately after eating is a manifestation of nerv- 
ousness. Nerves are also a potent cause of heartburn. Another important 
cause is bad eating habits. In view of all this, it will be seen that the 
remedy lies more along hygienic than medicinal lines. You might: 

1. Cure constipation. 

2. Eat slowly. 

3. Put your teeth in order and keep your mouth clean. 

4. Eat lightly; never gorge. 

5. Drink a glass of water one hour after each meal. 

6. Eat simple foods. 

1. Avoid those foods the eating of which is followed by heartburn. 

8. Exercise in the open air. 

9. Keep your nerves in hand. 

Take Cheese and Milk. — J. F. P. writes: "Will you kindly set forth 
how intestinal putrefaction may he overcome? I presume flatulency is an 
evidence of this condition. Is it possible for stomach eructations to come 
from this cause?" 

Reply. — Live on a diet of cheese and milk. Get the Department of 
Agriculture bulletin on cheese. Indeed, write your congressman to send 
you the diet series of bulletins. 

Eructations of gas are due in the main to nervousness. It is a fre- 
quent semi-hysteric manifestation in men and women. 



650 



DIGESTION 



Pork Must Be Cooked.— #. W. W. writes: "Does the process of curing 
and smoking hams and sides make ham and bacon good, clean, healthful 
food, the equal of No. 1 beef?'* 

Eeply. — The curing and smoking of hams and sides makes the meat 
good for eating after it has been cooked but not before. It has been 
demonstrated that smoking does not kill trichina or bacteria. 

Drink More Water.— J". J. writes: "1. What is intestinal indigestion? 
I have had it for eight months. Is there any cure for it? 2. The amount 
of urine passed each twenty-four hours is thirty-two ounces. Does that 
indicate anything serious? My bowels will only move when I eat bran 
bread." 

Eeply. — 1. What is called intestinal indigestion is generally fermenta- 
tion of the food in the intestines. Three hours after eating the food has 

got out of the stomach. Its fur- 
ther adventures take place in the 
intestine where it lies for purposes 
of digestion and absorption for 
forty-five hours. Many people get 
rid of intestinal indigestion by a 
milk, cheese, vegetable and fruit 
diet persisted in for some time. 

2. It does not mean anything 
serious. It does throw light on 
your indigestion. If you will drink 
twice as much water as you have 
been doing you will be better off. 
Don't economize on water. 

Buckwheat Cakes.— Mrs. H. F. 

R. writes: "1. What is the nutri- 
tive value of buckwheat cakes? 2. 
What is the difference between 
graham flour and whole wheat flour? 3. Are pickles and spices such as 
cloves, allspice, and others harmful or beneficial to the system?" 

Reply. — 1. About the same as corn or flour cakes. They furnish heat 
and energy especially. Eating them can be too long persisted in. 

2. Wiley defines graham flour as unbolted wheat meal and whole 
wheat flour, improperly so called, as fine wheat meal from which some of 
the bran has been removed. 

3. A moderate amount of pickle is beneficial, especially in winter. In 
summer fresh vegetables and fruits are abundant enough to supplant 
pickles. Spices, such as cloves, allspice and the like, I think do more harm 
than good. 




Fig. 229.— Trichina in Muscle. 



Eat Three Meals. — C. M. C. writes: "Is it not better for a man of 50 
in normal health and weighing 200 pounds or more to continue eating 
three meals a day rather than omit luncheon for fear of becoming too fat? 
He is a man of business and actively engaged." 

Reply. — Yes, three meals a day are better than two. The aim should 
be to decrease the amount of food taken. This can be more easily done 
where several small meals are eaten rather than two large ones. 



SUGAR EATING 651 

California Raisins. — V. F. N. writes: "Please advise me if it is well 
for a person in good health who craves the large California raisin to eat 
half a pound after dinner four or five times a week." 

Reply. — The article is all right. The quantity is large, especially for 
anyone who takes in other food anything like the usual quantities of starch 
and sugar. 

Cuts Out a Meal. — C. E. E. writes: "From time to time you are ashed 
how to reduce weight, and recently you answered one person who ashed 
you to outline certain food for that purpose. You said that what was good 
for one might not he for another. I speak from personal hnowledge when 
I say that it is not the hind of food but the quantity that does the business. 
Here is the history of my own case. On December 31, 1911, I weighed 
196 pounds. I am 5 feet 6 inches tall. This weight I hnew was wrong, 
and I determined to reduce my weight to a reasonable basis. I also decided 
that the less food I ate the less my weight would be. This was the hard 
way, but it proved to be the right one. I cut out lunch. Then I ate less 
at breahfast and dinner than before, and for a time walked five to ten 
miles a day. It tooh some time to start to a lower weight, but in six 
months I was down to 165. I wrote you, giving reduced weight and diet. 
You advised me to eat more so as to slightly increase my weight because I 
had reduced too rapidly, with the suggestion that later on, if I wished to do 
so, I could start again. I was surprised to find that it was harder to start 
uphill than it was down, for I had to double my ration and it was two to 
three weehs before I could gain any at all. I went to about 170; then 
reduced the amount of food, and held at that for some time. Later I got 
to eating more at each of the two meals, and different food. I went to 185. 
Then I reduced the amount, but used the same food and lowered to 162. 
Now with a different diet but eating more I am at 17 If-. This proves that 
if you eat more, regardless of the particular food, you will gain and lihewise 
will reduce with the lessened amount. In fact, the way to reduce weight, 
and in my opinion the only way, is the hardest of all ways: Eat less in 
quantity and eat fewer meals." 

Reply. — I think the average man will find it easier to distribute his 
food into three or four meals rather than two. 

Effects of Gum- Chewing. — ^Y. S. writes: "What are the good and bad 
effects of chewing gum? Is oil of cinnamon injurious to the stomach?" 

Reply. — 1. To chew gum after a meal aids digestion. Most people do 
not chew their food long enough to mix saliva with it thoroughly. The 
chewing of gum adds some saliva to the stomach contents. It is of more 
service in stimulating the stomach muscle. It is especially serviceable in 
helping the stomach to empty its contents. If one has overeaten and the 
stomach is heavy something is gained by chewing gum for half an hour, 
beginning two hours after eating. It helps to settle the stomach in a 
"katzenjammer." So much for its good effects. 

Gum does harm when continuously and everlastingly chewed. If saliva 
is poured into the stomach all the time, if the stomach muscle is continu- 
ously stimulated to work the digestion will be harmed. 

2. Oil of cinnamon has a powerful effect on the stomach. Wisely used 
it will help; unwisely used it will harm. By this I mean when used in 
medicinal doses — more than a drop. The little used to flavor gum will 
make no difference one way or the other. 



652 DIGESTION 

Bicarbonate of Soda's Use. — Mrs. C. B. says: "In a recent Tribune 
article you said that bicarbonate of soda was not harmful if taken occa- 
sionally. I am obliged to take a teaspoonful about five times a week after 
dinner, even though I am fairly careful with my diet, certain combinations 
of food sometimes unexpectedly causing the heartburn for which I take 
the soda. Will you kindly inform me if you think five times a week will 
be injurious?" 

Reply. — Five times a week is too frequently. You should have your 
digestion investigated. Change your diet. 

Sour Stomach. — M. M. writes: "Should a person who has been trou- 
bled more or less with a sour stomach leave cereals alone? Often, no 
matter how simple the meal, the food will sour before she leaves the table. 
Sometimes hours later it seems to sour. She is 56 years of age and seem- 
ingly, except for this disturbance, is in perfect health. She is careful in 
her diet. Her breakfast of grapefruit, breakfast food, bran bread, and 
cereal coffee often causes as much trouble as a heavy meal. Digestion 
seems slow. She cannot eat anything of a lunch and then eat dinner at 
the usual hour. Of late a mouthful of sour liquid comes up sometimes a 
few moments after the meal. She occasionally consults a physician. He 
gives her a few pellets, which do not seem to give any permanent relief." 

Reply. — 1. No. Fruit acids such as enter into ordinary foods are not 
related to the acid which causes acidity. 

2. My guess is that she had a dilated, and perhaps also a displaced, 
stomach but this is a guess and maybe wide of the mark. Have her go to 
see a physician who will examine her thoroughly and then advise. Advice 
as to hygiene is of first importance. A physician who superficially con- 
siders the condition and gives a few pellets cannot help. 

The Disease of "Bad Habits." — B. S. writes: "I am a man 65 years 
old, good habits, fair appetite, sleep fairly well, but yawn continuously 
during waking hours, feel tired, no ambition. Constipated badly for twenty 
years, take Epsom salts every day before breakfast. Friends suggest my 
trouble is kidney trouble. Tired always on arising. What is your advice?" 

Reply. — Your case is easy. Your disease is bad habits and that is a bad 
disease. It is worse because you don't know you have it. When one is 
tired on arising it is because he has slept too much. Yawning continuously 
means that you do not move about actively enough or fast enough in the 
open air. Constipation means that you do not eat the right foods nor 
drink enough water. Taking Epsom salts before breakfast is the worst 
habit in the bunch of bad habits. 



BELCHING 

Belching is a sign of hysteria, neurasthenia or some other kind of a 
"jimmy." Furthermore, it is a habit and a bad one. It belongs in the class 
with stammering in that one learns how to do wrong when doing right is 
easier. 

It is true a little gas may form from decomposing food in the stomach 
but the quantity will be small. A little gas may find its way from the intes- 



BELCHING 653 

tines into the stomach but the gas inflated areas of the intestines are some 
inches away and the direction of flow is away from the stomach. 

Practically all the gas belched is first swallowed as gas. We swallow 
some air when we eat hastily. We swallow gas with carbonated water, when 
we chew and in many different ways. The profuse belchers, however, delib- 
erately swallow air and then quickly belch it up. 

If you will watch the Adam's apple of a person drinking water you will 
notice a certain characteristic swallowing motion. Now notice the Adam's 
apple of a belcher in action and you will see that he first swallows the air 
and then belches it. Physicians demonstrate it more plainly by watching 
the Adam's apple with X-rays. 

How is the habit acquired ? A person overeats. In his distended stomach 
there is a good deal of air. He belches and gets relief. Eecollection of this 
remains with him in his subconscious memory. At some later time his 
stomach is too tight. He can belch no gas to get relief. He swallows air 
and then belches it. Before he knows it he has acquired the habit. 

Neurotics, neurasthenics and hysterics are apt to get this habit just 
as they are prone to get the whisky habit or the morphin habit or the tobacco 
habit. 

Of course, back of the habit lies some error. It may be overeating, 
rapid eating, irregular eating, or indigestion, slow digestion, dilation of the 
stomach or mild neuralgia of the stomach. 

The habit has been acquired in an effort to find relief from some dis- 
comfort. When such discomfort shows itself in a sensible person he changes 
whatever is wrong. When it shows itself in a neurotic he leaves the cause 
undisturbed but takes to belching just as another neurotic who feels off a 
little takes to morphin or cocain or whisky. 

Does any harm result? Yes, often. The belching of air siphons bile 
into the stomach. Bile does not belong there. Bile persistently in the stomach 
disturbs the digestion. The longer the belcher belches to relieve his stomach 
the more surely he embarrasses his stomach. 

The persistent swallowing of air upsets the working of the gate into the 
stomach and also the gate out of the stomach. The stomach may become 
dilated through the persistent swallowing of air. 

However, as bad as any of these is the frame of mind of the belcher. He 
is an "ailer." He probably regards himself as a dyspeptic. He is pretty 
certain to have some form of persistent stomach complaint. He gets the soda 
habit. 

Of course, to start with a belcher is not thoroughly well poised or he 
would not be a belcher. But the habit makes him more of an "ailer." 

Cause of Belching. — F. D. writes: "What is the reason a person belches 
about four hours after eating, and what should be the diet of a person so 
afflicted? The belching generally lasts an hour or more" 

Reply. — Belching is due to nervousness. The stomach should be empty 
four hours after eating. If yours is not the irritation from the retained 
food could start the nervous belching spells. If your stomach has not 
emptied itself four hours after eating, the stomach muscle is weak, and 
probably the organ is dilated. A dilated stomach requires attention. To 
diet is not enough. 



G54 DIGESTION 

Excessive Belching. — N. S. writes: "I have teen belching for three 
days at intervals of from five to ten minutes, and I feel a lump in my 
throat. Sometimes I find it difficult to belch and feel as if it would relieve 
me, but it doesn't. It does not hurt when I eat and the lump in my throat 
seems to resist the saliva and sometimes I feel a burning sensation when I 
get through belching. What is the cause of this?" 

Reply. — You are nervous. Control yourself. The only way to belch 
every ten minutes is to swallow air, otherwise there would be no gas to 
belch every ten minutes. You swallow air and then belch it just as some 
people bite their finger nails. Get back on your keel. 

Must Work Out Own Cure. — J. A. R. writes: "7 note you state that 
nervousness is the cause of belching. Kindly give me some practical 
remedy for nervousness, as I am troubled with belching/' 

Reply. — Nervousness cannot be cured by a remedy. It means bad 
mental training. A person must work out his cure by mental hygiene. 



CONSTIPATION 

There are few persons whether civilized or uncivilized who do not at 
some time or other suffer from constipation. The old, the young and the 
middle aged are troubled more or less. It matters not whether they are fat 
or lean, outdoor workers, indoor workers or idlers; whether rich or poor, 
well fed or half starved they have been, are now or will some time in their 
lives be interested in the question. 

Constipation has probably existed in all ages and in people of all nations. 
No human ailment is so universally prescribed for by the medical profession 
and no ailment is the subject of so much self-dosage. Doctors try to give 
permanent relief but self-dosage looks chiefly to temporary relief. 

To comprehend the problem one needs a little knowledge of the in- 
testines and their contents. The entire alimentary canal including the 
esophagus, stomach and small and large intestines is about five times the 
length of the individual. The large intestine or colon is from four to six feet 
long and from one inch and one-half to two inches and one-half in diameter. 
It is of this part of the intestine that we are chiefly concerned in considering 
the causes of constipation. 

The colon is encircled by muscular fibers that contract and expand 
alternately and this motion moves the contents along from above downward 
toward the rectum, its lower and distant end. The lining membrane of the 
colon is capable of absorbing fluids from its contents or of discharging fluids 
into its cavity. 

Too little fluid in the colon may be a reason for constipation. The lack 
of fluid may be caused by too little being drunk and too little poured into 
the bowel from its walls; or the fluid in the colon may be too readily absorbed. 

Sometimes the character of the food is such that little residue is left to 
pass on the colon because it all was absorbed in the digestive process. Under 
these circumstances there is likely to be constipation, since there is little in 
the bowel to be moved along. 

The contents of the colon is made up of waste matter that has been 



CONSTIPATION 



655 



collected from all the tissues of the body thrown into the bowel and discarded 
as no longer useful. Another item is the undigested particles of food that 
are passed on from the stomach through the small bowel to the colon. The 
next item is the fluid that is thrown into the tube from the mucous membrane 
with which it is lined. 

Only one of the three factors is subject to control and that is the 
residuum from particles of food that have failed to be digested and absorbed. 

Every adult of normal health and activity should have an action of the 
towels each day, although two or three movements may occur with perfect 
health. If hut little is eaten, and 
especially if that little leaves a 
small residuum to be passed on 
to the colon, a normal movement 
of the towels once in two or even 
three days may te perfectly natural 
and no harm ensue. 

When the fluids are persis- 
tently absorbed from the colon and 
the contents become dry and hard 
in the rectum with difficulty of 
evacuation the condition is called 
constipation. It is in some people 
chronic — that is, continuous and 
persistent. In those the bowel has 
become distended with loss of the 
contractile power of the muscular 
fibers encircling it and the usual 
warning sensations of a desire to 
evacuate the rectum are lacking. 

It must be remembered con- 
stantly that the colon, especially 

the rectum, is largely a receptacle for waste matter where it may be retained 
under control for hours and even days at a time. 

The most natural time for the emptying process is in the morning after 
breakfast. With many persons it is possible to postpone this necessary act 
for hours and even days but if such practice be persisted in the bowel witl 
tecome accustomed to retaining an ever increasing quantity, the sensibility 
will be lessened or lost, the normal desire for bowel movement will not occur, 
and the pressure of the mass or reabsorption of excrementitious matter will 
cause disability or ailment of some sort. 

In the early morning when both the muscular and the nervous systems 
are relaxed by sleep and rest an action of the bowels may be had in one who 
perhaps has no promptings in that direction. It is important that one take 
sufficient time before the mind and body become tuned up to the day's activi- 
ties to attend to this important physical function. Children and youths, 
both boys and girls, should be carefully coached in this respect by parents 
and others responsible for their care and instruction. 

It is important that parents should know that there is no sovereign 
remedy, or drug, or combination of drugs that will effect a cure of consti- 




Fig. 230.— V-Shaped Colon Mat Cause So- 
called Intestinal Indigestion. 



656 DIGESTION 

pation. Its remedy lies in knowing and practicing daily correct habits of 
life. Nothing will take the place of daily "going to stool" in the right frame 
of mind and getting relief. If this can be carried out faithfully in child- 
hood and youth the majority of cases of constipation will be corrected. 

Ultimate and permanent relief of long standing constipation must 
come through education in the home, the school or the college, and through 
the daily press; but as matters stand that is not possible today and other 
aid must be sought, especially for adults in whom the habit has become more 
or less confirmed. 

Under these conditions the use of cathartics that throw into the colon 
large quantities of fluids that wash it free from contents gives no tone to the 
impaired bowel but leaves it flaccid and soft and more easily distended than 
it was before. Mild laxatives may be resorted to daily but these do not cure. 
All cathartics are for temporary relief only, and all take fluids from the body 
that should be retained, while disturbing digestion more or less. 

The foods that are eaten have an important bearing upon the constipation 
habit. Fruit juices have a laxative effect with most people but there are some 
in whom fruits only set up fermentation and create a gas that distends the 
colon. 

Foods that leave a residue to be carried along to the colon furnish bulk 
and are beneficial because they make some irritation of the mucous lining 
of the colon inducing a flow of watery substance that helps to soften the 
mass and sweep it along. All vegetables such as spinach, other greens, let- 
tuce, celery, asparagus, cabbage and radishes leave some residue. There is 
also residue from lean meat. 

Excessive fats and oils beyond what the digestion can absorb are carried 
along and mechanically lubricate the bowel and hasten the emptying process. 
These, however, may do harm by overloading the digestive apparatus and 
creating indigestion. 

The outer wall of all grains is indigestible and when eaten is carried 
along to furnish the bulk. It does more than that. If the bran of wheat 
or the outer skin of corn is examined under a magnifying glass it will be seen 
to have a sharp edge. This sharp edge scratches the lining membranes 
of the colon; the irritation excites contraction in the bowel and this forces 
the contents along. It also increases the flow of juice into the tube, and 
this also favors bowel action. 

It is because of the above fact that all cereals have a vogue as break- 
fast food and that whole wheat bread, bran and cracked wheat have been 
found useful as remedies for constipation. 

All kinds of nuts leave a residue and in addition they contain oil; 
and all oil is a laxative if it finds its way into the colon. 

The skin of most fruits are not digestible and are carried along to 
make bulk in the colon and to excite it to action. That is the principal reason 
why prunes have had a vogue as a breakfast food. 

The pulp of oranges, even the inner part of the peeling, is edible and is 
useful in forming bulk in the colon. Figs have a reputation of being useful 
in constipation due to the multitude of indigestible seeds they contain that 
scratch their way along the bowel in addition to whatever of aid there may 
be in the fruit and skin. 






CONSTIPATION 657 

Mucilaginous foods such as okra and flaxseed also are useful. Agar may 
be regarded as a food if it is eaten. It is not digested. It travels through 
the intestines as a moist, bulky mass. 

Careful attention to a diet that leaves a residuum in the bowel will over- 
come constipation in most people. In others where the habit is confirmed 
and obstinate resort must be had to some laxative medicine taken judiciously 
and at the right intervals. In the treatment of such cases the personal pecu- 
liarities that may be the cause of the trouble must be inquired into, and this 
is the field of curative medicine. 

The Internal Bath. — A. R. writes: "1. What is an internal bath? 
2. Should the internal bath be used as a regular routine?" 

Eeply. — 1. Internal bath is a term which the manufacturers of a cer- 
tain type of syringe are seeking to introduce. By it they mean the forcible 
injection into the lower bowel of a considerable quantity of water. 

2. No. 

In explanation: After the food has been broken up and digested by 
the saliva and gastric juice it enters the small intestine. During its travel 
through this twenty-five feet of tube digestion is completed. Whatever is 
soluble goes into solution and absorption progresses. 

About five hours is required for the passage of food from the mouth 
through the stomach and small intestine. The contents of the small intes- 
tine are poured into the large intestine. This tube is about five feet 
long. The progress of food through this tube requires about forty hours. 
There is no digestion in the large intestine. That was completed in the 
small. Absorption, however, is active. Bacterial action is at its maximum 
in this part of the intestine. 

The last eight inches of the large intestine is called the rectum. The 
four feet above that is called the colon. The tube is the same, of the 
same general structure, the same muscles, the same nerves and the same 
arteries. It happens that toward its lower end the intestine makes a double 
loop which, because of its S shape, is called the sigmoid. All of the intes- 
tine below the sigmoid is called the rectum. 

The intestine is lined by a self-cleansing membrane called the mucous 
membrane. Whoever talks about using injections to wash that membrane 
clean shows that he is an ignoramus or else that he is trying to put some- 
thing over on the people because he thinks they are ignorant. 

An internal bath consists in the injection into the intestine of water 
under considerable force. In other words, it is a violently applied enema. 
Now you have it and that is all there is to it. The enema causes the rectum 
to empty itself. By its pounding force it may cause the colon to move 
and empty some of its contents. So far as the washing effect is concerned, 
the water docs not go above the sigmoid. It has the advantages and 
disadvantages of an enema. 

It is not good judgment for a man to be violently stimulating his lower 
bowel every day with any form of enema. Presently he will have a lower 
bowel which cannot be stimulated by anything. 

The proper method of overcoming constipation is by changing habits of 
eating and exercise. 

Seeks Constipation Cure. — G. F. A. asks if there is any manner of cur- 
ing chronic constipation, and if the constant use of laxatives is injurious. 



658 DIGESTION 

Reply. — Chronic constipation does impair the health. If the teachings 
of MetchnikofF are correct it is a factor in bringing abvut senility pre- 
maturely. It is his teaching that absorptions from the lower part of the 
digestive tract cause the arterial walls to thicken. There is a saying that 
"a man is as old as his arteries." This means that with age the arterial 
walls first become thicker and less elastic. Later they become brittle. 
That which the affected person notices is that he does not feel up to par. 
For years this may be all. But that is enough to make it worth while to 
end it. It is a common condition especially among city people. 

The reasons are many but two are more important than the others, viz., 
lack of physical exercise and eating too small a quantity of bulky food. 
Ordinary walking around a factory office or store or walking around the 
house doing the household work does not suffice. If there is no better way 
of getting exercise walking to and from work is commended. A daily walk 
of two to four miles should help materially. If a man lives two miles or 
less from his work let him walk to and from it. If he lives more than two 
miles let him walk two miles before he takes the car or get off the car two 
miles from his destination and complete the trip on foot. Walking to be 
effective should be rapid. 

The food of the city man is too nutritious and concentrated. One's 
dietary should contain much fruit, cabbage, salads, corn, cucumbers, to- 
matoes, turnips, carrots and vegetables of the rougher, tougher kinds. 
Apples should be washed and eaten unpeeled. The peelings are just the 
part which are most needed. The same is true of the peelings of plums 
and most other fruits. Breads and cereals containing the husks of the 
grain are advised. Ordinary flour is made from the inside of the berry. 
It has discarded the outer cellulose parts that are not worth much for nutri- 
tion, but are needed for bulk. 

There is no short cut cure for constipation. Relief will only come from 
methods persisted in until they become the daily routine., It is not the 
proper plan, therefore, to rely on laxatives. When medical advice is 
sought, as will be necessary in many cases, do not stop with a prescription 
for pills and more pills. Have the physician find out the difficulty in your 
particular case. Have him stay by it until he does find out and then go 
after the cause. You cannot "short cut" in the medical end any more 
than you can in the habit end. 

Liver Does Not Cause Constipation. — E. B. aslcs : "Suppose the cause of 
constipation is the liver, what should be done?" 

Reply. — I doubt much if constipation is ever caused by the liver. I do 
not know of any way by which anyone could say that the liver was caus- 
ing constipation. I think that the simpler explanation is the better and 
that is that constipation is practically always due to lack of physical 
exercise and the eating of too highly concentrated food. After a habit has 
been established a long time it sometimes becomes necessary to do some- 
thing more than remove the cause in order that a cure may be effected. 
These cases will require medical attention. I do not believe that anything 
done to the liver will help them. 

Remedy for Constipation. — 8. writes: "In replying to ( T. I. K! you 
say, 'Do not take medicine for constipation' Being a chronic sufferer, I 
ash what should be done to obtain relief by one 60 years old?" 



CONSTIPATION 659 

Reply. — Try eating bran bread and bran muffins instead of white bread 
and partake freely of fruits, especially figs, dates and prunes. Eat spar- 
ingly of potatoes and meat but freely of vegetables, especially spinach, 
rhubarb, and raw sauerkraut. Sometimes a glass or even two glasses of 
cold water drunk about one-half hour before getting out of bed proves 
effective. Where the condition is the result of lack of exercise practicing 
bending exercises, forward, backward and laterally with the hands on the 
hips is helpful. Walking, of course, is always helpful. Practice good body 
hygiene. In some cases chewing and swallowing agar is of assistance. If 
minor means of this sort do not help you then be advised by some physi- 
cian. By all means do not take medicine unless so directed by a physician. 

Constipation. — Mrs. M. T. B. writes: "My son, 2 years and 8 months 
old, has been constipated ever since he was born. I give him a teaspoon of 
cascara every night and that is not sufficient, for every little while he has 
a sick spell, fever, and vomiting and his appetite is not good. He craves 
sugar, candy, and sweet things generally. He is under weight and peevish. 
Kindly suggest a good diet for him." 

Reply. — My guess is that you are giving him too much starch and 
sugar. Give him meat, fruit and vegetables. Correct his constipation with 
vegetables and bran bread. Encourage him to play hard in the open air 
and with other children. 

Constipation and Pregnancy. — Mrs. M. K. writes: (( Would the fact that 
a young woman has suffered for a long time from persistent constipation be 
a danger if she should bear children? That is, would she be more liable 
to Bright' s disease or other diseases that are liable to come on during 
pregnancy •?" 

Reply. — Practically, no. 

Water in Constipation. — F. A. writes: "1. Is there any cure for con- 
stipation? 2. Will drinking a quart of water or more a day make a person 
fat who is naturally thin?" 

Reply. — 1. Yes. The chances of cure of late cases is slight. 

2. No. Drinking plenty of water makes the assimilation of food easier 
than it would otherwise be and thus it contributes to "taking on flesh," 
but as the only change in one's habits it would be ineffective as a fattener. 

Castor Oil and Calomel in Constipation. — F. N. I. writes : "Please say 
something as to the relative merits of castor oil and calomel as a cathartic. 
There is a general idea that castor oil will not act as efficiently as calomel, 
but that the latter is liable to be injurious in more ways than one. If 
calomel is injurious and castor oil is not sufficiently far-reaching, what 
would you recommend to take its place in cases where agar and fruits and 
lots of vegetables and other coarse foods seem to be without effect?" 

Reply. — Neither castor oil nor calomel should be used as a remedy for 
constipation. For cases where fruit, vegetables, bulky food, bran and agar 
fail some physicians are recommending nonabsorbable oils. My advice to 
you, however, is to pass your problem up to a physician — one who has given 
thought to the question. You have gone as far on your own hook as you 
are justified in going. 



660 DIGESTION 

Oatmeal in Constipation. — J. E. H. recommends as a remedy for con- 
stipation the following: Put a cup of uncooked oatmeal into a quart of 
cold water. Let it stand over night. Drink this water and eat the oatmeal 
uncooked. 

Reply. — The remedy proposed for constipation is good. 

Wheat for Constipation. — Z. R. recommends the following as a cure for 
constipation: "Take wheat in the grain, clean it as best you can, and 
grind it in a coffee mill. Then cook it about an hour for breakfast. You 
can eat it with milk or cream. It is cheap, wholesome, and good. It will 
cure you of constipation." 

Senna in Constipation. — R. writes: "Will the daily use of senna leaves 
as a laxative tend to aggravate an obstinate case of constipation, or cure 
it? Is there anything better to use?" 

Reply. — It will have a slight tendency to produce constipation. Bran 
or agar with plenty of rough food is better. 

Laxatives. — R. E. V. writes: "What is your opinion of a laxative 
compound from aloin, strychnin, belladonna and ipecac? If taken two or 
three times a week by one troubled with constipation would there be any 
harmful effects?" 

Reply. — This is about as harmless a medicinal laxative as there is but 
bran, vegetables and fruit are better. 

Bowel Obstruction. — M. E. R. writes: "I have a strange feeling in my 
stomach. Sometimes it seems as if it is in the right side of my stomach, 
and sometimes near the center. It is not a pain, but seems as if some- 
thing is clogged there. It has been like this for about a week. I have a 
rumbling sound in my bowels. Do you think I have appendicitis?" 

Reply. — Nothing in the history written suggests appendicitis. It does 
suggest obstruction, partial and incomplete. If thorough purgation does 
not prove this supposed partial obstruction to be fecal you had better see 
a physician. 

What to Do. — N. H. L. writes that he is "a young man greatly troubled 
with indigestion." He then proceeds to describe a constipation which has 
not yielded to the continued use of pills. He wants to know what to do. 

Reply. — Constipation is prevalent among office and store employees in 
cities. It is rare among laboring men and women. 
Several things must be done to bring about a cure: 

1. Eat bulky food in large quantities, apples unpeeled, all kinds of 
fruits with the peeling wherever it is possible, cereals, whole corn bread, 
whole wheat bread, wheat bran, celery, spinach and radishes. Especially eat 
the tougher, woodier parts. Decrease the amount of meat, milk, white 
bread and other less bulky foods. When meat is eaten consume the 
stringier parts. The point is to go after the rougher parts of meat, vege- 
tables and breads instead of trimming these off or leaving them on the 
plate unconsumed. 

2. Physical work, particularly strenuous work which brings the abdom- 
inal muscles into play. 

3. The plan mapped out must be persistently followed. Enemas and 
pills are makeshifts. 



CONSTIPATION 661 

If the above plan does not work out your salvation you must have your 
case studied and a plan laid out for you and then you must follow it per- 
sistently. Your condition is due to wrong habits and nothing short of a 
changed habit will help you. 

Pumpernickel in Constipation. — Inquirer writes: "I have been advised 
to eat bran bread for constipation. My father says German pumpernickel 
will answer the same purpose. Is this correct?" 

Reply. — It has much rougher fiber in it and will give satisfactory re- 
sults for most people if they will eat enough of it. Others will require 
bulkier, coarser foods. 

Try Eating Wheat Bran. — J. E. S. writes: "I have been troubled with 
constipation as far back as I can remember. I am 28 years old. I also 
am afflicted with indigestion. I always eat slowly, thoroughly insalivating 
all my food." 

Reply. — Cure the constipation by eating an abundance of wheat bran. 
When you are relieved of constipation your indigestion should end of itself. 

Try Eating Bran and Agar. — C. H. R. writes : "In obstinate costiveness 
what is the fundamental trouble? Is it not torpid liver? Does not a weak 
stomach cause costiveness? I eat cherries, pineapple, cheese, white bread, 
and corn beef, and drink lemonade, buttermilk, chocolate, and coffee." 

Reply. — As to torpid liver, no. As to weak stomach, no. Most cases 
of constipation are due to concentrated food. Add to your present diet a 
cup of bran, cooked if you like. Also eat a handful of agar a day. Drink 
plenty of water. These methods failing, you had better see a rectal 
specialist. 

Use of Bran Bread. — E. B. writes: "Kindly state how much bran bread 
one should eat daily for constipation. Is there any danger of eating too 
much? You have published recipes, etc., but never have stated what 
amount should be taken and how often. I eat several pieces at every 
meal." 

Reply. — Enough to get results is the measure. Eat plenty of fruit and 
vegetables. Drink plenty of water. Remember the need of an abundance 
of water in summer. 

No Harm from Bran. — E. P. H. writes: "Is it harmful to eat bran 
in its crude state, providing, of course, that it is well mingled with saliva 
before swallowed?" 

Reply. — No. 

Suggestion for Constipated. — Well-wisher writes: "Here is a good, 
tested, and tried recipe for bran gems: 'Mix a teaspoonful of baking soda 
in one-half a pint of flour, with three-quarter teaspoonful of salt. Add 
one pint of coarse bran. Mix six table spoonfuls of molasses in one-half a 
pint of milk. Stir all together and bake in gem pans in a moderate oven 
for about twenty minutes. Eaten with butter, they are as good as graham 
or wheat gems and inexpensive, as they require no eggs and no butter. A 
cup of prune juice drunk a half an hour before breakfast and agar taken 
twice a day at meals with moist foods, together with bran gems, have been 
known to cure aggravated cases of chronic constipation of years' standing." 



662 DIGESTION 

Reply. — We print the above as a suggestion. 

Uncooked Bran Better. — H. M. S. writes: "Will eating bran bread 
aid constipation as much as using the uncooked article?" 

Reply. — No. 

Laxative Food. — Subscriber writes : "Is -flaxseed good for constipation? 
If so, how should it be used?" 

Reply. — Flaxseed meal as an ingredient of a laxative food would have 
the advantage of containing a laxative oil as well as "roughening." It 
would have the disadvantage of spoiling more rapidly. It is better suited 
for use as an ingredient of a laxative food mixture than as a laxative food 
of and by itself. 

See Physician for Constipation. — L. S. writes: "I have been troubled 
with constipation for about five years, although I have lived on a strict 
diet of laxative foods. Can you tell me of any method of correcting this 
trouble?" 

Reply. — If agar, bran, plenty of water and an abundance of fruit have 
not cured you you are in need of the services of a physician. There are 
specialists on bowel troubles. Perhaps one of these can cure you without 
an operation. 

Enema in Constipation and Indigestion. — A. D. D. writes: "1. Would 
you advise the use of a stomach pump, or enema, for indigestion and con- 
stipation? 2. Do you think that by using one occasionally one will become 
dependent or a slave to it? 3. Does indigestion cause cold feet and hands, 
and a person to be cold natured in general?" 

Reply. — 1. No. 

2. Yes, though much depends on the frequency of use. A large pro- 
portion of the indigestions are due to constipation. When constipation is 
relieved the indigestion disappears. The way to cure constipation is not 
by using drugs or enemas but by changing one's habits of eating. Cut 
your meat and bread bill down one-half and double your bill for fruit, 
vegetables, molasses, preserves and candy. 

3. Yes. 

Home Treatment for Constipation. — Dr. S. recommends the following: 
1. Before rising, drink two-thirds glass cold water. 2. Automassage five 
minutes. 3. Dress in union suit and, take constipation exercise. Jf. Go to 
stool. 5. Breakfast. 6. Stool again, if first attempt was failure. 7. Lunch. 
8. Dinner. 9. Bedtime. Wear moist abdominal bandage all night. 

Constipation diet — [a] Liquid intake, [b] Food rich in fruit acids. 
[c] Food rich in fruit sugars. [d] Food rich in cellulose, [e] Special 
diet; cranberries, bran, agar, etc. 

Food in Constipation. — Reader writes: "1. What foods should be 
avoided by constipated persons? 2. Is it harmful to take any sort of a 
bath after a meal?" 

Reply. — 1. None. The condition is a sin of omission, not commission. 
2. It is better not to take a cold bath or any other bath which is in- 
tended to cause a shock. 



SEASICKNESS 66\ 

What Is Agar? — M. S. writes: "What is agar? You mention it as a 
cure for constipation. Where can I get it?" 

Reply. — Agar is a seaweed. It has no taste and no nutritive value. It 
is valuable because it holds on to water. Your druggist will get it for you 
if you insist. 

Keep On With the Oil. — Mrs, R. H. G. writes: "A great many of my 
friends were converted to the use of paraffin oil after reading the article 
in a magazine. The article said that a prominent London surgeon recom- 
mended the use of the oil, refined and purified; that its use prevented auto- 
intoxication; that it was not absorbed by the body. We all started its use, 
enthused by the claims of the article, and the results have been great. One 
person, a sufferer from bilious headaches, has had none since; another has 
lost her depression. In fact, we all swear by the paraffin. Then along you 
come and say of its use, 'Nothing is absolutely harmless.' We were all 
frightened. Now, please be explicit. We are supposed to take a dessert- 
spoonful of the oil every night forever. It is supposed to add to our years; 
certainly it has added to our physical comfort. But if there's the least 
modicum of future harm in its continued use we want to know it. Please 
tell us and relieve us all." 

Reply. — A few reports of harm from imperfectly refined oil have been 
printed. Your attitude is wrong. To avoid everything absolutely without 
risk you would quit breathing, eating, sleeping, riding on the cars, going 
on the street, et cetera. Hazards cannot be escaped. Try to avoid the 
extra hazards and forget the ordinary hazards. The oil is benefiting you. 
Exercise care to get a good article and use it. 

Patent Medicine in Constipation. — V. E. D. writes: "1. What is ver- 
acolate and what are its properties? 2. Would its use for ninety days tend 
to deaden the natural action of the bowels? In other words, would the 
bowels learn to depend on the stimidation of the drug and not function 
naturally? 3. I am 5 feet 5 inches tall and since July 5 have taken down 
my weight from 190 pounds to 160 pounds by reducing amount of food con- 
sumed and eliminating fats, sugars, and starches. I work in the open air 
most of the time, but am constipated unless I use something to help. Will 
veracolate do it?" 

Reply. — 1. It is said to be a bile salts, phenolphthalein, cascara and cap- 
sicum, and to be a mild laxative. 
'2. In some measure, yes. 
3. Yes. Probably bran and agar would be better. 



SEASICKNESS 

In The Dietetic mid Hygienic Gazette Dr. Boyd tells us that seasickness is 
not a disease but a condition. Most of those who suffer from seasickness 
will find themselves unable to judge whether Dr. Boyd is right or not but 
they will agree with Grover Cleveland that it is a condition and not a 
theory which confronts them. 

Furthermore, Boyd tells us that most authorities recognize two forms 
of seasickness — the psychical and the somatic and that it is often very hard 
to make a differential diagnosis between these forms. In other words, some 



664 DIGESTION 

of those who have it really have it and some think they have it and it is very 
hard to tell the sheep from the goats. 

There is no doubt but that many people can prevent seasickness and 
that many others can make life more bearable while suffering from it by proper 
attention to certain details. The first of these is to take a dose of citrate of 
magnesia the night before sailing. The second is to eat frequently but very 
sparingly during the voyage. 

If the steamship companies would charge one fee for the haul and 
the lodging and then serve all meals a la carte they would do more to 
prevent seasickness than the ship surgeons have ever been able to do. 

Then comes our old friend fresh air — the sovereign remedy, good for 
all the ills that flesh is heir to. A good stateroom with plenty of window 
access to the fresh air, a good deck place occupied by a good deck chair, and 
that occupied by the party of the first part just as many hours a day as 
possible are what is needed. 

And do not forget that Boyd says it is almost impossible to tell the 
imagination cases from the others. There is a pretty fair chance that you 
may be one of the imagination cases and not know it. At any rate give 
yourself the benefit of the doubt. 

Bring your mentality to bear on the side of escape. Think about 
the other fellow. He is probably worse off than you. Maybe your endolymph 
is surging in your semicircular canals. If so, you may decrease the effect 
of the surging by letting it surge unnoticed, and certainly by letting it 
surge unanticipated. 

If in spite of all you have done trouble overtakes you lie as quietly 
as possible for as many hours as possible in the open air. Best a short while 
after eating. Eat simple food and but little of it but eat. 

Consult the Ship's Doctor. — C. B. C. writes: "I have taken a number 
of long ocean trips, and, being susceptible to seasickness, I have used 
Mother Sells' seasick remedy, which has prevented acute illness, and I have 
not noticed any harmful results except extreme dryness of the throat. Can 
there be anything harmful in its use?" 

Eeply. — I judge you mean Mothersill's seasick remedy. If so, you will 
find an article on it in "Nostrums and Quackery" (published by the 
American Medical Association), page 475. According to that publication 
it depends for its effect on its content of 8 per cent caffein and 46 per cent 
acetone chloroform. The book referred to says it does not do all that the 
label claims. If you use it have the ship's doctor keep an eye on you. 

To Avoid Seasickness. — J. B. writes: "Would it be dangerous for a 
woman who is five months' pregnant to cross the ocean? How can one 
prevent seasickness?" 

Reply. — 1. There is some danger but it is not great unless she is excep- 
tionally subject to seasickness. 

2. Eat lightly several days before sailing. Keep the bowels in good 
condition. Keep the mind on other things. Do not expect to be sick but 
keep cheery and optimistic and you will do much to avoid it. 



CHAPTER XXXVIII 



Hernia 



Why hernia? Whenever any part of the body contains organs of size, 
weight, and importance the walls are bony. The head carries the brain in a 
bony case. The chest carries the hmgs and heart likewise in a bony case. The 
abdomen and pelvis constitute an exception. At that the method of forma- 
tion of the abdominal wall during fetal life is the largest factor in pro- 
ducing hernia. 

Hernia runs in families. One practitioner found a family history of 
hernia in one-third of his cases. Another 
found that more than half of 700 hernias were 
congenital. 

Some of the external sexual organs start 
their development in the abdomen and about 
the middle of fetal life push their way to the 
outside. This leaves a weak area, the inguinal 
ring, in the abdominal wall through which 
a hernia can escape either then or later. 

The great blood vessel of the leg is formed 
in the abdomen and pushes its way into the 
leg. The point of exit, the femoral ring, makes 
another weak area. 

Until after birth the great blood vessels 
which feed the child enter through the um- 
bilicus making another weak ring. 

There are an even dozen of these weak 
areas in the abdominal wall. In about half 
of them an open canal persists until after birth. 

Not that there is an opening through the skin; that. is extremely rare. The 
skin is only a covering. It has but little strength. The weakness is in the 
muscles and fascia layers which should be and elsewhere are tough and strong. 

If a man as he walks rapidly along will hold the palm of his hand 
against his abdomen he will feel the jolt of his organs against the wall 
with each step. But that jolt is nothing as compared with the drive of cough- 
ing, sneezing and vomiting. 

In a fit of coughing the intestinal drive against the abdominal wall is so 
hard that occasionally some weak place gives and into the open space a loop 
of intestines pushes. This is what is called an acquired hernia. When the 
intestines push into a ring which has never closed it is called a congenital 
hernia. 

In addition hernias take the name of the weak spot through which 
they push; for example, inguinal hernia, femoral hernia, umbilical hernia. 

665 




Fig. 231. — Method of Applying 
Adhesive Strips for Maintain- 
ing Reduction in Infantile 
Umbilical Hernia. 



666 



HEKNIA 




Fig. 232. 



-A Hernia Sack is a Pouch of Peri- 
toneum. 



Of every one hundred hernias eighty-four are in the groin — inguinal; 
ten are just outside the groin — femoral, and five are at the navel — umbilical. 

The other one per cent is 
divided between the other nine 
locations. 

Hernias are important be- 
cause of the inconvenience and 
disability they cause and the 
dangers they induce. Some 
strain on the abdominal wall 
converts a weak place into a 
hole, just as a crawfish hole 
breaks a levee in times of high 
water. Through this hole any 
organ in the abdomen or pelvis 
may pass. As a matter of fact 
only two structures pass with 
any degree of frequency — loops 
of the small intestine and 
pieces of omentum. 

In the exposed locations 
the contents of the hernia are extremely liable to become strangulated or 
ruptured or otherwise injured. One out of every thirty ruptures strangulates 
or gets seriously hurt some- 
how. A hernia emergency 
is a great emergency. It is 
no child's play. Quick eye 
and instantaneous action 
are required. None but the 
best surgical skill will avail. 
Hernias are also impor- 
tant because of the disabil- 
ity they cause. Six inches 
of intestine outside the ab- 
domen gets in the way, 
limits work, and makes the 
party timid about taking 
necessary exercise. When it 
is pushed back by a truss 
some of the timidity will 
pass away, but the truss it- 
self gets in the way. Never- 
theless, a truss must be 
worn. 

The question arises : 
What should one do about 
a hernia? If the hernia is Fig. 233. — Sites of Ruptures: 1 and 2, Epigastric 

in a baby the chances are ^hST """"^ * lN ° CmAL HEENIA: 




HERNIA 



667 



six out of ten that a truss will cure it. If the person is between one and ten 
years of age, the chance is one to ten. Of children less than fifteen years of 
age trusses will cure one in twenty. When the affected ones are more than 
fifteen a truss will cure an occasional case, but these cases are too few to count. 

This, then, is about a reasonable policy : When a hernia is noted in a baby 
give it about a year's trial under simple truss bands. If at the end of that 
time it is not cured have it operated on. 

What shall the adult do? The answer to that question depends on the 
answer to other questions : Am I to be in reach 
of the best surgical skill in case of strangula- 
tion ? Do I want to run the risk of being the 
unlucky thirtieth? How well does a truss hold 
any hernia up? How many spells of pressure 
colic have I had? How much am I incon- 
venienced by the truss? How much am I dis- 
abled by it? 

If the decision is in favor of operation shall 
the operation be by injection or by cutting? In 
the injection method the canal is filled with 
paraffin or with some irritating chemical. These 
methods are both inefficient and dangerous. It 
is dangerous to inject an uncontrollable irritant 
poison into the tissues hoping that it will inflame 
just enough and not too much. The cures are 
exceptional and rarely permanent. 

The cutting operation consists in damming 
the hole by sewing over it the strongest muscles 
and fascia found in the neighborhood. It is the 
common sense method. 

The best opinion is that no kind of an 
injury or accident can cause a hernia. Dr. Plummer, chief surgeon of the 
Rock Island Railroad, says : "In my opinion, a single strain can never be the 
sole cause of a hernia. I have seen patients that had been run over by wagons 
and by automobiles, squeezed between cars, struck by flying boards, who have 
fallen from heights, been struck by locomotives, who have suffered ruptures 
of the stomach, intestines, kidney, liver, and fractures of the bones from the 
skull to the feet, but in no case have I seen an inguinal hernia resulting from 
any of these injuries or from any injury." 

Xow, there is no doubt that men have noticed hernias for the first 
time just after an accident of some sort or another. They charged the 
rupture to the accidents. They acted in good faith. What fooled them ? 

What happens when hernia develops is this : 

The intestines push their way through the wall of the abdomen; a loop 
comes to lie in a sac; this sac is covered by skin but it is without the 
wall of muscle which we call the abdominal wall. The sac is lined by the peri- 
toneum, the covering of the intestines. The muscles of the abdomen are laid 
clown in layers. There are weak places in the wall. The weak places are 
the spots where the wall did not grow together until the child was nearly 
ready for birth. For instance, one of the weakest spots is the navel. 




Fig. 234. 



Skein of Worsted 
Truss. 



668 HERNIA 

Hernia never happens except at one of these weak spots. Furthermore, 
hernia does not come on suddenly. The protruding intestines must push 
the peritoneum before them in order that the sac shall have a lining. 
This lining pushes slowly. The weak place gives slowly. 

Dr. Coley says: "In the vast majority of cases hernia is a disease rather 
than an accident. The congenital defect is the main cause of a hernia, while 
the immediate or exciting cause plays but a minor role." 

The congenital defect he calls a disease. By it he means that the man 
with a hernia was born with one or more weak places in his abdominal wall. 

How does it happen that men frequently notice hernias for the first 
time following accidents? The hernia was there before the accident. It 
was small. It was gradually pushing its way through the wall. It caused 
no pain. 

When the accident had occurred the man felt of himself for the first 
time, or for the first time he had a careful examination. The small soft 
swelling was noticed. If the hernia was inguinal it may have pushed its 
way to its final location. In case it was umbilical or femoral it was found 
as a soft, non-tender swelling. 

A hernia does not cause many symptoms. It is not tender or painful. 
If pain is present it is because the loop of the intestine is being pinched. 
The pain is colic and it is in the intestine. The sac does not pain or give 
pain. Any painless condition is liable to steal upon those affected. 

The history of hernia, then, is this: The person is born with a weak 
spot in the abdominal wall. Through this weak spot a loop of the intestine 
gradually pushes. Prolonged coughing and straining hasten the process. The 
presence of hernia is generally discovered by some chance. Hernia usually 
causes no pain. A painful hernia should have medical attention at once. 

Hernia. — J. E. 8. writes: "In the case of a hernia in an adult, is the 
person in as good a condition after a successful operation for it as he was 
before he was afflicted? Do the life insurance companies reject an appli- 
cant because he has had an operation for a hernia? I do not want to wear 
a truss, because it keeps the abdominal muscles from healing over the 'hole' 
that the intestine has made under the previous abnormal condition. A 
hernial supporter is almost worthless in my case because it does not come 
low enough, and at times it seems to bear down against the hernia. I 
thought I should get an ordinary web abdominal supporter and have a few 
thicknesses of felt sewed directly over the affected part. Is this a wise pro- 
cedure? What causes a hernia ordinarily? I contend that it cannot be 
lor is not] caused by ordinary coughing, except in a spasmodic cough or a 
whooping cough." 

Reply. — 1. Yes. 

2. No. 

3. I do not think it will avail. 

4. If the wall is very weak an ordinary cough may cause hernia. As 
the child is forming the abdominal walls grow from the region of the 
backbone around toward the front to inclose the abdominal cavity. It is 
very necessary that certain openings in this wall be left open until the 
time of birth, or very near it. One of these openings is the navel; others 
are in the groin. These openings close imperfectly because they close late. 
If the imperfection is very great any cough will cause the weak place to 



HERNIA 669 

open and let the intestines through. If the closure is very strong no cough 
will break it. A truss should press on the opening and nowhere else (so 
far as possible). If when a truss is worn there are colicky pains it is a 
sign that the truss does not properly close the opening and the intestines 
get pinched. This seems possible in your case. 

No Bar to Marriage. — E. H. writes: "Do you think it would be advis- 
able to marry a man with a double rupture? He is healthy otherwise. I 
have been told not to marry him. I am healthy; a little hard of hearing 
caused by catarrh/' 

Reply. — Yes. Your difficulty is more liable to be transmitted than his 
is. 

Rupture. — P. S. J. writes: "Can a rupture on each side be cured with- 
out an operation?" 

Reply. — Sometimes a truss will cure — very exceptional. All other 
methods of cure are operations. Sometimes injection of paraffin cures — 
but it is uncertain and risky. Sometimes injection of' an irritant cures — 
also uncertain and very risky. What is known as a radical operation is 
safest and surest. 

Operation Should Cure. — C. W. writes: "About fifteen years ago I 
underwent an operation for hernia, and a supposed cure was effected. The 
rupture has since come bach again. Do you think that, with the rapid 
strides made in the treatment of this ailment, a permanent cure coidd now 
be had by undergoing a second operation? Would you advise continuing 
to wear a truss as long as no ill effects are felt and the truss is properly 
fitted?" 

Reply. — An operation should result in permanent cure. The exceptions 
are few. If your hernia never gets caught and never produces colic you 
should decide as to operation on the basis of the amount of inconvenience 
from the truss [and the hernia]. If you are greatly inconvenienced be 
operated on. 

Need Operation for Rupture. — Jane writes to ask if there is any cure for 
rupture besides operation. The rupture was caused after an operation for 
appendicitis and fibroid tumor (abdomen). She asks: "Should one wear 
a supporter or bandage all the time?" 

Reply. — 1. No. 

2. Yes. Rupture is purely a mechanical condition and cure must be 
mechanical. In rupture the muscles have pulled apart leaving a weak area 
through which pressure forces the intestines. The only cure is to pull the 
separated structures together and fasten them securely. 

Cure for Rupture. — A. E. G. writes: "Kindly state whether there is 
any absolute cure for rupture outside of the knife, Christian Science, or 
similar faith. I have come in contact with absolute proof of cures under 
all of the above, but regarding other methods, nothing more than printed 
testimonials." 

Reply. — A man with a rupture should wear a properly adjusted truss. 
When the rupture is so troublesome that radical cure becomes advisable 



^ 



670 



HERNIA 



the proper thing is an operation. Nothing else can be recommended. 

Band May Help. — D. H. H. writes: "Can a child horn with a rupture 
he cured without an operation? If so, how?" 

Reply. — A band well adjusted sometimes helps the muscles and fascia 
to cover over the hole. If this result does not follow within two months 
it will not follow. No other method except operation need be tried. 



Truss Will Not Cure. — Subscriber writes: "I have a single rupture. 
Can it he cured by wearing a truss? Are doctors who advertise to cure 
without an operation reliable?" 



Reply. — 1. No 




Fig. 235. — Abdominal Support, Plas 
ter and Webbing (Dr. B. Schmitz). 



it can be held up but not cured by a truss. 

2. No; what they do is to inject 
something into the sac. This is an 
operation as much as the ordinary 
surgical procedure. It is less certain 
to cure and is more dangerous. 

Not Cured; Held Up, — E. M. 

writes: "Can hernia possibly be cured 
by the so-called plaster pad truss 
or by any form of manipulation?" 

Reply. — Cured, no; held up, yes. 

Patent Hernia Remedy. — W. P. 

W. writes: "Has lymphol the proper- 
ties claimed in this pamphlet, and 
is this treatment likely to cure?" 

Reply. — The remedy purports to 
cure hernia radically by rubbing 
with a liniment. 

No, as to each question. 



Knife for Cure. — A. L. T. writes: "For a healthy male, aged k0, do 
you consider any treatment for inguinal hernia, other than the knife, 
worth bothering with?" 

Reply. — Truss for relief; knife for cure. Other methods are usually a 
disappointment. 

Rupture in Baby. — J. H. writes: "1. What is cause of rupture in boy 
less than a year old? 2. What do you think of circumcision? 3. What is 
indicated by baby now four months old that has been holding his head up 
and tidying to sit up ever since birth?" 

Reply. — 1. Straining; possibly violent crying. 

2. Frequently advisable; sometimes necessary. 

3. Nothing. Do not encourage him in his efforts. 

Hernia and Rupture. — R. W. N. writes: "1. Is it generally advisable 
to operate for cure of hernia or rupture? 2. Is the operation for rupture 
often fatal? 3. Is laughing gas and oxygen superior to ether for an anes- 
thetic? If so, why?" 



HERNIA en 

Reply. — 1. Yes, when the operation is done by a careful surgeon and 
the person operated on is not too young. 

2. No. 

3. In short operations, yes; in prolonged operations, no. It produces 
less congestion and less degeneration. For this reason it is preferable 
when operating on persons who suffer from chronic bronchitis, other lung 
troubles, or Bright's disease. 



CHAPTEE XXXIX 

Obesity and Thinness 

TOO FAT OR TOO THIN 

I presume the idea is general that the average man wants to be fatter 
than he is if he is thin, or thinner than he is if he is fat. Certainly they 
write that way and the getting fatter or thinner is talked about every time 
a group get together. 

You and I must not take these complaints too seriously. The speakers 
are joking; they do not mean what they say and they do not intend that 
you and I should believe them. 

A woman will complain loudly about being fat when she has just seen 
some woman whose lines are very graceful but she will not feel deeply 
enough about it to change her methods of living. A man, having had trouble 
fastening his collar, will talk about the tribulations of a fat man and will 
then walk out to his dinner and eat in such abundance as to add still further 
to his flesh. 

Men are about what they really want to be, their complaints, pretensions 
and idle statements to the contrary notwithstanding. A man's weight repre- 
sents about that balance between eating and working which best suits him. 
Though if he be thin he may feel inconvenienced by the cold or if he be fat 
by the heat, he finds enough convenience all in all in eating just about what he 
does and working about as he does to more than offset the inconvenience 
which he feels. Fat people should either "put up or shut up." 

A man who is willing to stand the inconvenience of it can be as fat or 
as thin as he pleases. This is true of well men and even more than is com- 
monly thought of those who are diseased. But the road is long and he who 
travels it must tolerate with inconvenience. 

Cures which claim that change in habits are not necessary are rank fakes. 
We shall suppose that a man has carefully weighed the situation and has 
decided that it is best that he should get thinner. He is wiping to undergo 
the trouble of it all, to readjust his eating and his work. He can make use of 
a system if he pleases provided he does not neglect to change his habits. 
He may even be benefited by "a system," for unless he is unusually endowed 
with "grit" he will need something definite as a staff to lean on. 

How is obesity brought about? 

Passing through some period in which extra work is done the person 
gets in the habit of taking more food and the digestive organs of digesting it. 
This extra food was needed on account of the extra work. When the period of 
work was passed his eating and digesting habit have been established. The 
extra nutritive material not being required for work is stored as fat. 

672 



TOO FAT OR TOO THIN 673 

Children and young people take an excessive amount of exercise; they 
add to their bones and muscles; they get adjusted to this demand; they 
grow up, quit growing, and take up sedentary occupations. Something must 
be done with the -surplus of food to which they have become accustomed ; it is 
stored as fat. 

A woman nurses her baby for a year. She must eat enough for the two. 
The demand stops; she stores the excess as fat. 

Feeding, getting fat, and getting thin are matters of chemistry and 
mathematics and nothing else. When Howe or Hawk at the University of 
Illinois start out to make a feeding experiment, they begin by getting their 
animals in a nitrogen balance — that is, they weigh and calculate just what 
the animal takes in the shape of food and what it passes as waste. When the 
nitrogen passed out exactly balances that taken in a state of nitrogen equi- 
librium is established — the animal neither gains nor loses. 

Starting with this they can run the weight of the animal up or dowr 
precisely as they choose and can calculate to a nicety just how many food 
units are required to make a given change. 

In the same way Atwater of the United States agricultural department 
establishes a heat equilibrium and with an instrument called a calorimeter 
he can run heat up or down and measure the relation of foods to it. So 
much of this work has been done, results are so certain, chemistry is such an 
exact science that were it not for individual and species peculiarities it would 
not even be necessary to "try it on the dog." 

We can analyze foods and get their calories and their nitrogen units. 
By calories we mean the heat and work value of foods; by nitrogen units we 
mean their nourishing powers. 

But a chemical analysis does not always give results which work out 
right when the substances are put into practical use. In the first place, there 
is no stone wall dividing these uses and each under certain circumstances can 
get somewhat into the other's field. We use kindling to start a fire and coal 
to continue it. But kindling can be used to continue a fire and one can 
even start a fire with coal. 

The principal reason for "trying it on the dog," however, is the differ- 
ence in the powers of digestion and assimilation of different animals. One 
of these qualities pertains to the food itself. It is called "units of energy 
required for digestion." 

Whole milk, as compared with bread in calories, runs 310 to 1,215; in 
nitrogen, 3.3 to 9.2. But these are somewhat offset by the high digestibility of 
milk, from 95 per cent for its fat and 97 per cent for its protein to 98 
per cent for its sugars. Milk from an economic standpoint does not make 
a good showing until this third point is taken into consideration. 

In addition to the difference in the case of digestion of different foods 
there is a difference in the digestibility of the same food by different kinds of 
animals. A dog eating meat can extract the largest amount of units from 
it with the least energy. A cow eating meat could get food units from it with 
the greatest difficulty. This is, of course, the great value of milk; it is the 
only common meeting ground for all higher animals. 

In addition to the peculiarities of race there are individual peculiarities 
and right here is where the great difficulties arise in our methods of dieting. 



6?4 OBESITY AND THINNESS 

The cry is for "short cuts," "lazy measures." People want diet lists. The 
handing out of diet lists is about the same sort of quackery as patent medicine 
cures for obesity. 

Of course, the really scientific way would be to follow the methods of 
Chittenden, Atwood, Howe and Hawk and scientifically measure work, food, 
intake and excretion and then adjust the diet and work in such a way that 
on, say, January 1, 1913, the weight would be, say, 160 pounds. But that is 
too much trouble and nobody would submit to it. 

Is there any compromise way, any way founded on good science and good 
sense and at the same time less difficult? Yes. 

Let one keep his work and worry — for worry is work — as uniform as 
possible. Let him weigh accurately. Let him measure and weigh his food and 
increase or decrease it until he finds the quantities which cause him to change 
in weight at the rate which he has planned for himself. 

The plan provides that he keep accurate account of his work. In practice 
he can allow a good deal of leeway for inaccuracy. There is no need for 
the scientific exactness demanded by laboratory experiments. 

It would be very much easier if a quantity standard could be set and 
those who are "taking the cure" could follow that blindly. But the variants 
are too great. The variation for the difference in percentage of values which 
one man can extract from food as compared with another is conservatively 
at as great as 25 per cent. 

The second factor requiring variation is the amount of labor done. A 
man doing hard physical labor will require 50 per cent more food than one 
who does but little. The man doing hard mental labor — particularly as re- 
gards worry and anxiety (since these work day and night) — will require more 
food than the man following a routine mental occupation. 

The third factor requiring variation is the season of the year. Between 
cold and warm weather a difference of at least 20 per cent in the amount of 
food is required. To keep up heat in winter requires food, especially fats. 
This applies to the man who is exposed to cold in winter. It does not go 
with the man who sleeps in a hot room, gets up, puts on lots- of wraps, walks 
two blocks to a car and then stays in a warm office until he starts home at 
night. 

The stimulus of a cold skin means a need of more food. The second 
man may call it winter but for him it is summer and he should not in- 
crease his food. Say, then, 20 per cent variation according as men are exposed 
to cold. 

With such wide variation in the amount of food required for different 
people it is just as impossible to lay down a quantity standard for all people 
as it is to write out a diet list. The only plan is for each one to regulate 
his quantity to suit his work, his experiences, the seasons, and his peculiarities. 
Having established this, he can work up if he wants to get fat; he can work 
down if he wants to get thin. But up or down, it will be work. 

Getting fat will prove more difficult than getting thin but if consump- 
tives who are in the nonfebrile stages do get fat whenever properly controlled, 
"the lean kind" should not lose hope. 

Finally there should be no intemperance in changing weight. A plan 
of gradual change is wise. If getting fat and thin is subject to mathematical 



REDUCING AXD FATTEXIXG 675 

and chemical control it is within the reach of any who are willing to undergo 
the necessary inconvenience. 



REDUCING AND FATTENING 

Sugars and starches the chemist groups under the head of carbohydrates. 
When the animal body burns carbohydrates energy is produced. Grease 
and fats the chemist groups under the head of hydrocarbons. As the 
word hydrocarbon is liable to be confused with carbohydrate by the readers 
of this article I shall use the term fat instead. When the animal body 
burns fat heat is produced. 

Albumins, whether from meat, milk, or vegetables, the chemist terms 
protein or proteids. When proteicls are burned the elements produced go 
to repair tissue. The salt and similar substances in foods the chemist terms 
salts. When these are absorbed and go into the tissues themselves, they are 
used to repair tissue. 

Anyone reading the above would get the idea that the different kinds of 
food are pigeonholed to stay — that carbohydrates can make energy only; 
fats heat only, and proteids repair material only. The fact is that a good 
deal of interchange is possible. When one needs energy and cannot get 
carbohydrates, fats and proteids can help out : when one needs heat and 
grease cannot be had, the other groups help out. and when one is doing things 
that ordinarily call for proteid and enough proteid cannot be had, by eating 
plenty of starch and sugar the proteids of the body can be spared. 

Arctic explorers have found that they can prevent their muscles from 
being burned out by feeding their life fires plenty of sugar. 

With this foundation, my readers will be able to understand what 
follows. 

The greatest authority on diet for disease is Professor von Xoorden of 
Vienna. 

Are you fat ? Do you want to reduce ? Then read what the great Aus- 
trian says about it. He tells us that we must get rid of the idea of something 
for nothing. The only way to have a cure is to earn it. 

When a man buys one of those get-thin-quick-Wallingford obesity cures 
he wants to cheat the game. He ends by cheating himself. The Wallingfords 
in the obesity business know that the suckers want to cheat and they see to it 
that they cheat themselves while Wallingford acts as receiving teller. 

Yon Xoorden says : "It was formerly thought that certain foodstuffs 
were especially bad for the corpulent, or the reverse. We now know this is not 
true. The amount of fat gained or lost by the body depends ultimately on the 
ratio between its requirements in calories and the actual supply." 

I should have explained the term — calories — earlier. It means heat units. 
It is a measure of the heat producing power of the food. As a measure of 
the energy producing value it is fairly good. As a measure of the repairing 
value of food it is only moderately good. Where we are limited to one way 
of measuring the value of a food the calorie is the measure employed. 

You will note that in the above quotation von Xoorden tells us that 
the way to reduce is to reduce the fuel value of the food taken below the re- 



676 OBESITY AND THINNESS 

quirements of the person reducing; in other words, to force him to supply 
the deficiency by burning up his own fat. 

The natural way to proceed is to reduce equally the three groups. Von 
Noorden tells us that that does not work. The appetite is satisfied by bulk of 
food, not by quality. The dieting man must not get too hungry. Further- 
more if his food is not bulky he will become constipated. 

The object should be to make the heaviest cuts in those foods presenting 
the most nourishment in the least bulk. He therefore excludes cream, butter, 
fat meat and all other forms of grease. 

Those of us who eat the tender meats made from fat, high grade pointed 
beef get a good deal of fat in the lean. His diet list allows about four 
ounces (a quarter of a pound) of protein (lean meat, for instance) a day 
and about eight ounces (half a pound) of starches and sugars. 

Bread is more responsible for obesity than any single article of diet. The 
reason is that bread does not usually figure in the count. If one eats at a 
restaurant the rule is that bread is not charged. If one recounts what 
he eats at home he tells his story in terms of meat and vegetables. Bread 
is what the New Orleans man calls lagniappe — thrown in without charge. 

When one weighs his food as a part of a dieting program he discovers 
what a heavy bread eater he has been. 

Von Noorden is of the opinion that rapid cures of obesity can be free 
from danger if the food bulk is kept up and the blood pressure is adjusted 
by drinking water. On the subject of cure by refraining from water he says : 

"The amount of water is entirely without influence on the process of fat 
reduction/' 

Water should be used to fight the disturbances of circulation. When the 
man feels exceedingly faint and "gone" he needs a drink of water to increase 
the volume of blood. 

Generally speaking, von Noorden is in favor of slow reduction and against 
rapid reduction. 

To sum it all up, the way to reduce is to eat less food than your 
system requires, not somebody else's system — your system. In reducing the 
food it is advisable to eat within limits of bulky food of low food value. The 
group of foods to be most cut are the fats. 

There are many people who think they want to get fat. Some of them 
want to get fat and some only think so. If a person is of a consumptive 
family, or has consumption, or has been cured of consumption he had better 
get fat and stay fat. All others are better off as they are. 

There is a large group of thin-as-a-rail, highly nervous people who are 
most anxious to get fat. They sometimes go to great trouble to get fat. 
Usually they have an idea that if they get fat they will be less nervous. 

It is the other way round. When they quit worrying, move out into 
smoother waters, get less nervous, they begin to fatten. But there is no use 
lecturing; there are large numbers of thin people who want to get fat. 

Von Noorden tells us that in his clinic they are able to fatten patients 
on an average of four pounds a week. This is better than the average 
in the consumption sanitaria. 

This is the von Noorden way. He is seldom able to give more than 
four ounces of proteid a day. If he tries to give more it brings on indiges- 



REDUCING AND FATTENING 677 

tion which defeats the object. The carbohydrates are raised as much as 
is possible but it is seldom possible to give more than ten ounces a day. 
Four ounces of proteid and ten ounces of carbohydrate give 1,400 calories. 

To this diet he then adds as much fat as the patient will stand. He 
usually gets up to ten ounces. This gives 2,700 calories a day. 2,700 
calories digested and absorbed by a man not doing manual labor will put 
on fat. 

In order to get a person to take that much food value in a day good 
cooking is required. By good cooking is meant skillful covering up of tastes 
and odors and development of new tastes and odors. Also an ability to 
take milk, bread, meat, eggs, butter, cream and oils and to twist them first 
this way and then that way. 

Von Noorden warns us that when we fatten a man we do not gain much 
for him. "We are only increasing the amount of fat in the body. Of course, 
proteins are well stored in the body, but even under the most favorable cir- 
cumstances their amount is very small compared to the increase in fats. 
Moreover, it is very questionable whether the nitrogenous substances which 
are retained during overfeeding really produce an increase in the living 
protoplasm/' 

Diabetes. — In diabetes sugar is present in the urine. The kidneys put it 
there but in doing so they only did their duty. They put sugar in the urine 
to get it out of the blood. The essential condition in diabetes is excessive 
sugar in the blood. There is always sugar in the blood. The work of the 
body requires it. In diabetes the amount is much beyond the require- 
ments and the kidneys eliminate the excess. The sugar is in the blood 
because the liver put it there. 

Now we are getting back to the important causative factor in most 
cases of diabetes. An excessive activity of the sugar forming function of 
the liver is a chief feature in diabetes. The most important excitant of the 
sugar forming function of the liver is the carbohydrates of the food. Note 
that the starch and sugar eaten do not pass directly into the sugar of the 
blood. They stimulate the liver to make sugar, using, however, elements 
that they furnish. They are first torn down and then built up. 

The first step then in treating diabetes is to cut down the starches and 
sugars — to cut out bread, potatoes, sugar and sweets of all sorts; to use only 
those diabetic flours that contain 20 per cent or less of starch and not to 
eat bread from those unless the starch has been well cooked, cooked as is the 
crust of the bread. 

To keep this up for months is as far as many people need to go. But. 
it cannot be kept up indefinitely. The man with diabetes burns up tissue 
much more rapidly than does the well man. Absolutely at rest he burns 
up more tissue than a healthy man digging ditches twelve hours a day. 
American investigators have proved those points. 

This waste must be provided -for. Naturally, we say increase the fat 
and the proteid. Give the man enough butter, cream, olive oil, cotton seed oil, 
butterine, lard and fat meat to compensate — which is good advice up to 
a certain point. The stomach will only stand for a certain amount of fat. 

Naturally, also, we say give the man an excess of lean meat, gluten 
flour and other forms of proteid. But there a danger lies. The experi- 



678 OBESITY AND THINNESS 

menters have found that proteids stimulate sugar production by the liver. 
Eubner tells us that in healthy people this action is slight but in diabetics 
it is great. 

Von Noorden tells us that we must give proteins but that they must not 
wholly replace the carbohydrates. They must not be given in excess. He 
says that proteins of eggs and vegetables are better for diabetics than those 
of meat and milk. 

He furthermore says that mixed meals should not be eaten. Where 
one is eating carbohydrates and proteids he should eat the carbohydrates 
at one meal and the proteids at another and more than two hours should 
intervene between the meals. 

However, fats cannot carry all the load. The stomach will not stand 
it. His advice is to give as much fat as the stomach will stand and then 
to divide the balance of the requirement between starches and proteids. 

After the first period of nearly complete carbohydrate starvation has 
been gone through with von Noorden allows his patients to increase the 
amount of starch and sugar taken and to decrease the amount of proteid. He 
thinks the meals and flours from oats are the best forms of starch. Next 
in order he places banana flour. 

He thinks that when the amount of meat and other proteid is kept ex- 
tremely low the patient can take wheat, rye and potato starch without harm. 

Diseases of the Kidney. — By this name von Noorden designates the 
different kinds of Bright' s disease. In them the kidneys are crippled. The 
crippled organs must be spared as much as possible. "The more protein is 
broken down in the body the more will the kidneys be tired out with work. 
The fact that medical practice has for a long time insisted on the value of a 
minimum intake of all forms of protein in nephritis is a special expression 
of the general view that damaged organs require the greatest possible amount 
of rest." 

Chittenden of Yale has taught us that we can get along permanently 
on a small amount of lean meat. People with Bright's disease need some 
meat, milk and eggs but they do not need much. Von Noorden says that 
spices and all extractives should be excluded from the diet. 

Everybody knows what spices are. Most will need to be told what 
extractives are. Extractives, roughly, are the flavors of meat. Beef tea 
is rich in extractives; boiled beef is poor in them. Meat soup is rich in ex- 
tractives; the meat removed from the soup is poor in them. A good rich 
chicken soup made out of an old hen is exceedingly rich in them. 

Von Noorden also lays stress upon the strain put on the kidneys by 
the removal of water from the blood. The practical teaching of that is 
that it is well for a nephritic to spend the winter in the far South where 
the climate is both warm and even. 

The idea is that in ridding the body of the surplus water the kidneys 
must do what the skin fails to do. In such a climate the skin stays on 
its job of exuding water all the year and the kidneys are never required 
to carry an extra burden. 

If spring waters are used the best are those with little mineral in them 
— the plain flat, pure waters. 

Von Noorden ends his article by cautioning against stereotyped rules in 



SCALE OF WEIGHTS 



679 



diet. What is too much for one man is not enough for another. What is 
food for one man is poison for another. 

It is an everyday experience that hard and fast rules are laid down 
and carried out which only regard the name of the disease and do not 
take any account of the individuality of the patient. 

In dieting two pairs of scales are necessary — one to weigh the subject 
on; one on which to weigh his food. 



SCALE OF WEIGHTS 



A woman 10 per cent overweight is fat. One 20 per cent overweight 
is obese. These statements recently appeared in a leading medical journal. 
To be called fat is bad enough ; to be called obese is intolerable. 

To reduce is not easy. Self-denial is required. Sensations unpleasant 
enough to be called suffering will be experienced. Something more than 
impulse is needed. Perhaps knowledge that one is obese may supply the 
necessary incentive. 

The New York Life Insurance Company uses a scale of weights from 
which the following table is made up : 



4 FEET 9 INCHES 


5 FEET 4 INCHES 


Age 


Sex 


Normal 
Weight 


Obese 
if Over 


Age 


Sex 


Normal 
Weight 


Obese 
if Over 


20 
30 
40 
55 
20 
30 
40 
55 


Female 

Female 

Female 

Female 

Male 

Male 

Male 

Male 


100 
105 
110 
118 
104 
110 
114 
117 


125 

131 

137.5 

147.5 

130 

137 

144 

147.5 


20 
30 
40 
55 
20 
30 
40 
55 


Female 

Female 

Female 

Female 

Male 

Male 

Male 

Male 


123 

129 

135.5 

145 

128 

136 

141 

145 


148 
155 
163 
174 
160 
170 
177 
181 


5 FEET 


5 FEET 6 INCHES 


20 
30 
40 
55 
20 
30 
40 
55 


Female 

Female 

Female 

Female 

Male 

Male 

Male 

Male 


109 
115 
121 

128 
114 
121 
125 

128 


138 
145 
152 
161 
145 
151 
156 
163 


20 

30 
40 
55 
20 
30 
40 
55 


Female 

Female 

Female 

Female 

Male 

Male 

Male 

Male 


130 

136.5 

143 

153 

136 

144 

150 

154 


163 
171 

178 
188 
169 
176 
186 
196 


5 FEET 2 INCHES 


5 FEET 8 INCHES 


20 

30 
40 
55 
20 
30 
40 
55 


Female 

Female 

Female 

Female 

Male 

Male 

Male 

Male 


116 
123 
128 
136 
122 
128 
133 
137 


146 
155 
162 
172 
152 
160 
167 
171 


20 
30 
40 
55 
20 
30 
40 
55 


Female 

Female 

Female 

Female 

Male 

Male 

Male 

Male 


138 

145.5 

152.5 

163 

144 

153 

158 

163 


173 
182 
192 
204 
180 
190 
197 
205 



680 



OBESITY AND THINNESS 



5 FEET 10 INCHES 


6 FEET 


Age 


Sex 


Normal 
Weight 


Obese 
if Over 


Age 

20 
30 
40 
55 
20 
30 
40 
55 


Sex 


Normal 
Weight 


Obese 
if Over 


20 
30 
40 
55 
20 
30 
40 
55 


Female 

Female 

Female 

Female 

Male 

Male 

Male 

Male 


147 
155 
162 
173 
153 
163 
168 
173 


184 
193 
203 
217 
191 
203 
210 
217 


Female 

Female 

Female 

Female 

Male 

Male 

Male 

Male 


156 
164 
172 
183 
163 
172 
178 
183 


195 
205 
212 
227 
204 
216 
224 
227 



A tendency to take on fat is of different significance according to age 
or other circumstances. It has been asserted that obese children are especially 
prone to develop diabetes in middle age. As will be noted from the above table 
there is a natural tendency to take on fat as age progresses. Between 40 and 
55 years of age this is very much more marked in men than in women. 

Producing this change are several factors. One is an improper relation 
between muscular work done and the amount and kind of food eaten. An- 
other change is in certain internal secretion glands — the thyroid and the 
sex glands particularly. A third is a general tendency toward equanimity. 

When senile atrophy has advanced further the tendency to obesity is re- 
placed by a tendency toward emaciation. People who approach three 
score and ten will do well to forego all measures having for their end holding 
the fat down. After that milestone has been passed effort should be made 
to put on flesh. 

OBESITY 

In all cases obesity results from a disturbance of nutrition. Too much 
food of all kinds is eaten and not enough exercise is taken. The body 
cannot burn the food up into the final products of combustion — carbon dioxid 
and water. The system uses a makeshift. It converts the excess of food, 
particularly the starchy foods, into fat and shoves it aside into the tissues 
to get it out of the way. 

If the food did not come in such large quantities and at such frequent 
intervals, if the body were given time and opportunity to oxidize the food by 
work, it would take the materials essentially needed, burn up the rest 
and not be burdened by excessive deposits of fat. Where laziness abides 
fat resides. 

All ease and pleasure loving peoples have their pleasure spoiled by the 
fat accumulated. Thus obesity is met with in great frequency among the 
oriental and African races. 

Obesity and gout are closely associated and both thrive on the same 
victim. Alcoholic indulgence, injury or invalidism preventing bodily exer- 
cise do their share to load the body down with fat. 

Outside of "looks" — which are sometimes in and at other times out 
of fashion — obesity is a serious hindrance to the enjoyment and comfort of 
life. The internal organs all have deposits of fat that may interfere with 
their proper action. Shortness of breath, bronchitis, palpitation and other 



OBESITY 681 

functional embarrassments are occasioned. It also results in lessened in- 
stance to infection. 

The prevention of obesity rests on regulation of diet, habits and exercise. 
No more food should be taken than can be used up by the body. An exces- 
sive diet of starch foods and malt liquors should be avoided. The real 
burning up of food is not accomplished in the stomach but in the lungs and 
muscles. They are the metabolic furnaces. Keep your lungs and muscles 
active. 

The treatment for those who already suffer is chiefly along the above 
lines. The fundamental conditions should be removed. Stop feeding the 
trouble. The diet should be cut to at least one-half the usual amount. 
Fats and starches should be limited a little more than the proteids. The total 
elimination of fats and starches is not thought advisable. The amount of 
liquids should also be limited. 

Indolence and disinclination to exercise should be strenuously combated. 
Too much sleep or idle lying abed should not be encouraged. 

Invalids not able to take active exercise should practice passive move- 
ments. Frequent cold bathing by those who can tolerate it is beneficial. The 
skin and kidneys should be kept active. There is an anemic form of obesity 
that requires special treatment. 

In most cases people can fight off fat if they are determined and per- 
sistent in their efforts. 

FAT AS A SIGN OF AGE 

The normal man is about 12 per cent fat. If a man eats each day just 
a little more food than he uses in his work and keeps it up he puts on fat. 
The amount of excess food required is slight. In certain experiments a 
nutritional balance was found by trial and then two slices of bread and a 
good sized helping of butter were added to the daily diet. This was enough 
to add on fifteen pounds in a year. Saundby calls obesity of this kind not 
abnormal but the consequence of an abnormal kind of living. 

The obese people of weak constitution only get 11 per cent of useful 
energy out of the food they eat instead of the normal 25 per cent. We do 
not care much so long as we are fat and useless whether it results from 
abnormality of the body or an abnormal kind of living. 

About the age at which occurs the change of life in women both men 
and women fatten up. This is the first sign of age. It is generally agreed 
that this change results from abnormality. Some say it is due to aged sex 
glands; others to aged thyroid glands; others to combinations of these; and 
still others to other causes. 

While the scientists are arguing we may accept this as true — the man or 
woman in the forties or in the fifties who slowly pui:s on flesh, who develops 
the "fair round belly and good capon lined" of Shakspeare is showing the 
signs of age. 

Of course., his mind is poorer; he tires more quickly; he cannot walk 
upstairs without panting; he snores because his head is filling up with fat; 
he is in increased clanger of pneumonia and of diabetes, but that is not 
the point. He is showing his first sign of age. Whether it be man or 



682 OBESITY AND THINNESS 

woman, it is a change of life. It is just as good a sign of advancing years 
as gray hairs. 

It is true that all people do not fatten up; that many get busy walk- 
ing, riding, playing golf, dancing, rolling ten pins and so keep the fat 
from accumulating. But on the other hand the hair is not an infallible 
sign. 

This period is followed some twenty or more }^ears later by another 
stage, "the lean and slippered pantaloon." In this stage the fat is con- 
tinuously disappearing from all parts of the body. In consequence the 
skin so long stretched to cover the body hangs in loose, inelastic wrinkles. 

Not only is there loss of fat until the man's body is less than 12 per cent 
fat but there is also a loss of water. The tissues dry out; the soft, almost 
gelatinous tissues harden up. This is the stage of old age accomplished. 

In this stage the body works extremely economically. There is little waste. 
Wear progresses slowly. 

In no other part of a man's career does he grow old so slowly. In no other 
part of his career is he as free from danger of infection and disease. With 
the exception of colds the body stands infection well. 

HOW TO DECREASE GIRTH 

The pouchy abdomen is in bad repute. It is rightly so, for, as Lyds- 
ton says: "Given the firm, well developed abdominal muscle, it is hardly 
necessary to examine the rest of the muscular system. Any set of exer- 
cises w 7 hich gives good abdominal development imparts an excellent general 
development. Abdominal protuberance in individuals out of condition is more 
apparent than real, and is due to flabbiness of the abdominal walls rather 
than to increase of fat or girth." ' 

This is pretty generally recognized, and, being so, many men and women 
put in some time each morning rolling back and forth on the floor. 

Rolling persisted in will reduce the girth — but there is a simpler way 
which is better in that it better builds up the abdominal muscles. 

The abdomen has muscles in front which bend the body forward and 
others behind which bend it backward. In addition there are three sets on 
each side which run around from back to front — one set straight around, one 
set diagonally downward, one set diagonally upward. The brain has excellent 
control over these muscles; therefore, it is not difficult mentally to pick out 
the muscles of a certain part of the abdominal wall and to throw them into 
a state of tension. 

First bend forward slowly and strainingly by making the front group 
outpull the back group ; then backward by making the back group outpull the 
front group. This exercises the up and down muscles. Next, by holding the 
breath fix the diaphragm and then push the intestines hard against it by 
pulling hard on the muscles which run around the abdomen straight and 
diagonally. Next, while holding the abdomen against the edge of a table 
take a deep breath thus using the diaphragm to press the intestines against 
the abdominal walls. 

In addition, from time to time during the day throw the abdominal 
muscles into a state of tension moving systematically through the lower part 



OBESITY 683 

right side, upper part left side and diaphragm back in the order named. This 
can be done without attracting any notice as one sits at his work. 

A good muscular tone to the abdominal walls will decrease the girth. If 
the man continues to overeat he will store up fat but the abdominal tension 
maintained by strong muscles will drive the fat to other parts of his body. 
Fat makes areas soft. It also seeks out soft areas. Whenever a given area 
becomes a work, or strength, or tension area fat packs up its baggage and 
moves. 

OBESITY CUKES 

To cure obesity is the easiest thing in the world. Practically anybody can 
be cured by any one else. The fattening of thin people is about as simple. 
There is not one person in a thousand who goes into a tuberculosis hospital 
while he is in the early stage but that can be fattened twenty pounds in 
six months. 

If this can be done with tuberculous people, given the same control 
of mind and body, nervousness, exercise and food it can be done with well 
people. All this means that anybody can add to or take from his flesh if he 
desires it sufficiently to pay the price. 

This is the method: 

1. Cut down the amount of food to a point where the patient steadily 
loses one or two pounds a week. To limit the water drunk helps some. 
To limit the bread, potatoes, stuffings, pastries and alcoholics aids 
some. But the crux of the situation is to get a pair of scales and weigh 
out an amount of food that causes a loss of weight in that patient. People 
vary in the food which is required to fatten them just as hogs do. What 
would fatten one man would starve another. Cut the amount of food low 
enough and the man will certainly lose weight. Xo man can be trusted to diet 
himself by guessing. The whole scheme fails unless the food is weighed. 

2. Exercise must be definitely taken. The record must show that a 
given amount of exercise is taken each day. Here, too, individuals differ. 
But the main difficulty is that the man cheats himself because he makes no 
definite daily record. 

3. Weigh each week. The amount of clothes must be uniform. The 
heart of the scheme is scales. No dieting scheme without scales is worth 
anything. With scales any man willing to take the trouble can reduce 
his weight. Any obesity cure, except that of patiently day by day earning 
the cure is worse than useless and is frequently harmful. It is in this broad 
sense that I have written that obesity is a sign of laziness. It would have 
been better to have said that it is a sign of lack of control and patient determi- 
nation. 

GETTING THIN 

Growing children seldom get enough food. Eubner, Waters and Aron 
have shown that full feeding will add to the stature attained by growing chil- 
dren. Workingmen doing hard manual labor seldom eat an excess of 
food. Therefore from the fat who would be healthier if thin these groups 
should be dropped. 

Financiers, merchants, office workers, clerks, and housewives, on the other 



684 OBESITY AND THINNESS 

hand, go about their duties as a class panting because they are too fat. All 
of them know it and some of them want to reduce. 

There is some danger in reducing. The system, mechanically and chem- 
ically, has become adjusted on the basis of fat, the mind is temperamentally 
on that basis, the subjects usually have passed the years of elasticity — 
readjustment is not so easy as it once was. 

But if the man has weighed the inconvenience and danger and has 
come to a determination to reduce — how shall he go about it? Let him begin 
with the following as one day's diet: 

Meat — Four ounces (four cubic inches). 

Egg — One. 

Cereal — One plate. 

Bread — Three slices. 

Butter — Two helpings. 

Sugar and cream in coffee. 

Vegetables (except potatoes) in small quantities. 

Drink water freely. 

Eat fruit freely. 

This total quantity should be divided into three meals. It is the starting 
point. The man, having weighed to begin with, should increase this quantity 
or decrease it until he finds the amount of food which will cause him to 
lose not to exceed a half pound a week in weight. 

Exercise alone will not cause a loss in weight. The man who exercises 
has more appetite, eats more and gets fatter. But increased exercise com- 
bined with decrease of food, each change in moderation, will build up muscle 
and replace tissue lost as fat. A fat man has a tight skin and below it his 
tissues are under tension; in reducing the muscles should grow to maintain 
part of this tension. 

Water helps the stomach to break up the food. Taken two or three hours 
after meals it liquefies the food and helps the stomach to empty itself. More 
of the nutrition of food is absorbed where the stomach's contents are well 
liquefied. 

STRAIN OF REDUCING 

Those who have an oversupply of thyroid secretion are disposed to be 
restless, energetic and under weight. Those who have an undersupply are 
slower mentally, have more poise and are disposed to be obese. 

Among the first effects of the wear and tear of life is diminished secre- 
tion of the thyroid. The first sign of this diminished secretion, therefore 
the first indication of senility, is a tendency to obesity. Therefore obesity 
is an effect. 

In turn it acts as a cause. On the one hand obese and overfat people 
not obese are less liable to be consumptive and perhaps also to disorders 
belonging to the worry family. On the other, they are more liable to have 
diabetes, pneumonia and fatty heart. 

Since the obese are short-winded and indisposed to exercise and suffer 
from a lot of disorders due to lives of physical inactivity they generally 
want to reduce or think they do. The last phrase is added because at least 



OBESITY 685 

nine out of ten who talk about reducing have not the determination to come 
across. 

On this feebleness of the average will the obesity cures are based. In 
the first place they advertise that they are easy. That appeals, for the obese 
want everything easy. In the second place, they figure that the fat man will 
quit before he finds out that he is being bunkoed, for, in the language of the 
political orator, each and every obesity "cure" is a fake. 

There is no medicine which will reduce a person who eats when he pleases, 
what he pleases and as much as he pleases. The same is true of exercise 
methods, machine methods and every other short-cut method. 

The person who has the determination needed to reduce by privation and 
work should not be discouraged; yet there are some facts he should know. 
Reducing does increase the tendency to certain conditions. 

When in the reducing process the store of glycogen is drained out of 
the tissue the susceptibility to infections is increased. There is an in- 
creased tendency to boils and other forms of pus infection. There is an 
increased tendency to consumption. 

The strain bears on the brain as well as the rest of the body and insanity 
has been known to develop. Insanity will not develop in a person of good 
poise but people not previously of good mental timber are liable to develop 
maniacal depressive forms of mental trouble. The drained out muscles record 
pains and cramps that are commonly described as muscular rheumatism. 

There is some increase in the tendency to Bright's disease. I have 
seen one case of leukemia develop in a person who was reducing rapidly, 
and I have heard that others have seen the same sequence. The person who is 
reducing rapidly in winter time will surfer unduly from the cold. These draw- 
backs are only liable to occur during the process of reducing. The desired 
weight having been attained and the diet having been increased to the amount 
needed to maintain that weight the above dangers and inconveniences dis- 
appear. 

Oertel Diet for Obesity.— W. J. T. writes: 'What is the Oertel diet 
for obesity and heart?" 

Reply. — Breakfast : 

One cup coffee. 

Three ounces bread. 
Noon: 

Three and one-half ounces soup. 

Lean meat roasted or boiled — seven ounces. 

Fish — one ounce. 

Fresh fruit — three and one-half to seven ounces. 

Bread — three and one-half ounces. 

Perhaps a little light wine. 
Afternoon : 

Coffee. 

Bread — one ounce. 

Water — six ounces. 
Supper : 

Eggs — one or two. 

Meat — five ounces. 



686 OBESITY AND THINNESS 

Bread — one ounce. 

A bit of cheese, a little fruit salad. 
Six ounces wine and four and one-half ounces water. 
Oertel places great stress on exercises. 

Fifty Pounds Overweight. — Subscriber writes: "I am a young man of 
23 years and a college graduate. While at college I took an active part in 
almost all branches of sport. Since graduating two years ago I have 
become stout, weighing 210 pounds. My height is five feet nine and one- 
fourth inches. I am still an active member of the Y. M. C. A. and also of a 
training club. I bowl, play baseball, handball, and medicine ball several 
times a week. My general condition is excellent, except that I always feel 
bloated, even after a light repast. I am naturally a light eater. Is there 
any certain diet I should follow, and if so, will you aid me?" 

Reply. — You are fifty pounds overweight. You evidently get large 
values out of what you eat. Probably you have intestinal fermentations 
by which the starches and sugars are in part converted into alcohol and 
gas. The alcohol easily burns into energy and that means that the other 
foods must be stored as fat because the tissues do not need them. People 
who bloat easily and have much gas are prone to become obese. 

One Way of Getting Thin. — C. E. S. writes: "I reduced my weight 
from 23Jf pounds in two years to 180 pounds. I left off taking soup and 
drank nothing with my meals and not for two hours after. I had been 
drinking from two to five glasses of water with each meal. I missed it 
at first, but soon forgot it and did not care for it. I soon got into the 
habit of drinking water after the two hours. I made no change in my 
diet and ate anything good that I could get, but I was careful to 
stop eating before I felt full. The only guide I had was that I should be 
hungry an hour before meal time and anxious to get to the table. If I 
was not hungry before meals I ate still less but always enough. I did not 
suffer any inconvenience and felt fine all the time. I did no hard work 
and did not have much exercise, being at my desk all day. But I never 
varied or had any lapses. I did not weigh the food and weighed myself 
only when it happened to be convenient, but when I did I found I was 
gradually dropping down. I did not make it a task and soon got into the 
new habit. Maybe this plan will work on other fat men. What do you 

think r 

Reply. — Fifty-seven pounds in two years was reducing too fast for the 
average person. Cutting down the amount of water with meals cuts down 
the proportion of food absorbed. It works in many instances as well as it 
did in this. A better plan is to cut down the amount of food eaten. Your 
plan worked well because you stuck steadily to it. Where the average 
man fails in any reducing plan is that he does "vary and have lapses." 
Again, you scored when you "were careful to stop eating before I felt 
full." 

Reducing Weight at 68. — A. McE. writes: "Last July I was found to 
have blood pressure of 226. I am 68 years old and then weighed 201/. 
Previous to that time (July) I had always enjoyed good health. I have 
been placed on diet and my weight is down to 190, blood pressure 185 at 
present time. I am still on diet and hope to reach 175 pounds. My height 
is 5 feet 8 inches, and I confine myself to sal hepatica one teaspoonful 



OBESITY 687 

three times per week as a remedy. Is this sufficient? I am and have been 
on a vacation since July and take moderate exercise every day. What 
further would you suggest?" 

Reply. — I would suggest nothing except that you consume at least a 
year in taking off those additional pounds and, better still, that you do not 
take them off at all. You are at the brink of the life period when obesity 
naturally becomes less, when the tissues naturally shrink some and when 
blood pressure naturally falls somewhat. In view of this I think you 
had better go slow about reducing further, particularly at the rate of three 
pounds a month. 

Cut Down Quantity of Food. — J. 8. H. writes: "I have been getting 
fat for the last ten years, about three pounds each year. My weight is 
175 pounds, my height 5 feet 5 inches, and age 35 years. I generally walk 
two or three miles each day, and sometimes more, also do some exercising 
in the morning." 

Reply. — You are about thirty-five pounds overweight. Walking ■ and 
exercising increase your appetite. Cutting down the quantity of food is 
your only remedy. 

Take Less Food. — Mrs. 0. M. P. writes: "I am past 30 and much over- 
weight. My head aches much of the time. Can you suggest something 
that will relieve me?" 

Reply. — Probably your obesity and your headaches are cut from the 
same cloth. When more food is eaten than is needed the surplus is stored 
as fat. Too much food and too little exercise together constitute one cause 
of headache. 

To get relief eat less. Decrease your food until you are losing weight 
at the rate of one pound a week. Stick to that quantity until you get 
where you should be. 

Reducing obesity is work. The short cuts are fads. 

Reducing Weight. — J. R. writes: "Please give me a formula for reduc- 
ing weight. I am 16 years old and weigh 135 pounds. I think I am a 
little too heavy for my age." 

Reply. — About the only formula worth while is to eat less and exer- 
cise more. What you eat is of little consequence. At 16' it should be easy 
to form habits of exercising in the open air that would keep you physically 
fit all the year round. 

Don't Take Medicine. — M. E. G. writes: "I am desirous of dieting 
in order to reduce my superfluous flesh, but find it extremely difficult to 
refrain from eating enough to satisfy a hearty appetite. Is there any- 
thing one can take to lessen one's appetite or relieve the pangs of hunger 
without, of course, in any way injuring oneself?" • 

Reply. — Poke root and iodids are sometimes taken as obesity cures. 
Some part of their action is because they lessen the appetite somewhat. 

My advice is that you do not take either of these or any other medicine 
for obesity. Fill up on soup, fruit and bulky vegetables, eat sparingly of 
bread, potatoes, meat and milk. A small amount of food eaten slowly is 
as satisfying as a large amount eaten rapidly. After all is said, to reduce 
obesity requires persistence and "grit." 



688 OBESITY AND THINNESS 

Short Cut Obesity "Cures." — F. L. writes: "Do you consider rubber 
garments to reduce flesh beneficial or harmful? I refer to rubber stock- 
ings." 

Keply. — They do no good. They do some harm to the skin. Eeduce 
your food and take more exercise. All short cut obesity cures are fakes. 
Rubber garments belong in the list. 

Diet Held Successful. — H. writes that using the following diet he has 
taken off fifty pounds in the last year. He has kept at work and felt well. 
For a time he would get hungry in the afternoon. When hungry he would 
fool his stomach with beef tea. 

The Diet. — Upon rising sip a tumbler of hot water (with a squeeze of 
lemon juice if you like). 

Breakfast — One or two cups of coffee or tea without milk or sugar. 
If sweetening is required dissolve a saccharin tablet in a little water and 
add two gluten biscuits. Four ounces of lean broiled chops or cutlets 
(four ounces equals about two chops), or four ounces of broiled or boiled 
white fish, such as sole, cod, turbot, haddock, halibut or perch; or four 
ounces of lean chicken, game, or broiled kidney. (Use plain condiments 
as below.) 

Lunch — Four ounces of lean broiled chops, steak, lean beef, mutton, 
chicken or game, taken hot or cold, roasted or boiled (with gravy if free 
from fat). Four ounces of green vegetables (given in list below). Four 
ounces of stewed or baked fresh fruit, such as apples, gooseberries, cher- 
ries, stewed pears, rhubarb, and the like (sweetened, if at all, with sac- 
charin, dissolved in a little hot water). Two gluten biscuits. 

Dinner — Any clear soup. Four ounces of fish (from breakfast list). 
Four ounces meat (from lunch list). Vegetables, stewed fruit, and salad. 
Two gluten biscuits. Shell fish, such as lobster, oysters, clams, and the like, 
may be taken at lunch or dinner. 

Details of Diet. — Before retiring at night sip a tumbler of hot water. 
Drink freely at or between meals of plain or mineral water so as to keep 
the kidneys acting well. The bowels must be kept open. Take gentle 
exercise each day stopping short of fatigue. All beverages and stimulants 
containing sugar must be eliminated. 

For necessary sweetening use saccharin dissolved in a little hot water. 
In place of bread use gluten biscuits. A cup of beef tea or strong, clear 
soup may be taken when liked. A cup of black sugarless coffee or sugarless 
tea can be taken when liked. 

One need not necessarily eat all of the variety mentioned for meal if 
less satisfies. Do not eat potatoes, green peas, butter beans, breads, pork, 
fresh or dried fruit, eggs, cream or milk, or fried food. Vegetables and 
salads allowed: Beets, cauliflower, eggplant, spinach, carrots, mushrooms, 
turnips, oyster plant, squash, green beans, cabbage, artichokes, asparagus, 
celery, cucumbers, tomatoes, lettuce, endive, water cress, brussels sprouts, 
mustard and radishes. Condiments allowed: Flavoring sauce, catsup, 
vinegar, pepper, salt, mustard, and horseradish. 

Comment. — It will be noted that this diet prescribes definite quantities 
and eliminates bread and starchy vegetables. The quantities may be large 
for some persons. If so they should eat three ounces when four is specified, 
or even less. 



OBESITY 689 

Peril in Reducing Weight. — E. K. asJcs for "balanced ration" for one 
who has dieted, reducing forty pounds in six months, to normal weight on 
"greens," zwieback, and the like, omitting starches and sugars. How may 
one retain this weight (greatly improved physical condition also) and also 
have a more varied diet? Is there danger of malnutrition if one omits 
sugars, starches, and fats? If there is a tendency to intestinal disturb- 
ances, what diet is best for one inclined to obesity? No complications or 
chronic ailments except rheumatism. Age fifty. 

Of course this case is in physicians' care but general directions and 
advice are desired. 

Reply. — I cannot send you a balanced ration in detail. You say that 
you are under the care of physicians and it is for them to determine what 
ration is best for you. However, if you hare reduced forty pounds in 
six months you are undoubtedly eating too little. Your internal organs 
have all been adjusted to the presence of some fat around them. This 
fat must not be suddenly removed. Your skin has been adapted to cover a 
certain amount of volume. It is inadvisable to reduce the tension inside of 
your skin too rapidly. You are not justified in reducing at a more rapid 
rate than twenty pounds a year, and ten pounds a year would be better 
judgment. 

If your present method of eating has reduced you forty pounds in six 
months it is evident that in order to make energy and heat sufficient for 
your needs you have had to burn up forty pounds of your fat and muscle. 
If you do not wish to lose more you will therefore have to increase the 
amount of food which you are eating. 

Zwieback is nutritious but greens serve in the main as filling. How- 
ever, it is not so much the things you eat as the quantity which you eat. 
You should therefore increase the quantity of food over that of the last 
six months. You will eventually suffer from malnutrition if you do not 
take some small quantity of meats and also sugars, starches, fats and 
vegetables. 

How to Check Obesity.— P. A. W. writes: "Please advise me as to a 
way to stall off 'getting fat/ I am a young man employed in an office, and 
although I get some exercise at night, am confined all day. Am now taking 
on weight, not solid, but flabby. More strenuous exercise doesn't seem to 
help me. Would a diet be effective? Also, what exercise do you recommend 
as most beneficial?" 

Reply. — Assuming you are increasing your weight more than three 
pounds a year what you need is to diet in addition to exercise. Dieting 
consists in reducing the amount of your food. While changing the articles 
so as to decrease the amount of sugar and starch is of importance the 
main thing is to decrease the amount you eat during the day in such a 
way that you will stop gaining. It is practically impossible to do this 
without being guided by the scale. You should weigh once every week and 
record your weight. I know of nothing in which people cheat themselves 
more than in reducing their food by guess. They cut down for a few 
meals and then eat enough to make up. 

Reducing Weight Intelligently. — Mrs. E. B. M. writes: "I have been 
following your directions for reduction of weight, and am succeeding to my 
own satisfaction and the astonishment of my friends. I find the amount of 
food you allow as reasonable is too much for me to reduce on, but I have 



690 OBESITY AND THINNESS 



worked out a diet for myself, which keeps me satisfied and yet allows 
the loss of one pound of weight a week without any injury to my health. 
The matter which troubles me now in hot weather is how much I ought 
to drink. I crave water and I wish to know if it is safe (with a view of 
losing weight) to drink water freely between meals if I avoid it at meal 
times?" 

Reply. — Water between meals can be taken freely. A moderate amount 
of water with meals will not increase flesh if the food is reduced in quan- 
tity. To take water with meals increases the available nutrition from the 
food, say 10 per cent. Therefore, when water is taken with the meal the 
food should be correspondingly decreased. Do not continue your present 
rate of reduction long. Your organs must adjust themselves to the extra 
room and that requires a little time. You are right in adjusting your diet 
to your needs. One person will fatten on what scarcely suffices for another. 
Wise people adapt standard diets to fit their peculiarities. 

Reducing Weight Too Fast. — C. E. E. writes : "I am a trifle less than 
five feet five inches in height and was 55 years old on May 10. About ten 
years ago I began increasing in weight. I went to 196 pounds. Late last 
year I decided that I ought to do something to reduce weight, and espe- 
cially to overcome the tendency to increase. My health is good, I always 
sleep well. I use no liquor or tobacco, but use coffee, also occasionally tea. 
I started with two meals a day on Jan. 2. For breakfast I have bacon and 
eggs with rolls and coffee, for dinner, for some time, rich cream with 
shredded wheat biscuit and fruit, no pastry. My weight is now (June) 
166, and I never felt better. Have I reduced weight too rapidly •? Am I 
eating the proper food?" 

Reply. — You are still a little above the proper weight for your height 
and age but a drop of thirty pounds in six months is going too fast. In- 
crease the amount of your food until you stop the drop. Do not increase 
it enough to make you gain. Other than that, the diet is right. 

Beware of Fat Reducers. — Mrs. G. McH. writes: "Have you ever 
heard of the following drugs, and if you consider them dangerous to take 
as a fat reducer? Aromatic elixir, 5 ounces; glycol arbolene, 1 ounce. 
Mix and shake well and take a teaspoonful after each meal." 

Reply. — This is an illustration of the new way of advertising a pro- 
prietary medicine. It is called the hidden "ad." No person is justified in 
taking any fat reducer. To decrease the amount eaten reduces fat. 
Medicines do not. 

Water and Weight. — H. E. B. writes: "I have not yet learned from 
your articles what effect six or eight glasses full of water before break- 
fast and two hours after eating, have upon the weight of a person. Would 
it make fat or flesh? I drink very little with meals, but fear I have been 
gaining fullness in the last month or two." 

Reply. — Eirst, there is a chance that it would dilate the stomach; sec- 
ond, it would contribute indirectly to "gaining fullness." If you wish to 
lose flesh reduce the quantity of your food and drink several pints of water 
a day but small quantities at a time, not six or eight glasses. 

To Overcome Obesity. — Subscriber writes: "Will you please let me 
know how to overcome obesity?" 



OBESITY 69J 

Reply. — Obesity is caused when the starches and sugars taken into 
the body are not completely burned up. The first effort should be to limit 
the intake of these foods. In fact, cut down the total quantity of food. 
The amount of fluids should also be limited. The next thing to do is to 
assist the body in using up what is taken. To this end exercise — walking, 
riding, swimming — is of great value. Cold bathing will help some. 

Reduce Your Food. — 8. F. A. writes: "I am about fifteen pounds too 
heavy. A friend told me I could reduce as much as I wanted to by tahing 
a dose of sal hepatica every morning. It is reducing me nicely, but I am 
afraid it will leave me in a run-down condition. Can you tell me some- 
thing better to take to reduce my weight?" 

Reply. — You are not justified in cutting down your weight by produc- 
ing diarrhea. Reduce your food. 

To Reduce Abdomen. — H. S. C. wants to know how to reduce an en- 
larged abdomen. 

Reply. — I cannot help you but I can help you to help yourself. My 
part of the program is a short horse quickly curried ; your part must extend 
through the forty-four years of your life. To speak more accurately you 
must keep up your efforts until you are eighty. After that age the tissues 
are disposed to shrink and you can let up. Enlargement of the abdomen 
can go on without a generalized obesity, or as a part of such condition but 
out of proportion to the enlargement elsewhere. We shall discuss that first. 

The abdomen is held in bounds by the muscles in front and the back- 
bone behind. The way to keep the front muscles from pouching is to make 
them about as strong and immovable as the bones behind. Muscle exer- 
cises to accomplish this end can be taught you by the physical director of 
the Y. M. C. A. 

There are several factors in the accumulation of fat at fifty-six — in- 
heritance, overeating and thyroid atrophy. Some have it "in the blood" to 
fatten up as they reach middle life. This means that such people must 
strive the harder if they would keep thin. 

The thyroid gland becomes senile in many people in middle life. As 
this senile atrophy develops such people tend to put on fat. They get 
relief from small doses of thyroid — just a little, enough to supply the de- 
ficiency and, therefore, but a fraction of the several grain doses so fre- 
quently given. In taking thyroid persistently you are imitating nature 
but thyroid must never be taken except under medical direction, for it is 
too powerful to be tampered with. 

Much the most important instruction is to decrease the quantity of 
food eaten. Whenever a man is getting fat he is eating too much and 
that is the main thing wrong. He may be eating like a canary, or not eat- 
ing enough to keep a sparrow alive, or eating less than other people, or 
eating less than he formerly did — nevertheless, he is eating too much. 

If his thyroid is atrophying or he is of fat stock there is all the more 
reason why he should adjust his food to his body and his work. The best 
evidence that it is not so adjusted is his increasing fat. 

The right policy is a gradual reduction of the amount of food to a 
point where the weight remains uniform, reducing just a little lower still. 
A full waist line is not inevitable. Want to be slender hard enough — and 
stick. 



692 OBESITY AND THINNESS 

Buttermilk and Weight. — M. S. K. writes: "What effect has buttermilk 
on one inclined to obesity? Is it a fat producer? Is it advisable to eat 
dry toast with unsweetened fruit juice or tea without milk for two meals 
each day when attempting to reduce one's weight?" 

Reply. — 1. It is a fat producer. It is an easily digested food, having 
all of the advantages of sweet milk except that it is less of a heat maker 
(sometimes an advantage) and is usually more easily digested. If you are 
reducing be sparing in your use of buttermilk. 

2. Yes, provided you do not eat too much toast. It is of prime impor- 
tance that the quantity of food taken be reduced. What foods to take and 
what not to take is of secondary importance. 

To Reduce Weight. — S. D. writes: "I have a daughter 10 years of age, 
who weighs lJj-5 pounds. She has been fleshy all her life, but she seems to be 
getting more and more so. She seems to be well in every way, and exer- 
cises as much as any child does. Is there any harmless remedy for her?" 

Reply. — 1. A girl ten years old of average height should normally weigh 
about sixty-five pounds. A weight of one hundred and forty-five pounds is 
certainly excessive. An excessive amount of sugar and starch in the 
food is one of the most controllable causes. A disinclination to exercise 
makes matters worse by failure on the part of the individual to burn up 
the sugars and starches. 

2. The remedy for the condition lies chiefly in limiting the amount of 
fluids taken by promoting bodily exercise to the utmost possible extent, 
and by cold bathing. If this program is persistently carried out satis- 
factory results will be obtained in the course of time in most cases. This 
course of treatment is best taken under the care of a skillful physician, 
who can watch and regulate the diet and habits of the patient. 

To Reduce Weight at 50. — I. M. H. writes : "I am a woman of 50 years 
and am getting stout. I have been told to take the juice of one lemon in 
water before breakfast. 1. Will this reduce my weight? 2. Is it injurious 
to the system?" 

Reply. — 1. No. 

2. No. If you want to reduce your flesh reduce your food. There is 
nothing to be gained by trying to short cut by using vinegar, lemon, or 
other cures. 

Reduction of Weight. — M. M. writes : "I was much struck by a recent 
article from your pen on the subject of obesity. The writer has long 
been afflicted with a good appetite and tendency to lay up surplus aliment 
in the shape of fat. Your article seemed to me so simple that it was 
most practical. To weigh daily and to cut one's food down in quan- 
tity, if found to be more than enough to keep one at a regular weight, 
appeared to me the summit of simplicity; no long list of interdicted dishes, 
with the consequent constant suffering from desire to eat those interdicted 
things, just simple abstinence in quantity. I have, in the past, had long 
formulas written for me by various doctors with lists of food good or bad 
for my constitution, and that course always seemed to me wrong in prin- 
ciple and to lead to an unbalanced diet, for who knows better what one 
needs to eat than the man himself, directed by instinct? So I resolved to 
try your method, and, having a set of good scales in my room, I have been 
testing your advice. Here is the result after eleven days' trial: 



OBESITY 693 

Feb. 26 weight 231 lbs., 8 oz. 

Feb. 27 weight 230 lbs., 8 oz. 

Feb. 28 weight 230 lbs. 

Feb. 29 weight 229 lbs. 

March 1 weight 228 lbs., 8 oz. 

March 2 weight 229 lbs. 

March 3 weight 229 lbs., 8 oz. 

March 4 weight 230 lbs. 

March 5 •. .weight 229 lbs., 8 oz. 

March 6 weight 229 lbs., 8 oz. 

March 7 weight 228 lbs., 4 oz. 

"This seems to me to show a proof of your statement that weight is 
very much a matter of eating more or less food. These figures are not 
anything extraordinary, as I have by no means starved and have par- 
taken of any food that appealed to me. Only I have eaten a reduced quan- 
tity. Of course one might reduce himself a pound a day without any harm, 
perhaps, but I have seen so many cases where people adopted the so-called 
Banting system of eating no sweet or starchy foods, and wound up severely 
ill, that it never appealed to me. During this trial of your method I have 
eaten sweets and. starches indiscriminately, only in reduced quantities. I 
feel much better already, as that sensation of fullness in the morning, on 
awakening, has already left me. My wind is also much improved, and the 
steep steps I have to climb daily to and from my office I negotiate with 
much less fatigue and short windedness. On March 3, by the way, I sat 
reading all day indoors and, instead of eating almost nothing, gave way to 
the usual Sunday stuff. The result shows in the weight column for two 
days after. The weights are taken without clothing in the morning after 
emptying the bladder and bowels just after rising." 

Keply. — This rate of loss is a little too rapid. After your weight reaches 
220 you had better reduce the loss to one pound a week until you reach 
210 and arrange for a slighter weekly reduction after that. 

How He Reduced Weight. — C. Mc. writes: "I have been reading so 
many requests for advice on 'reducing weight' in your department that I 
have fancied perhaps an account of how one woman worked out your advice 
for herself may be interesting. 

"I am — or had been for some ten or twelve years — 5 feet 3 inches tall, 
weight 11^-116 pounds; am of large frame for my height. I have been a 
heavy eater all my life, because I was going on the theory that I needed 
lots of food to keep my strength up. Last year I had a severe illness, and 
when I recovered began to get fat. By Christmas I weighed 138 pounds 
and felt like a stuffed sausage. Stomach was upset all the time. Took 
any amount of medicine, but it didn't work. After Christmas I decided to 
try the starvation plan. I am employed all day long, so cannot get enough 
exercise. I eat this year at a high grade cafeteria. I began by either eating 
almost nothing at my evening meal or going without it. Also I cut out 
potatoes, bread, and pie. It was pretty hard at first, and I got hungry. 
My moral courage received reinforcement when Lent came, because I re- 
solved for once to keep the rules of fasting and abstinence for my body's 
health as much as my soul's. 

"I could not weigh my food, so I merely cut it down more and more 
and guessed at proper quantities. After a while I found I did not crave 
the heavy meals I had formerly and was feeling infinitely better. So when 



694 OBESITY AND THINNESS 

Easter came and my 'Lenten discipline' was over, I found no desire to 
'make up' by excess. A week ago I found I weighed HJf. pounds. I feel 
better, work better, digest better than I have in years, so much so that 
I hear many remarks about my improvement in health. The only thing 
I am still tied to is an occasional mild laxative. The sense of control, of 
not being tied to the whims and vagaries of a sluggish body, of self-re- 
spect and nerve poise gained from the knowledge that I can if I will, is 
worth an infinite deal. About the middle of Lent I came across Courtney's 
'Conquest of Nerves/ and found it helpful. I wish I had seen it a year 
ago." 

Reply. — This should prove a healthful experience. 

Reduce Quantity of Food. — H. I. M. writes: "If you wish to reduce 
your weight should you eat foods containing calories or protein? I am 
interested in your statements of food values." 

Reply. — Eat food low in calories — or, to put it more simply, decrease 
the supply of bread, potatoes, sugar, and milk. Best of all, cut down the 
quantity of food eaten. 

Limit to Haphazardness. — Hotel Boarder writes: "Your suggestion 
that everyone who tries to become either stouter or thinner by dieting will 
fail unless he goes to the trouble of weighing every morsel of food he eats 
seems to me wholly impracticable. It is certain that few will adopt it, in 
any case, especially among hotel dwellers. If a man wants to increase his 
weight, would it not meet the case if he would begin by simply eating a 
little more than usual of everything he is accustomed to eat, by guess; get 
on a weight scale once a week or so, and keep on eating a little more and a 
little more until the scale showed satisfactory results'? I can't see any 
difficulty in that, or any need whatever for spending half of one's time 
in making arithmetical calculations as to the exact number of grains of 
this, that, and the other that one has absorbed at the dining table." 

Reply. — Theoretically your suggestion is all right. Practically, there is 
a limit to haphazardness beyond which not much is gained. The man who 
is not enough in earnest to take some trouble in his dieting does not get 
results. He may think he is dieting but his "fingers are crossed." Arnold's 
"Diet Tables" (any large book store) give approximate weights of ordinary 
"helpings." The limit set by these is about as far as one can go and get 
results. 

Amount Varies for Persons. — E. D. L. writes : "As a stout man anxious 
to reduce, I have been following your articles on diet with much interest. 
I regret, however, that they are all negative — viz.: telling what not to eat. 
May I suggest that you follow these articles up with one telling what to 
eat, as, for example, a daily menu." 

Reply. — As to a list of things to be eaten and another not to be eaten 
I do not take much stock in them. As to specifying quantities for people 
generally that I have not. much faith in. What is too much for one man 
is not enough for another. 

Why not do the proper thing — find out what amount of food causes 
you to lose a pound a week and eat that amount? 

Practice Is Harmful. — M. I. writes: "A friend is taking two heaping 
teaspoonfuls of Epsom salts each night before retiring for the purpose of 



HOW TO GET FAT 695 

reducing flesh. I insist that this is harmful. Will you kindly give your 
opinion?" 

Reply. — You are right. The salt will lose its effect and he will be left 
with an intractable constipation. If he does not intend to let the excess 
of food absorb, why eat it ? 

Should Weigh 160 Pounds. — T. P. R. asks : "What is the correct weight 
for a young woman 5 feet 9 inches? At one time I weighed 183 pounds, 
out have lost thirty pounds." 

Reply. — You should weigh about 160 pounds. 

Proper Weight. — A. B. writes: "Will you please tell me the proper 
weight for a woman Jj.3 years old, and 5 feet 4 inches tall?" 

Reply. — 135 pounds. 

Keeping the Weight Down. — E. I. W. writes : "I have been doing with- 
out sweets and starches and eating meals dry for three months to reduce 
weight. Have lost twenty-five pounds. Have been adding a little sweets 
each day for a few days and find I am gaining, although I am still eating 
gluten bread and keeping up the rest of diet. Will it be possible for me to 
get into a general diet again without losing all that I have gained?" 

Reply. — Yes — provided you cut out some meat, milk, eggs or some other 
nutritious element in proportion as you add sugar. If you add sweets faster 
than you cut out other foods you will fatten. 

Bread a Fattening Food. — A. W. P. writes: "1. Is there any kind of 
bread — about three pieces a day — one can eat that will not increase one's 
weight? Some say white bread is the most nourishing. 2. Will half a 
pound of Epsom salts added to the daily warm bath help make a person 
thin?" t 

Reply. — 1. One is about as fattening as another. Bread is the fattening 
food. 
2. No. 

HOW TO GET FAT 

First — Regulate the amount of food. 

Second — Regulate the amount of work — worry is work. 

A fat animal is one out of nutritional balance on the plus side — one 
which eats and assimilates more food than is required to supply energy and 
Tepair waste for and incident to the work which it does. The individual who 
thus gets out of balance may have at first a series of diarrhea spells — nature 
trying to get rid of the surplus — but presently the machinery settles down 
into a routine of storing the excess — at first in the areas of low pressure and 
later any and everywhere. 

This storing is only an exaggeration of a normal process. Some fat 
around the eyeballs, some under the skin rounding out the angles, some under 
the bones of the feet to soften the jar, some here and there for special purpose, 
is natural. 

As the excess of food over work persists there is labored breathing — an 



696 OBESITY AND THINNESS 

effort to burn up the surplus — kidney and liver strain, in an effort to unload, 
perhaps migraine. The fat man then has an increased danger from heart 
disease, kidney disease, sudden death and, above all, pneumonia. On the 
other hand life insurance tables show that the fat man is less liable to 
consumption. General belief is that he is cheerier, happier, and worries 
but little. 

If a man having weighed the arguments for and against obesity wants 
to get fat or fatter, how shall he proceed ? 

First — Limit his work, and particularly his worry. 

Second — Leave his work where it is, but increase his food. 

As a starter he should take in the twenty-four hours about the follow- 
ing articles and quantities : 

Meat — Five ounces (five cubic inches). Potatoes — Four ounces. 

Milk — Three pints. Butter — Six servings. 

Egg — One. Bread — Half a loaf. 

Cereal — One plateful. Dessert — One helping. 

A way to divide this is as follows : 

BREAKFAST 

Coffee — One pint, with milk and sugar. Egg — One. 
Bread — Three slices. Fruit. 

Butter — Three helpings. 

LUNCH 

Meat — Two ounces (two cubic inches). Pudding — Five ounces. 

Fish — Two ounces. Butter — One helping. 

Bread — Two slices. Cheese — One-fourth pound. 

Vegetables. Milk — Eight ounces. 

SUPPER 

The same as lunch. 

He should gain not to exceed one pound a week. If he is gaining more 
than this he should decrease his food. If he gains less he can increase it. 

He should be temperate in gaining. He will be a chump if he works 
his kidneys to pieces or "pants like a porpoise" just to get some extra fat on 
his frame. 

Weight Gaining Foods. — H. L. B. writes: "1. 1 am twenty-jive years old, 
5 feet 6 inches tall, and weigh IkO pounds stripped. Do you think this 
underweight? 

"2. I drink at least two cups of beef bouillon and one glass of butter- 
milk a day. Will that help me gain in weight? 

"3. Will patent foods guaranteed to put on weight do the work?'* 

Reply. — 1. No. 

2. The buttermilk will, the bouillon will not. 

3. No. The best foods to put on weight are milk, meat, and bread. 
The best of the advertised foods, pound for pound, are on a par with milk, 
dried milk or other milk products. Most of them cost so much that none 
but millionaires can afford to eat pounds enough a day to help much. 



HOW TO GET FAT 697 

Would Gain Flesh. — W. K. R. writes: "Will two tablespoonfuls of olive 
oil taken upon arising and two upon retiring cause a person to gain flesh?" 

Reply. — Four tablespoonfuls of olive oil contains about 600 calories — 
about as much as three-quarters of a pint of cream. Olive oil is princi- 
pally used by the body to make heat. Nevertheless, if a man were eating 
about enough food to repair wear and to take care of his needs and to that 
amount were to add four tablespoonfuls of olive oil a day he would gain 
flesh slowly. 

To Increase Weight. — A. P. writes: "I am 11 years of age, and weigh 
about 110 pounds. What is the best hind of exercise and the best food to 
increase my weight?" 

Reply. — 1. The best kind of exercise is some form of competitive sport 
in the open air. Play football until Thanksgiving. Play in some con- 
venient park playground or Y. M. C. A. until very cold weather. Skate 
as soon as the season comes. The best kind of food is meat, bread, milk, 
vegetables, and fruit. Don't waste time on diets. Eat plenty of plain, 
wholesome, nutritious food. The point is to eat enough. 

Weight Is Too Low. — Brevoort writes: "1. Is a weight of 11+5 below 
the average for a height of 5 feet 11 inches? 2. At the age of 35 years 
what can be done to increase weight? 3. Is wine after eating of benefit?" 

Reply. — 1. The proper weight for a man of that age and height is 170 
pounds. You are 15 per cent below on the Nylic scale. 2. Eat more; 
worry less. 3. No. 

Will Make One Fat. — F. C. H. writes: "Will the drinking of butter- 
milk make a person fat?" 

Reply. — Yes, if enough is used. 

How to Increase Weight. — D. C. A. writes: "My appetite is good. I 
eat three good meals a day. I am very thin and pale; haven t the energy 
it seems to me I should have. I have been told by physicians time and 
again that my food does not assimilate. What do they mean by it?" 

Reply. — Food in being built into tissue undergoes the following — 
mastication, digestion, absorption, assimilation, the last being the final step 
in tissue building. If you are in good health you can put on flesh if you 
want to bad enough. 

First — Do not fret or worry. 

Second — Weigh your food. 

Third — Increase the quantity of milk, buttermilk, eggs and bread 
until you commence fattening at the rate of one pound a week. Keep 
this up until you are satisfied. 

Milk to Increase Weight. — H. F. B. writes: "I drink an average of 
one-half pint of milk and eat about same amount of ice cream a day. 
Would that help me gain in weight? If not, what do you advise to use to 
gain at least thirty pounds of good solid flesh?" 

Reply. — It will help but it is not enough. Eat plenty of meat, bread, 
vegetables and fruit and drink several pints of milk in addition. At 
least a pint a day should be taken. A quart will be more satisfactory, 



698 OBESITY AND THINNESS 

Eggs to Increase Weight. — M. M. writes: "Do you advise my taking 
raw eggs — six daily — in an effort to gain in weight?" 

Reply. — It will help but you should take an abundance of milk, bread, 
meat, and vegetables in addition. 

Below Normal Weight. — T. writes: "1. I am 5 feet 9 inches tall and 
weigh but 132 pounds. 2. Will drinking one pint of buttermilk a day in- 
crease my weight? 3. Is buttermilk better than sweet milk? 1/.. Is there 
any danger of contracting disease from fresh buttermilk?" 

Reply. — 1. Your proper weight is 148 pounds. You are 8 per cent 
■underweight on the Nylic scale. 

2. No, you need more than that. 

3. Not quite so good. 

4. Depends on the buttermilk. Some is safe, some not. It averages 
safer than sweet milk. 

How to Get Fat. — F. L. B. writes: "1. I am trying to take on weight. 
Would you kindly advise me on that point? 2. Are the following good: 
Eating of fats, (3) drinking lots of water and milk, (If.) bathing a lot, 
running quite a bit, and boxing?" 

Reply. — 1. Eating abundantly of all kinds of food is good. Starches 
and sugars are more effective than fats. 
2. Yes. 

3 and 4. Of no special service. 
To get fat : 

Do not worry or fret. 

Eat more than you need. 

Eat heavy suppers. 

Sleep more than eight hours. 

Eat More ; Sleep Long. — H. P. W. writes : "Being 6 feet 2 inches and 
weighing but 165, I should like to increase my weight a little, if it can be 
done with no detrimental effects. I have been advised to use three grain 
hyponuclane capsules, and I wish to inquire if they are the proper thing. 
What constitutes an adult's dose and with what frequency should they be 
taken? What is their approximate cost?" 

Reply. — You should not depend on any sort of medicine to fatten you 
any more than you should depend on crutches to win you a foot race. To 
get fat, eat more than you need, keep quiet, do not worry, be regular in 
your habits and sleep long hours. Eat supper and go to sleep shortly after. 
You know how we turn the trick with animals. Follow the same plan. 

In Need of More Fat. — A. S. weighs 11+0 pounds, is 5 feet 10 inches high, 
and 30 years old. He takes a teaspoonful of olive oil twice a day. Will 
this do any good? 

Reply. — You are about twenty pounds underweight. A teaspoonful of 
olive oil contains 60 calories — not enough to be of any service though it is 
good as far as it goes. 

Should Increase Diet. — C. B. P. writes: "I am nearly 60 years of age, 
5 feet 9 inches in height, and until a couple of years ago weighed 11+5 
pounds. But I only weigh about 135 now. My general health is fairly 






HOW TO GET FAT 699 

good. Lately I have been drinking a cup of hot milk before meals. Could 
you suggest a line of food tliat would tend to fatten me up?" 

Reply. — You are twenty-five pounds underweight. Hot milk before 
meals is excellent. Increase your diet still further. If you are organically 
sound you can gain some weight. 

How to Gain. — E. J. A. writes: "I am 23 years of age and weigh 110 
pounds. I have a great fondness for stewed apples, cake and milk. 1. I 
don't think apples cooked in this way have any fattening tendencies, but 
would like to know whether or not they are injurious. I work at night, 
and when I reach home about If. a. m. I eat a big dish of stewed apples, 
several pieces of sponge cake and a couple of glasses of milk. Then I go 
to bed and don't arise until 12 or 1 o'clock. 2. I have heard eating just 
before retiring is injurious, but suffer no ill effects. I don't seem to fatten 
up any. 3. Could you tell me what I should or should not do in order to 
flesh up a bit?" 

Reply. — 1. They are not injurious. 

2. Eating before you retire will not hurt you. 

3. You do not say what you eat besides stewed apples, cake, and milk. 
If this is all you eat you need bread, meat, and vegetables. If you will eat 
enough plain, solid food, drink enough milk, sleep enough, and keep calm 
you will put on weight. 

Worry and Weight. — A. Z. writes: "About a year ago I worried a great 
deal over domestic troubles which I think caused me to lose ten pounds of 
my weight, making me look thin. The cause of my worry has been removed 
for some time, but I have not gained a pound. What can I do to gain 
weight?" 

Reply. — If you have quit worrying your task is easy. Add food to your 
present dietary until you eat enough to fatten you half a pound a week. 
Continue on that ration until you have got back the ten pounds. Increase 
particularly in your use of milk, buttermilk, cream, cheese, eggs, bread and 
sweets. Drink plenty of water. 

Would Lay on Fat. — A. W. writes that he and his wife had a breakfast 
consisting of the following: Four pieces of toast, two cups of coffee} one- 
sixth pound of cheese, one egg, four pats of butter, four heaping teaspoon- 
fuls sugar, two ounces and a half 18 per cent cream, two teaspoonfuls 
orange marmalade. He wants to know whether three meals similar in food 
value would be too much for a man, who does office work, and his wife, who 
has light household duties. 

Reply. — This figures out 1,600 calories and 795 grains of protein. 
Three such meals would be about 10 per cent too much. You would lay 
on fat on such a diet. 

Properties of Peanut Butter. — J. F. F. writes: "1. What properties as 
a flesh builder has pure peanut butter? 2. Would the consumption of, say, 
ten pounds in five weeks have a tendency to increase the weight of a very 
thin person?" 

Reply. — 1. Peanuts run about 1,500 grains of protein and 2,200 calories 
to the pound. They are better at making heat than making flesh but they 
are good for both. 

2. Yes. Enough other food being eaten. 



CHAPTER XL 

The Skin 

The human body is in touch with its surroundings through the skin 
which covers it externally and lines its cavities internally. These two sets 
of structures at places merge into each other. They are built alike in some 
ways and have work to do which in some particulars is similar. The lin- 
ings are delicate, easily wounded and can only work when things are about 
right. The skin is tough, hard to hurt and adjusts itself to widely varying 
conditions. The linings to work well must be bathed in moisture. 

There are those who believe that the reason for so much pneumonia, 
consumption, and colds is that the lining of the lungs works in air which, 
though moist, is a dryer medium than lining membranes work well in. Com- 
pare the lung conditions with the variable conditions under which the skin 
works — in contact with air sometimes wet and sometimes dry, sometimes 
hot and sometimes cold, sometimes light and sometimes dark. If the 
skin were at all delicate or had delicate work to do it could not adapt itself 
to all these changes. 

The reason for the toughness of the skin is in its structure. It is 
composed of a true skin and over this a covering of epithelial cells called 
the epidermis. The bottom layers are live cells and the outer layers are 
dead. Dead cells are being constantly shed from the surface and in turn 
replenished from the underlying live ones. The blood vessels and the 
nerves are below the epidermis, which means that they are several layers 
below the surface. Were it not for this blood would ooze out on the surface 
and sensitive nerves would make life unbearable. It is the dead layer 
which distinguishes skin from lining membranes, and this dead structure 
is just as useful as any other, or maybe more so. 

Out of the dead layer are developed the hairs and nails — each formed 
for a special purpose. The nails are of service in protecting the ends of 
the fingers and toes. The more we use them the better the nails. Our 
custom now is always to protect the toes and seldom to use them and in 
consequence the toenails, and, in fact, the toes, are disappearing. The only 
toe now having a nail of any consequence is the big toe. To the contrary 
horny masses called corns are becoming universal. We are shedding the 
nails from the old places and developing pseudo nails at new ones. 

The hair is for the purpose of keeping the body warm. The fur of 
wild animals in the far north is heavier, better and more valuable than that 
of the same species in the south. A few years ago a number of monkeys 
in Lincoln Park were kept out all winter. By spring they were heavily 
furred. 

In human beings the growth of hair has practically disappeared from 
all parts of the body except those which are habitually uncovered, and it is 

700 



THE SKIN 



701 



gradually disappearing from these, largely because it is becoming unnecessary. 
With the hair as well as with the nails, and with everything else, nature takes 
from us through disease or heredity or some other agency those things of which 
we make no use. Any policy which makes for thin, pink, pretty nails will 
make for poor nails after a few generations, 
though good -finger nails will persist for a 
few centuries after toenails hav-e gone. If 
we are not to become a hairless race we 
must give more thought and care to con- 
servation of the hair. 

Just as the dead layers of the skin 
pile up to protect the underlying nerves, 
so there are layers of pigment in the skin 
which prevent the underlying tissues from 
the hurt of light. The difference between 
the white, yellow, red and black man lies 
in the skin pigment. Too much sunshine 
may be just enough for some things but 
not for the tissues below the skin. Wher- 
ever races are subject to much sunlight 
their complexions gradually darken. It is 
held that the negro is black because as a 
race he developed in the tropics. 

In an interesting book entitled "Effects 
of Tropical Light on White Men," Dr. 
Woodruff of the United States Army argues 
that acclimatization of the white men to 
tropical light with its abundance of short 
actinic rays will require many generations 
and it will not come about until they have 
developed skin pigment to protect the 
underlying organs. In the interim they 
should protect their tissues from the harm- 
ful rays by wearing black or yellow under- 
clothing and white, gray or yellow top 
clothes. Black should be worn by those 
who work in the shade. Helmets lined 
with tinfoil and with wide brims are need- 
ful. White men in the tropics should rest at midday. 

There are those who argue that in the end those who live out of doors 
will survive in the struggle for the survival of the fittest ; that for survival out 
of doors the darker people are better fitted than the lighter. Therefore, the 
darker races will survive, the blondes — the fair haired — will pass away. The 
people of the world will all eventually be black, or at least dark. 

The other side argues as follows: The light races live in cold climates. 
No structure is in contact with the cold except the skin. Cold applied to 
the skin — for example, cold air on a cold day — makes the man, woman, 
and child eat more food, causes the tissues to burn up better, causes the life 
fires to burn brighter and hotter. This, secondarily, means greater mental 




Fig. 236. — Section of Hair Showing 
the Epithelial Cells Which Pro- 
duce It and Sebaceous Glands. 



702 



THE SKIN 



activity, greater physical stature, more physical force, more energy and 
more stamina — and that these are the qualities that determine which people 
are to survive. 

The first group says the American people in conquering the diseases 
and controlling the parasites of the tropics have made it possible for the 
darker people of the tropics to do more work proportionate to needs than 
the lighter people and therefore in another generation they will be out- 
stripping them. To which the second group says that such people will always 
be runty physically and "dolce far niente" mentally because they lack the 
stimulus of cold air against the skin. 



Sweat Pore 



Epi- 
dermis < 




--— Hair 

Bulb 



Blood 
Tube 



Fig. 237. — Section of Skin Showing Hair, Sebaceous Gland, Sweat Gland and Blood 

Vessels. 



Whether the one or the other is right, it is interesting that the skin 
is to settle the question. 

Attached to the skin, or rather developing from it and a part of it, 
are two sets of glands — those that make sweat and those that make grease. 

The sweat is water and a little salt. Its only work is to help the 
skin to get rid of the body heat. When scores of tissues are making heat and 
but one is getting rid of it, that one needs help. The sweat glands with their 
secretion, sweat, are doing a body service much in excess of that of the nails, 
hair or pigment. 

The skin having as one of its uses the protection of the body against 
cold, it follows that one of its uses is to get rid of heat. We cannot live 
or move, digest or think without making heat. Every tissue in the body 
is engaged in making heat while but two, the lungs and skin, are engaged 
in getting rid of it. In animals covered by hair the lungs have most of the 
work to do. In consequence a dog or chicken breathes faster and harder, 
pants more when exercising or hot, than does a man whose skin does most of 
the work. 



THE SKIN 703 

The blood brings the heat to the under surface of the skin and the air 
absorbs it from the outer surface. But more important, the sweat glands 
pour out warm water — sweat — by the pint and this evaporating liquid chills 
and cools. When much heat is made the sweat glands pour out much heat. 
When little heat is made the skin muscles shrivel and pucker the skin — goose 
flesh — and close the pores of the sweat glands while the little muscles in the 
blood vessel walls contract and press most of the blood away from the surface 
and into the deeper tissues. 

The grease glands furnish grease to keep the skin soft and pliable and to 
keep the hair in good condition. In those parts of the body where there are 
no hairs there are no grease glands — the palms of the hands and the soles of 
the feet. Their usual location is at the hair roots. So important is grease 
for the well being of the hair that heavily covered animals usually have 
large accessory oil glands and with this oil they oil themselves. When you 
see a duck reaching with his bill to a point on his back and then grooming 
his feathers you may know what he is up to. 

A dry skin cracks, fissures and breaks easily. The grease glands in 
keeping the skin pliable and soft really help it in the doing of its work. On 
the other hand people want to keep their hair as long as they can. More 
people are interested in the grease glands and their help in preventing bald- 
ness than in their other uses. The hair may be useless. It may have nothing 
to do with the really important work of the skin but just the same men and 
women want to keep it although they generally discover their interest when 
it is too late. 

The skin, having some contact with the blood, is occasionally the seat of 
disease due to bacteria thrown out by the blood. This is the probable ex- 
planation of the eruptions of typhoid fever, smallpox, and scarlet fever. More 
frequently the skin is the seat of eruptions caused by chemical poisons in 
the blood which act either on the skin itself or on the nerves. Such is 
the explanation of eczema, urticaria, ivheals, herpes, shingles, food and drug 
eruptions. 

The idea that most of the skin diseases are venereal in origin is erroneous. 
Of the three such diseases two do not affect the skin and the third does 
not affect it in all of its stages. Skin diseases usually are due either to 
local conditions or else to digestive disturbance. Skin eruptions do mean 
bad digestion, overeating, fast eating or constipation. They come from 
those gouty conditions which result from a man's eating one dollar's worth of 
food and doing two cents' worth of physical labor. 

As a general rule the skin diseases due to so-called impurities of the 
blood are caused by the germ of the skin. Against these the dead layer stands 
like a stone wall. A germ stands a slim chance of getting through so long as 
that dead wall is there. Once it is brushed off enough to cause oozing any 
germ which falls can go through. 

This dead wall also stands as a barrier against the entrance or the 
exit of anything. Through it neither flesh foods, foods, fats, medicines nor 
drugs — nothing, passes in. Through it nothing from the interior passes out. 
The only gates in or out through it are the pores of the sweat and grease 
glands. A few bacteria go into the grease glands and make pimples, a few 
infect the hair roots and make boils, a few hookworm parasites get in and 



704 THE SKIN 

cause hookworm disease. The barrier occasionally fails ; generally it does its 
work well. It protects, it works hard to get rid of heat made in excess, to 
shield the underlying tissues against heat, cold and light. 

It wears out its life trying to adapt itself to temperature, to wind, to 
weather. It sometimes has diseases, sometimes spreads disease to the under- 
lying tissues; more frequently it receives diseases from them. It is more 
sinned against than sinning. 

SKIN TAN 

There are skins which naturally are thick and oily and others which are 
thin and dry. The condition of the skin is the result of environment. 
A woman out in the sun and wind a great deal must expect her skin to tan. 
If she is in the dark and behind walls all of the time she must expect it 
to be soft and white. 

The object of the skin is to furnish protection to the underlying 
tissues. If the light is bright the deeper layers of skin will pick up an 
increasing amount of pigment so as to let less light through into the 
underlying organs. 

An albino is a person born without pigment, or with very little. It is de- 
ficient in the hair, the eyes, the skin. All of the light which strikes him leaks 
through into his underlying tissues and to him the daylight is as painful as 
it is to an owl. 

Sunshine is a good thing for a human being but too much of it is bad for 
him and even a moderate amount is bad for his skin. Basking in the sun- 
shine can be overdone, however pleasant it may be. When a tubercle bacillus 
or the diphtheria germ tries it death follows in about seven minutes. In 
order that he may indulge, the turtle must grow a thick shell, the man must 
plant trees, build roofs, provide broad-brimmed hats and accumulate pigment. 

As life in the open air is necessary for health a white, pliable skin is 
proof that the owner is leading an unnatural and in the end an unhealthy life. 
Tan, and sometimes freckles, indicate that the owner is leading a life which 
is good for the body as a whole but is bad for the skin. 

This should be kept clearly in mind : It is the exercise and the open 
air which does the good, and the strong sunlight is of secondary importance, 
in fact, is to be guarded against as much as is compatible with exercise 
and air. Lying around on the beach loafing and tanning scarcely gains 
enough good to offset its harm. 

About the same conclusions apply to the wind's tanning. The winds of 
a dry country make the skin brown and leathery. The moving, hot, dry air 
must have water and it takes it from the skin. The climatic condition which 
makes so much for improvement in tuberculosis of the lungs is harmful 
to the skin. On the otheV hand, exercise in the open air on a wet day does 
not harm the skin. The exercise makes heat, the hot blood is sent to the 
skin to be rid of its heat, the sweat glands pour out sweat but the rain 
and snow have filled the air with moisture and the skin is not dried out or 
tanned or mummified. 

The point to this article is that the skin is for the purpose of protection. 
It has work to do. The things that are good for us such as open air and a 



SKIN TAN 705 

moderate amount of sunshine are bad for our skins. If a woman wants 
a lily-white or house complexion she must stay in the house. On the other 
hand staying in the house makes her liable to get fat and flabby and to de- 
velop indigestion from which a bad skin results, so that in the long run 
nothing much is gained for the skin. A woman with a white skin will some- 
times be ahead at thirty but not frequently; after that she is pretty certain 
to be a loser and what woman wants to lose out at thirty? 

SPARE YOUR SKIN 

Tanning is a process by which the skin protects the underlying tissues 
from the effects of light. This is accomplished by the development of a 
heavier pigment layer. The point to keep clearly in mind is that violent 
light is a harming agent. If the skin covering does not stop the work of 
this agent the underlying tissues are harmed; if the skin stops it, the skin 
is harmed; the tissues below are spared. If the skin is much hurt it 
blisters, swells, becomes edematous. If less so, it becomes red and sore and 
eventually peels. If still less so, it tans. 

Pusey says: "As a result of long continued tanning and other results 
of the action of light, very positive deterioration in the skin occurs. It is due 
very largely to the effects of light that the skin of the hands and face 
shows those changes which we recognize as those of increasing years." 

This does not mean that people should not go in swimming, or lie on the 
beach, or fish, or hunt. It does mean that they should try to avoid being 
sunburned and tanned. Of course, there is no justification for sun blister- 
ing. Such an excess limits the pleasure of the outing and gains nothing. 
But if tanning is brought about so gradually that the skin does not get 
sore it stops the light rays and makes one better able to stand the sun 
glare. 

The skin is harmed but the individual gains enough to compensate. To 
lie around on the beach just to tan is foolish. To tan as a means of in- 
creasing the pleasure of the out of doors is usually justified. The prospec- 
tive resorter might well begin gradual tanning before he goes away. After 
going it is well so to regulate the daily exposure that the skin does not 
get sore. 

Nothing is gained by going bareheaded and exposing unnecessary parts 
of the skin. Tanning as a means in a given case may be justified; tanning 
as an end is never justified. 

Going bareheaded, exposing the head to the heat and light in sum- 
mer, is not good for the hair. It is possible that it may do no harm, and 
may even do good in the winter, spring and fall; but the conditions are 
different in summer. 

Baldness is a senility change. It may be contributed to by dandruff, 
by disease and by bacteria. It may be in advance of and apart from 
general senility. A man may be old in the hair but not demonstrably old 
elsewhere. As Pusey says, "Too much sunlight assists in bringing about 
senile changes in the skin. The hair is a part of the skin. Exposure of the 
bare head to the glaring sunlight in summer is more apt to cause than to 
prevent baldness." 



706 THE SKIN 

THE SKIN AND BATHING 

The skin consists of two layers — the true skin and the outer skin or 
cuticle. In the skin are millions of oil and sweat glands which empty 
their contents on the surface of the skin, hair follicles and hair. There are 
also numerous blood vessels — veins and arteries and nerves. 

In that great expanse of skin are a multitude of nerves sensitive to 
heat and cold and a wilderness of thin-walled blood vessels filled with 
blood. 

To make use of warm water and soap baths for cleansing purposes is 
well enough. To fail to use baths for their effect on that great expanse 
of nerves and also for their effect on the great volume of blood contained in 
the skin capillaries is to neglect a great resource. 

• The skin grows from below. The old cells are pushed to the outside 
by the young ones. As they move out they die. The dead cells are finally 
pushed to the surface where they lie mixed with grease, sweat from the 
sweat glands, and the bacteria of decomposition. This decomposing mass 
must be removed; else the products of decomposition irritate the cells be- 
neath. 

The cleansing bath being for the purpose of removing dirt from the 
ducts of the sweat and grease glands as well as from the surface, the water 
should be warm enough to cause the small skin muscles to relax and to cause 
perspiration and grease to pour out of the gland ducts washing out the 
dirt and bacteria. 

If the person is prone to bath itch a less thorough removal of the dead 
layers will bare the sensitive nerves less and is therefore better. In such 
people the cleanliness bath can be overdone. 

The morning cold bath is in no sense a cleansing bath. Its purpose 
is to get an effect on the skin nerves and blood vessels. It is a nerve treat- 
ment rather than a bath. It consists of a few minutes of exercise to start the 
heart to pumping harder, then a few seconds of exposure to cold. When 
the exposure comes, whether it be through cold water or cold air, the 
skin muscles contract and the skin blood vessels are in great measure 
emptied. Then follows the rub and the exercise whereupon the blood 
courses through the dilated capillaries, and the skin muscles become re- 
laxed. 

A cold bath is a stimulant, a tonic, and a preventive of cold feet, if the 
person is able to get up a good reaction. Unless the afterglow is good, the 
cold bath does no good. 

The warm bath without soap soothes and calms. It induces sleep. 
It is good for insomnia, for mental tension, for conditions bordering on 
delirium. 

A warm bath should be continued more than fifteen minutes. In hydro- 
pathic establishments they have baths so arranged that the disturbed person 
stays continuously in the bath for hours, even days. 

To get at the nerves various methods of giving local baths have been 
devised. Such are sitz baths, hot foot baths and wet packs. To get at 
the nerves of a part by a hot or a cold bath is better than to do it by taking 
medicine out of a bottle. 



ECZEMA 707 



PIMPLES 



We say that any consumptive whose disease is inactive can be made 
to put on fat, from which we argue that if a well man does not fatten 
it is because he will not take the trouble. 

If a prize fighter stripped for battle were to show a back and face 
full of pimples he would be booted out of the ring. Prize fighters are thick- 
skinned, full-habited and right at the pimple age. What is the secret ? 

1. They exercise violently every day and make much heat; in order 
to get rid of it their skin blood vessels carry a great deal of blood, their 
sweat glands pour out a great deal of sweat and their grease glands secrete 
much grease. 

2. They keep the quantity of their food in some relation to their work. 
They eat a great deal but they work a great deal. Ninety-nine times out 
of a hundred they are losing weight which means that, however much they 
may be eating, they are in need of more fuel and in consequence they 
burn up some of the fat of their bodies. 

3. They keep their skins very clean. The openings of their grease 
glands are not plugged up by dirt or scarf skin. Incidentally, I imagine 
blackheads are squeezed out wherever found. 

To sum up — the prize fighter takes the trouble to be rid of his pimples. 
There would be no money in his business for him if he went around, instead, 
asking for help — lying down on the job. 

It is reasonable to conclude that every case of pimples or ordinary acne 
would be cured by following the same program. Some persons with thick, 
greasy skins very susceptible to local pus infection may have to play out the 
string. Others may not have to go to so much trouble. 

But everyone who wishes to be cured of pimples should begin at the 
beginning and keep on going until results are had. Those subject to pimples 
must either be troubled with them or take the trouble to cure them. 

There is a relationship between the skin and the digestion and assimila- 
tion. When the skin is being kept properly clean and pimples persist the 
cause is to be sought in disturbance of the stomach or intestines or both. 
That contributing cause is frequently chronic constipation. Almost as fre- 
quently it is overeating. Often it is one of those stomach conditions that we 
lump together and loosely call dyspepsia. 

But this does not alter the original statement — most cases of stomach 
trouble will yield to a sensibly restricted diet; nearly all cases of constipa- 
tion to a proper diet. 

ECZEMA 

If one turns to a medical dictionary for the meaning of eczema he finds 
salt rheum and tetter given as synonyms and then follows a definition which 
allows room for almost every skin disease. Stedman's dictionary gives twenty 
different kinds of eczema. . ■ . 

Now it is • a well recognized fact that where there are many cures 
for -a- disease there are no cures. Nature and nursing do the curing, some- 
times aided by the cure, sometimes hindered by it. ■ - 



708 THE SKIN 

Whenever one finds a shotgun disease he is not dealing with one disease, 
but with a group. For instance, whenever catarrh is spoken of any one of 
a dozen conditions may be meant. It follows that there is no catarrh 
and there are no "catarrh cures," advertisements to the contrary, notwith- 
standing. 

There are scores of diseases called eczema and scores of eczema cures. 
Occasionally somebody having a particular kind of skin disease and calling 
it eczema happening to hit upon a cure for his particular disease can 
thank his stars for his luck is with him. He has won in playing a game 
where the odds were as much against him as in keno. 

There is no clear cut disease known as eczema, though there is a certain 
group of skin changes that are known as eczematous and often as eczema. 
Eczema is a condition in which there is inflammation of the skin character- 
ized by something wrong in the dead layer. This layer breaks up into a 
soapy, greasy mass or it macerates and falls away exposing sensitive nerves 
and allowing some of the tissue juices to ooze through. 

But however striking the skin changes may be the trouble lies back 
of there. The skin is the telephone bell which Tings to announce a con- 
dition at the other end of the line. The bell rings in the skin but the 
impulse which rings it and the cause which talks are elsewhere. If the bell 
were not there then it could not ring — the skin is a contributing factor — 
but the battery, the initiative, the starting cause is elsewhere. 

Eczema on a baby's head calls for just enough local treatment to prevent 
local aggravation. The fundamental treatment is to be directed toward the 
baby's digestion and nourishment. The same is true of eczema in grown 
people. As much local treatment should be given as is necessary to prevent 
local aggravation. In so far as possible the unduly exposed cells of the 
true skin must be protected from being harmed by maceration, by absorption, 
rancid fats, decomposition or bacteria, or by irritation of the nerves. But 
these are of secondary importance. The essential is to remove the basic 
trouble — the constipation, the gout, the indigestion, the perverted chemistry, 
the wrong habits, the nervous basis. 

Almost without exception the doctor who takes off his coat and digs will 
find a cause for a case of eczema and almost without exception the patient 
who carries out directions persistently enough will be cured. 

But to say "over and over the story ending as he began" — it is not a 
blood disease. 

ECZEMA IN BABIES 

There are three kinds of eczema in nursing babies. One is a dry, scal- 
ing, itching eczema, principally on the chest. This condition is found 
in thin, scrawny, under-nourished children. When such children are fat- 
tened up and proper attention paid to their diet the itching passes away. 

The second is an ordinary eczema of face and head in fat babies. 
While local applications of salves may be of some service the keynote of 
treatment is to change the food. Generally the trouble with the food is that 
it contains too much fat. Speaking generally, also, the indication is for a 
food containing a low percentage of fat with some increase in the amount 
of starch and sugar to offset the decrease in fat. 



DISEASES WHICH SHOW THEMSELVES IN THE SKIN 709 

- The third variety is allied to the second. It is what is known as 
tetter or milk eczema. The cheeks are very red and sometimes chapped. 
Somewhere on the skin, usually on the head, there are curdy patches. 

Dr. Grulee tells us that there are two often overlooked skin appearances 
which are due to a mild grade of eczema. When they are recognized for what 
they are and the food changed to what it should be these cases can be halted 
before they develop. 

One is that of the red cheeks slightly roughened and a bit chapped, to 
which allusion has already been made. The other is a yellowish gray patch 
on the top of the head near the soft spot — the cradle cap. These patches are 
usually thought to be dirt and are treated as such until the disease develops 
into a full blown case of tetter. 

These children have other peculiarities. They are prone to constipation. 
This constipation persists as long as the food is rich in fat. The weight 
curve is peculiar. Generally these children are fat but they are apt to stop 
gaining weight for a while, and then to shoot up rapidly for a while followed 
by another stop. 

They digest gruels well. They are free from tendency to diarrhea. The 
tongue is apt to be white in spots. There is a great tendency to colds, coughs 
and croups. Children a little older are very apt to develop enlarged tonsils 
and adenoids. They are nervous and susceptible to contagion. 

What is to be done with these children? First of all, and very much 
the most important, the diet must be changed. In babies the fat in the milk 
must be reduced to the minimum. To offset it the starch and sugar must be 
increased. 

These babies are able to digest well-prepared starch by the third month. 
They can take malt food from the second week; as they get a little older, 
vegetables and gruels, fruit and meat juices can be taken. Cod liver oil agrees 
with these children better than cream. They must be kept in the open air as 
much as possible. They must be wrapped well and kept warm in winter; in 
summer they must be kept cool. 



DISEASES WHICH SHOW THEMSELVES IN THE SKIN 

A dry goods store which had no show window or did no display ad- 
vertising would not interest many people. The skin is the show window, 
the display ad. page of many internal conditions. Not every man knows 
a bargain when he sees it in the window or reads about it in the adver- 
tisements. Men vary in the skill with which they read what the skin tells 
of conditions within. 

Not every store uses its window display to best advantage. Not every 
disease paints a skin picture. Of those that do, not every one tells a clear cut, 
definite story. 

Following are some of the physical conditions that display their wares in 
the shin show window: A bronzing means that 'way off yonder in the adrenal 
glands tubercle bacilli are destroying tissue. Sunburning of the hands, face, 
and chest when there has not been exposure to the sun means that somewhere, 
in some internal organ, the cause of pellagra is operating. 



710 THE SRItf 

In the deeper layers of the skin are blood vessels and the blood in these 
determines whether the skin is pink or pale. A thin skin allows the blood 
to show through easily and a thick one poorly; bnt the hnman skin is never 
so thick but that tint is given to it by the blood. If the blood is rich or 
there is much blood the skin is pink and ruddy. On the other hand, poor 
blood or little of it in the skin results in pallor. 

A pale, white skin means anemia due to poor blood making or excessive 
blood breaking. A faint lemon hue means that somewhere in the tissues 
blood is being excessively destroyed and pernicious anemia is resulting. A 
marked yellow means that bile instead of flowing where it is needed is being 
poured into the blood. 

Pimples and toils mean that the germs which naturally lie quiet and 
inoffensive on the skin are traveling down the grease glands and hairs into 
the deeper layers — part of the responsibility for which lies in the shin itself 
and part in the chemistry of the body. Carbuncles mean that ordinary sur- 
face germs have traveled still deeper. Not infrequently back of the carbuncle 
lies diabetes, a profound change in the chemistry of the body. 

Physicians diagnose scarlet fever and measles by the "looks" of the 
skin. Often they prognose in the same way. These infections enter through 
the throat and the skin manifestation is by no means the only one. Any 
observer can see that the inside of the mouth also breaks out. It is reasonable 
to conclude that the inside linings are in much the same condition as the skin. 

The hair falls out after typhoid as well as several other profound poison- 
ings. On the other hand, in some cancers and other diseases profoundly 
affecting nutrition the skin becomes covered with a fine growth of hair — wit- 
ness the poor, weazened, down-covered babies who have survived months of 
summer complaint. 

Finally, the red-veined and often bulbous nose, often called "whisky 
nose," means protracted indigestion. If a whisky fiend has one it is because 
he has burned out his stomach. But the stomach can be burned out in other 
ways. The drunkard must share his honors. 



STRAW ITCH 

If our relations with Mexico are broken off and our army is forced 
thereby to enter Mexico the soldiers will swap some of their present itches 
for others. They will get rid of their winter itches. Those are due to the 
hot, dry air common in houses, offices, stores, and some factories. Those 
will disappear within a week after the men are put into tents. Summer 
itch or bath itch will disappear. The supersensitiveness of the skin re- 
sponsible for this condition will disappear. 

In their place will come "chigger itch," old-fashioned, or seven-year 
itch, and straw itch. These are due to small bugs. 

A few years ago the First Cavalry was camping at Elgin, Illinois. It 
bought straw from near-by farmers and filled ticks with it. At sick call each 
day a mob of scratching troopers came forward. They were broken out with 
an eruption that had the appearance of hives. In some of these wheals there 
were small blisters and some of these blisters contained pus. 



PSORIASIS 



711 



Schamberg tells us that sometimes this straw itch looks like chicken 
pox and occasionally it has been mistaken for smallpox. 

The government men found that this straw,. or grain, itch was due to a 
small oug, a first cousin to the red dug, and a second cousin to the ordinary 
itch hug. This oug lives in the straw from grain fields. It lives on ordinary 
grain insects and only feeds on man when its usual food supply fails. 

The bug is found in straw which has been stored without airing or 
sunning. Any commander who buys straw for his men can protect them 
from this parasite in a simple way. Let him see to it that the straw is 
exposed to the sun and air for one day before it is used to fill the ticks. The 
parasite is so delicate that one day of sunlight and air kills it. 

The men who han- 
dle the infested straw 
should grease their bodies 
well with lard or vase- 
lin. At night they should 
bathe thoroughly. The 
clothing should be sunned 
and aired for a day. Wil- 
dermuth showed that the 
parasite would starve to 
death in a day. 

When the eruption 
is present the treatment 
is simple. The clothing 
should be changed and 
the infested clothes 

should be thoroughly aired. The bug does not bore in. The red bug buries 
itself in the skin; the tick buries its head; the itch bug bores deep but the 
straw parasite stays on the surface. A good bath and rub get rid of most of 
those that have not already turned loose. 

To grease with a mild sulphur ointment helps somewhat. If there is 
much itching a soda water bath followed by a zinc oxid ointment will help. 

Straw that has been exposed to summer heat or that has been cured out- 
side does not contain parasites. 

Probably an army in Mexico would not be troubled with this parasite. 
The troops in the state camps will suffer. This story concerns them. 

It also concerns some people who do not go to war. Farmers working 
in grain fields suffer. Occasionally city people who sleep on straw mattresses 
suffer from it. In fact one of its names is straw mattress disease. 




Fig. 238. — Red Bugs (harvest mites). Highly magnified. 
Dots under anal extremity indicate natural size. (After 
Riley.) 



PSORIASIS 



Probably few people are justified in going to much trouble about 
psoriasis. However, a person with psoriasis usually thinks he is willing to go 
to a good deal of trouble to control it. Some of them are. This may be 
accepted as an axiom. Anyone who wishes to spare himself trouble from 
psoriasis must go to some trouble. 



712 THE SKIN 

Schamberg thinks that eating too much protein is a large factor in 
psoriasis. He argues that a man can cure his psoriasis or put it in such 
a condition that chrysarobin will cure it by changing his eating habits. In 
the discussion which followed the reading of the paper several excellent men 
disagreed with the proposal, but any suggestion from Schamberg is worth con- 
sidering. 

He advises the following diet: 

BREAKFAST 

Ounces. Ounces. 

Bread 2/3 Apple 4V 2 

Butter x /2 Cream 1 

Breakfast food 1/3 Tea 4 

Orange 5 

LUNCH 

Ounces. Ounces. 

Bread x /2 Turnips 2*/ 2 

Butter V2 Cornstarch 6V2 

Grapes 5 Potato cake 10 

Lima beans 1 2/3 Tea 4 

SUPPER 

Ounces. Ounces. 

Bread 1 Corn 31/3 

Butter y 2 Celery 1 

Prunes 3 Potatoes 7 

Cauliflower 2V2 

This furnishes for the day a total of 1,888 calories and seventy-five 
grains of nitrogen, enough for a man engaged in any form of desk work. 
This he varies by substituting Diet No. 2, as follows: 

BREAKFAST 

Ounces. Ounces. 

Bread 2/3 Bananas 3y 2 

Butter y 2 Rice 1/3 

Grapefruit 5 Cream 1 

LUNCHEON 

Ounces. Ounces. 

Bread M> Cabbage 2y 2 

Butter y 2 Lima beans 2^ 

Cornstarch 5 Potato cake 8 1/3 

SUPPER 

Ounces. Ounces. 

Bread 5/6 Corn meal 4 

Butter y 2 Prunes 3 

Lettuce 5/6 Sweet potatoes 3 1/3 

Beets 3 1/3 Cream 2/3 



BOILS 



713 



This diet furnishes 1,812 calories and sixty-nine grains of nitrogen. 

It will be noticed that this is a vegetarian diet. The percentage of 
protein is brought up by such articles as bread, lima beans, potatoes and 
corn meal; the calories by cornstarch, potato cake, corn meal, sweet potatoes 
and butter. But of more importance than the regulation of articles of 
diet is the regulation of the quantities eaten. 



BOILS 

Since the time of Job a man's behavior when afflicted with boils has 
been the standard by which his patience has been determined. Boils hurt; 
they are diabolical in their selection of locations and they keep coming. 

It is an ill wind that blows good to no one. The blood purifier people 
have reaped a rich harvest by selling blood medicine to people with boils. 




Fig. 239. — Infections at Root of, Beneath and Near End of Nail. 



Their easy money is at an end. Almost everybody knows now that boils 
do not result from impure blood and that blood purifiers do not help 
one to get out of the Job class. 

When a person near middle life has crops of boils it is advisable that he 
go to a physician and find out if he has diabetes. With that ruled out the 
cause of boils comes back to infection of the skin and the tissue below it by 
pus germs. 

The age-old custom of poulticing a boil with a hot flaxseed poultice made 
the skin soft and soggy and a dull knife could cut it without difficulty. In- 
cidentally it infected the near-by skin and caused a crop to grow where one 
boil had grown before. Therefore the plan now followed is to clean the skin 
and keep it clean — bacteriologically clean. 

Berger advises to paint the boil and an inch around it on every side with 
tincture of iodin. Give it a good coat. Then apply ichthyol vaselin, 10 
per cent, on a piece of gauze, cover with cotton and a bandage. The next 
day the dressing is to be removed, the skin cleaned with benzin, then the 
painting with iodin and the application of the ichthyol ointment are to be 
repeated. 

This is kept up day after day unless the skin is irritated by the 



714 THE SKIN 

iodin. If so, the iodin is left off and the ichthyol ointment alone is 
used. When the boil heads it may be lanced or left to open by itself at 
the discretion of the physician. 



PRICKLY HEAT 

Use talcnm powder freely. If severe, wash with one part water and 
three parts alcohol. Dust afterward with talcum powder or wash with 
lime water containing two drops of carbolic acid to the ounce. 



DERMOIDS OF THE FACE AND NECK 

Not infrequently in the developing child some part of the machinery 
will not work just right. When two plates of bone are due to grow toward 
each other along an edge they may not get together at all and a cleft 
persists after birth, or one may get there first and turn the other to grow into 
the underlying tissue, or some other accident may happen. Many things 
are responsible for the location of these developments. 

Miss Bevington wrote : 

The softest dimple in a baby's smile 
Springs from the whole of past eternity, 
Tasked all the sum of things to bring it there — 

which caused Sir Francis Wilks to say "that there is a material basis for 
these pretty and significant lines." Bland Sutton says these small benign 
congenital tumors are prone to develop in the locations on the face where 
dimples occur. 

Many of the congenital tumors, moles, birthmarks, hairy patches, tabs 
and clefts found on the face and neck are dermoids. 

A dermoid is liable to result whenever in the development of the unborn 
child a bit of skin grows into some place where it does not belong. Among 
the better known dermoids are the following: 

The tabs which frequently are seen on the neck of hogs, goats and 

sheep and occasionally on the throat of a man. In fact the old 

Greek statues of fauns always showed these tabs — dermoids — on the 

neck. 

The small tumors on the ears or just in front of, below or back of the 

ears. In some cases these little mounds are covered by hair. 
The small tumors, out of which a tuft of hairs grow, so frequently seen 
on the cheek about an inch from the corner of the mouth. Dermoid 
tubercles in this location are almost the rule in terriers. 
The small tumors at the outer corner of the eye below the eyebrows and 

on the nose near the inner corner of the eye. 
The small tumors on the bridge of the nose. 

The tufts of hair which are sometimes seen on the bridge of the nose 
or at its tip. 



DISEASES CONTAGIOUS THKOUGH THE SKIN 



715 



DISEASES CONTAGIOUS THROUGH THE SKIN 



Those whose conceptions of the contagiousness of leprosy are due to 
the Bible accounts are more disturbed by the proximity of a leper than is 
warranted. It is possible that leprosy was more violent two thousand years 
ago than now but it is probable that in those days many different diseases were 
called leprosy and some of them were very contagious. At least such is the 














Fig. 240. — Hookworms, a, newly laid egg; b, beginning segmentation; c, egg, further stage 
segmentation; d, e, advanced stage segmentation; f, preceding formation embryo; g, embryo 
in first stage; h, embryo just before leaving shell; i, embryo after leaving shell; j, embryo 
several days old; k, embryo covered by chitinous envelope in stage to infect. 



716 THE SKIN 

conclusion of Ih\ Ernest L. McEwen, who has studied the subject carefully 
and has written the results of his study in the Biblical World of September, 
1911. 

Leprosy today is a mildly contagious disease, the contagion spreading 
through the scarf skin. 

Louisiana, Minnesota, California and the Hawaiian Islands find even 
moderately careful segregation enough to control the contagion of leprosy. 

Nowhere does the problem of stamping out leprosy present great diffi- 
culty; certainly no difficulty comparable with diphtheria or measles. 

Tuberculosis of the skin — lupus — can be spread by any case where there 
is secretion of pus but the danger of tuberculosis from this source is scarcely 
worth considering. 

In some cases of typhoid fever there are typhoid patches on the skin — 
small, obscure, and easily overlooked. When cultures are made from fluid 
these red areas from typhoid bacilli grow — but typhoid is never spread in this 
way. The germs are always below the layer of dead cells of the skin. 

In scarlet fever and measles there are skin 

Female % / 1 # Male eruptions in a rough way similar to those of 

\ / typhoid. In these diseases the contagion is 

Fig. 241. Hookworms, Actual spread by the mouth and nose secretions but not 

Size. by the skin. 

Smallpox infection is distributed by the 
blood to many organs including the skin. It is probable, though it is not 
certain, that the germs of smallpox are thrown off with dead skin and skin 
►exudates — that it is spread by the skin. 

In itch and in ring worm the parasites causing the disease are just under 
the skin but do not wander any deeper. By applying proper insect destroy- 
ers to the skin they can be killed almost as easily as can those insects which 
are on the outside of the dead layer. Itch and ring worm are spread by 
the skin. 

On the other hand, there is a group of parasites, of which hookworm 
is the only widespread illustration in this country, which get in through the 
skin but travel to find a field of activity elsewhere in the body. Whether 
a boy with "ground itch," "dew itch," or "dew poison" can spread hook- 
worm through his skin I do not know. 

People have quit poulticing boils, because poultices spread the pus germs 
of the boil from infected to noninfected areas. 

Finally, there is a skin infection so widespread that it overshadows every 
other. It is that little known skin infection which causes somewhere about 
70 per cent of the baldness. This infection is spread by brushes and combs. 



HIVES 

The scientists call hives urticaria. Until recently the man who knew 
the disease as hives had about as much information about it as the man who 
called it urticaria. He knew that raised red wheals or whelks which itched 
almost beyond power for restraint were hives. 

Further he knew that a simple wash of witch hazel or soda water gave 



HIVES 717 

some relief to the itching; that behind the trouble lay some irregularity in 
digestion and that a free purge was indicated. 

In some cases attacks followed eating shellfish, strawberries or some 
other food toward which the individual had an idiosyncrasy. 

The scientist is gaining on the man of general information. He has 
learned that the eruption is in the nature of a neuralgia; that behind the 
neuralgia lies the presence in the blood of a substance poisonous to that 
person. In most instances the poison has been absorbed from the intestines. 

The poison most frequently present is an amin, formed out of an amino- 
acid named histidin. There are certain foods rich in histidin. Such are fish, 
blood, milk, juicy meat and especially meats from carcasses that have not 
been drained of blood and are classed with blood. 

Acting upon this information, Salomon, Eustis and other physicians 
treat their hives patients by keeping them on a diet. For the first two weeks 
they live on tea, coffee, bouillon, lemon and grape juice, potatoes, rice, cereals, 
plenty of butter and sugar, and seven ounces of bread made from coarse 
flour. After the two weeks beets, celery and spinach are added to the diet. 

In reestablishing one's eating habit care should be taken to restrict 
greatly the quantity eaten of milk, buttermilk, cheese and all foods made 
from whole milk, eggs, fish and juicy meats. Boiled meat is less harmful, 
particularly if the meat is soaked in cold water before being boiled. 

It is not possible to cure hives by this method unless the bowels are 
cleaned out and kept open. To bring about the first Dr. Eustis gives a 
calomel purge. To accomplish the second purpose he uses two or three 
ounces of albolene, agar in oatmeal in the morning or fig paste containing 
chopped up senna leaves. Drinking a full glass of water upon rising in the 
morning is a great help. 

A method of giving relief to the itching and reducing the swelling used 
by Swan is of interest to the physician only. It consists of injecting under 
the skin a small dose of extract of adrenal gland. The hives disappear at 
once and stay away for eight hours. More than half the cases of hives are 
of the type which yields to this treatment. 

The man who wants to escape hives can do so by eating the right food 
and refraining from eating the wrong food. 

Eczema Loose Term. — R. E. L. writes: "Bo you mean to say that 
cleanliness will cure eczema? My uncle, himself a doctor, was slowly tor- 
tured into his grave with eczema, and my fathers life is made miserable 
with the same trouble. It certainly is not a question of cleanliness with 
him, as he gives most of his time to caring for it. Father s is called, I 
believe, 'hidden eczema.' " 

Reply. — I do not. Cleanliness is of very limited value in the cure of 
eczema. It will cure some cases. 

Eczema is a very loosely used term. It covers a variety of skin dis- 
eases. Cleanliness helps some of them. Most cases of eczema will respond 
to a properly regulated diet, a hygienic life and proper toilet of the skin. 
I do not know what is meant by "hidden eczema." 

Eczema in Babies. — Mrs. L. G. F. advises for eczema of the head in 

babies that the following plan be tried: 



?i§ THE SKIN 

Besides the regulation of diet, I found, after costly experience, that 
eczema, if taken in time, will readily respond to simple remedies, such as 
vaselin, zinc ointment, and olive oil, if applied (according to the stage) in 
alternate treatments. In both my cases one thing used alone lost its effi- 
ciency in a short while, but the cure was effected by not using the same 
ointment in succession. 

Cause of Dry Skin. — W. J. writes: "What causes roug\, dry skin on 
the arms and upper portion of the lower limbs, especially in winter?" 

Reply. — Dry air in the living room and office. 

Holds No Theory. — B. B. B. writes: "I have understood that what 
eczema really is is unknown; that the American Medical Association's 
theory is that it is a parasite or germ attacking and imbedding itself in the 
skin at the most susceptible point: hence, it. can be eradicated by external 
applications of germicides. Is this so?" 

Reply. — If you mean that no definite single cause of eczema is known 
you are right. 

The American Medical Association has no theory as to the cause of 
eczema. To take positions on such questions is not in its line. While any 
member may hold any theory he pleases not many of them think eczema 
is the result of a parasite or germ, nor do they use ordinary germicides 
in the ordinary way for the cure of eczema. 

Eczema Not Contagious. — B. L. C. writes: "We have an acquaintance 
who is suffering from eczema. It comes of blood poisoning caused by vac- 
cination. Is there danger of giving this disease to members of a family 
where she has access to the bath and uses soap, towels, etc.? Being a dress- 
maker, is it safe to have her handle goods, do fitting, etc.?" 

Reply. — Eczema is not caused from blood poisoning nor from vaccina- 
tion. It is not contagious. It is not spread by soap or towels. It cannot 
be communicated in fitting clothes. 

Has No Effect. — Reader writes: "1. What effect does muriatic acid have 
upon a person having eczema, if taken one drop in half a glass of water 
twice each day? 2. Will it cause the eyes or lids of the eyes to swell?" 

Reply. — 1. None. 
2. No. 

Eczema. — Subscriber writes: "I have a patch of eczema on my foot. 
1. Please tell me what eczema is, and how it spreads. 2. Is it always heredi- 
tary, and, if not, may it be transmitted to the children of one having it? 
S. What is the best method of curing it? -4- When cured will it stay cured?" 

Reply. — 1. Eczema is a mild inflammation of the skin. If you mean 
by "how it spreads," is it catching — No. 

2. No as to each question. 

3. Your physician will advise you how to change your habits and the 
care of your skin so as to put yourself in shape to have the patch get well. 
He will give you local applications which will help. Persist in doing as 
you are told. 

4. It will if the new methods of caring for the skin and new habits are 
kept up. If not it may recur. 



HIVES 719 

Scalp Eczema. — A. F. writes: "I am bothered with eczema around 
the hair line. Sometimes it itches terribly, and I find dry sulphur is the 
only thing that stops it. What will cause this complaint to disappear?" 

Reply. — Probably you have a seborrheic eczema. This is the most 
frequent cause of dandruff and loss of hair. The remedy is to take good 
care of your scalp, to wash your hair frequently, to grease it slightly, to 
use sulphur daily one way and another, to brush your hair well. To cure 
the condition by giving your hair attention all of the time, in season and 
out, is not difficult but you must stick to it. 

Must Cleanse Daily. — A. F. W. writes: "What causes itching, cracking 
of shin, and festering between one's toes? How can this condition be 
prevented?'' 

Reply. — This is an eczema. It results from decomposition of secretions 
and wastes. In other words, it starts from lack of cleanliness. Having 
started it may persist in spite of great care and cleanliness. 

If the oozing is extremely bad cleanse daily with oil. If it is not so 
bad cleanse with soap and water. After everything has been made clean 
use powdered boracic acid as a dusting powder. 

Daily attention is the keynote to success. 

Sensitive Skin. — B. S. B. writes : "I suffer from a severe itching on my 
chest and limbs after bathing. I have tried all temperatures of the bath 
water, but the itching is no less irritating in cold than in hot water, or 
even with the omission of soap. It usually lasts from twenty minutes to 
half an hour, and ceases only when I have taken a walk in the cool air. 
I have tried many patent remedies, but none of them has given me any 
relief." 

Reply. — Do not bathe frequently and do not stay long in the water. 
Bathe in tepid water containing from two to five pounds of bran to the 
bath. After bathing anoint the skin with a little fresh oil or dust with 
talcum powder. 

What Sycosis I s . — C. M. D. writes: "Can you tell me what sycosis is 
and what causes it? Is it contagious? One of the neighbors is all broken 
out with it and I am wondering if it is best to go there." 

Reply. — Sycosis is an inflammation of the skin, due either to pus cocci 
or ringworm infection or some allied cause. Ringworm is one form of 
sycosis. Barber's itch is another. It is mildly contagious. You are in no 
danger provided you do not use the same brushes, wash basins, and towels 
as are used by the affected person. 

Warts. — W. S. G. writes: "I want to "know how to remove numerous 
warts from my hand" 

Reply. — Trim them down to the quick, then burn with a hot pin or with 
nitric acid. Repeat after a week if necessary. Your physician would 
probably burn them with a carbonic acid crayon or carbonic acid snow — a 
better method. 

Let Your Moles Alone. — 8. Q. P. writes: "Let me tell B. A. K. how I 
removed a mole which was growing near my left temple : It was nearly the 
size of a nickel when I applied oil of cinnamon occasionally for a few days, 
when I was able to remove it clean by picking. I then applied extract of 



720 THE SKIN 

witch hazel a few times and the shin healed. That was about two years ago 
and there has been no sign of a mole since." 

Reply. — I judge you mean a wart. Warts are easily removed. Some- 
times it is entirely safe to remove them by any simple method; sometimes 
it is not. When it comes to moles the story is different. The penalty for 
tinkering with moles is death. 

Mole on the Nose. — Mrs. G. G. writes : "I have a mole on the end of my 
nose. It is conspicuous and getting larger. 1. Should I have it removed 
by an electric needle? 2. Is it dangerous or will it leave a noticeable scar?" 

Reply. — 1. I think you had better have it removed if it is growing. 
2. Most moles are not dangerous, but from some of them sarcomas — a 
kind of cancer — develop. One should be suspicious of a growing mole. 

Have Mole Cut Out. — L. F. A. writes: "Would it be perfectly safe for 
me to have a hairy mole removed by the electric needle? It is located on 
my chin and seems to be growing larger." 

Reply. — Perfectly safe ? No ; have it cut out. 

Removal of Scar. — W. W. writes: "Is a long scar caused by an opera- 
tion in the neck removable by any means? It has caused great sensitive- 
ness." 

Reply. — Yes. A surgeon would cut out the scar and bring the edges 
carefully together. The new line of healing in a short while would fade 
to a delicate line. Massage begun soon after healing was complete would 
remove practically all trace of the incision. 

You no doubt wonder, if this is true, why a scar was left after the first 
operation. The first operation was done to remove tubercular glands or 
abscess walls. The skin was affected more or less. The main object was 
to cure a deeper condition. Under those conditions scarring was unavoid- 
able. 

In the second operation there would be no infection; the field would 
be clean and the skin sound. The removal of the scar would be the prime 
and only object and therefore a cosmetic result would be possible which 
was not possible in the first operation. 

Treatment for Eczema. — E. R. H. writes: "What is eczema? When 
does it break out all over the body? Is it catching? Is it curable?" 

Reply. — Eczema is generally a chronic oozing eruption. It affects 
patches of skin here and there. It is not catching. Most cases of eczema 
are curable. All cases are benefited by good care. 

As to the remedy for eczema, what helps one case harms another. When 
a man discovers he has eczema the first step is to correct whatever in his 
habits bears on eczema and is in need of correction ; the second, to correct 
contributing constitutional states ; then to give proper care to his skin and 
especially his eczema areas. 

In other words, treatment must be individual and it must also be 
broad. Salves and other eczema cures miscellaneously applied are usually 
disappointing. 

Tetter. — Tribune Reader writes: "What do you consider the best treat- 
ment for the disease known as tetter? Is it curable?" 



HIVES 721 

Reply. — Tetter is another name for eczema. It is sometimes curable 
and sometimes not. Eczema is dependent upon a cause. If that cause can 
be found and cured the eczema gets well. The crusty eruption on babies' 
heads is frequently called tetter. It means the food is not quite what the 
baby needs. The proper treatment for this disease is to regulate the baby's 
food. When this is done the inflammation and oozing of the scalp stops. 

Scalp Eczema. — Paris writes: "What can I do to prevent my hair from 
falling out? My scalp is covered with a thick, oily dandruff. After wash- 
ing the hair the dandruff soon appears again with an itching sensation. 
After drying my hair it is sticky and lusterless, so I can hardly get a comb 
through it. What causes such a condition?" 

Reply. — I think you have a seborrheic eczema. It is reasonably certain 
that you neglected your scalp for years. Wash thoroughly with soap and 
water every day, rub in a very little vaselin and spend several minutes 
twice a day brushing your hair. Do not brush hard enough to make your 
scalp sore. Carry out this program persistently. 

Has Flour Eczema. — W. J. M. writes: "My work necessitates having 
my hands in flour a good deal, and on them has appeared a kind of scale 
with much irritation. A friend calls it 'flour eczema.' Does flour cause any 
such trouble? Doctors have prescribed different remedies, but they bring 
me no relief. I hear of others being troubled in the same way. What will 
help us?" 

Reply. — Your trouble is flour eczema. Some bakers have this disease. 
It is more common among candy makers. If you will keep your hands out 
of the dough the condition will get well of itself. I think X-rays would be 
of service. 

Would it be possible to wear rubber gloves while at work? 

Cause of Fever Blisters. — S. J. writes: "Will you please tell me the 
cause of so-called 'fever blisters/ and how can they be prevented? Why 
do they usually come around the mouth and always on the face?" 

Reply. — Fever blisters may occur on any part of the body. They occur 
more frequently around the mouth than elsewhere. Fever blisters are 
found in pneumonia, in bad colds due to the pneumococcus, in typhoid, in 
malaria, and in several other diseases. 

Digestive disturbances cause them. If a man has them without a defi- 
nite disease or infection the probability is that the cause lies in the diges- 
tive apparatus. Too much food is being eaten or the food is not wisely 
chosen or the bowels are not acting properly. 

In such cases they are to be prevented by changing diet, by better 
adjusting the food taken to the day's work and by correcting improper 
bowel habits. 

Camphor for Cold Sores. — E. W. 8. writes: "1. What is the cause of 
ulcerated sores in the mouth? Have they any relation to cold sores? It 
has been found that camphor is a good cure for cold sores. Would it be 
harmful to rub camphor on the inside of the mouth? 

"2. What is the cause of large abdomen in a man SO years of age? 
What exercise or remedy would you recommend to reduce the abdomen? 

"$. What diet would you recommend for a man SO years of age who is 
troubled with ulcerated sores of the mouth? He leads a sedentary life. 

"If. Is the mortality from pneumonia high in Colorado or other places 



722 



THE SKIN 



of high altitude in the West? Is it true that pneumonia generally results 
fatally in places of high altitude? If so, why is this the case? 

"5. Is it true that a person who is inclined to he gouty or rheumatic, and 
who has had rheumatism, is not so apt to contract tuberculosis as others? 
Is it true there is an antipathy of the two diseases, rheumatism and tuber- 
culosis?" 

Reply. — 1. The ulcers in the mouth result from digestive trouble; cold 
sore from an infection. Camphor on the ulcers will do them good. Touch 
the ulcers with a bit of cotton saturated in spirits of camphor; or a 
stronger caustic will be better. 

2. There are several causes. Obesity is one. If the other muscles are 
flabby the abdominal walls will be flabby. When the abdominal walls are 
flabby the weight makes them pouch out. As the abdomen pouches the 

shoulders are 
thrown back to com- 
pensate. This bows 
the back and makes 
the abdomen pouch 
still more. Cut down 
the food and take 
exercises to 
strengthen the mus- 
cles of the abdo- 
men. 

3. You are right 
in thinking that the 
cure lies in the diet. 
How much you eat 
is of very much 
more consequence 
than what you eat. 
Eat vegetables, 
fruit, meat and bread, varying your diet from day to day, but eat 
not more than two-thirds what you are now eating. It is evident that 
all your troubles are cut from the same cloth — too much food and too little 
exercise. 

4. [a] Yes; [b] The mortality rate is high, but the disease does not 
generally terminate fatally; [c] I do not know. 

5. Yes. There are certain families which run to rheumatism, and other 
families that run to consumption. 

Itch. — W. writes: "Is a shin irritation of bright red spots that do not 
appear on the hands, but itch violently, a parasitic infection? Can the 
itch be communicated to a family by a washerwoman through the clothes? 
Are sulphur remedies the only treatment, or isnt there a treatment less 
offensive? Must the patient destroy all infected clothes, or is boiling a suf- 
ficient means of making the clothing aseptic and preventing reinfection?" 

Reply. — 1. It is difficult to say from so little data but red spots without 
break in the skin are not liable to be due to ordinary itch. 

2. Yes. However, the danger from laundried clothes is not great. 

3. If you mean applications to the skin there are other efficient prepara- 
tions besides sulphur. However, sulphur preparations are not offensive. 

4. The boiling temperature kills the itch parasite. 




Fig. 242. — Itch Mite. Female. Fig. 243. — Itch Mite. Male. 



HIVES 723 

Ordinary itch is due to a parasite which burrows through the skin, espe- 
cially in thin places such as between the fingers. The eruption is a mixture 
of blisters, pustules and scratch marks. The parasite is easily killed by 
chemicals and by heat. The disease is contracted by contact of sound 
skin with infected skin. Some infection by clothes as a carrier is possible. 
The disease is easily cured. 

Cause of Itching. — A. J. B. writes: "I read so many good articles in 
'Hoiv to Keep Well' that I shall venture to ash a question that seems to 
puzzle several. 1. What causes itching of the shin? The shin is as smooth 
as a baby's and yet at times I have that acute itching which comes in 
spots, generally when I am sitting still or lying down. 2. Does tea heep 
one awahe nights?" 

Reply. — 1. Dry air in the living room. 

2. Yes. 

Has Winter Itch. — Mrs. J. D. C. writes: "The last four years I have 
had a rash break out on me every fall as soon as cold weather comes. It 
disappears in the spring. It first appears in spots and loohs lihe tiny 
pimples and then turns scaly. Water seems to irritate it and cause it to 
spread. It is on nearly every portion of my body, but is worse at the joints. 
Will salves or blood medicine do any good? Kindly tell me what it is and 
what to do for it. I am 39 years old." 

Reply. — This is winter itch. The most important factor in its causa- 
tion is too little moisture in the air. Blood medicine will do no good; 
salves will do no good. Get a hygrometer. Keep the humidity of the air 
in your house above 50 degrees and you will get well. Drink an abundance 
of water. 

Winter Itch Cure. — A. T. C. writes: "I am troubled with an itching on 
the calf of the leg and occasionally on the forearm. The itching is much 
worse after tahing a bath. At times it does not bother me, but after a bath 
it starts, and after a day or two a rash appears. My legs are usually cold, 
although I wear woolen underclothes. Is there any way that this disease 
can be permanently cured? It seems to be worse in winter than in summer, 
although I wear woolen all the year." 

Reply. — Winter iteh results from drying of the skin. Rub the skin 
with a little grease. Do not scratch. The air in your flat probably has a 
humidity of 10 or 15. Get a hygrometer. Evaporate enough moisture to 
keep the humidity over 50. When you do this your trouble will cease. 
Otherwise it will hold on until the heat is turned off in the spring. 

Palliative for Itching. — 8. E. writes: "I noted with interest the article, 
'Steam Heat Itch,' and feeling that I may be of service I offer, subject to 
your approval, the following remedy to 8. H.: Three per cent carbolated 
vaselin, to be rubbed over the affected parts or surfaces with the hands. 
This is also a great remedy for prickly heat in summer. My experience 
seems to have been the same as S. H.'s, but, since using this remedy for 
the last few years, my two complaints have lost all their terrors. At times 
I had to { cut out' fats and considerable of the meat in my diet. I had used 
many things, but this is the only one I found to relieve the trouble. In 
both cases the vaselin apparently oils the dry, parched shin and the carbolic 
acid tahes away the sensations of itching, priching, and irritation. Vaselin 
without the carbolic acid I found useless. At retiring time, when I dis- 
robe, the sensations begin; I rub on the carbolated vaselin and put on 



724 



THE SKIN 



pajamas. In a few minutes all disagreeable sensations have disappeared. 
The carbolated vaselin of commerce (of 2 per cent strength) I found not 
strong enough in my case, and I found the 3 per cent salve to he magical. 
For several years I have observed people with prickly heat make themselves 
worse with evaporating, cooling liquid applications and various kinds of 
powders. I use the salve as often as the skin gives trouble and desist when 
there is no itching or irritating/' 

Eeply. — Carbolated vaselin is a palliative. The cure is moister air. 

Barbers' Itch Treatment.— J. E. B. writes: "Kindly advise me as to the 
treatment for barbers' itch. It has got into the eyes and scalp now and is 
annoying." 

Eeply.— The hair should be cut short and the affected hairs pulled out. 
Wash the places twice a day and then rub in sulphur ointment. Eub it in 
well. Spend twenty minutes on the job. It is important that other mem- 
bers of the family do not catch this disease. It is contagious. 

Dry Air Rash Cause. — B. S. asks the cause of a rash breaking over the 
body and arms, but not on the face or neck. She asks if it is caused by 

heavy underwear, as she wears a 
light fleeced weight, or by the con- 
dition of the blood? 

Eeply. — Few rashes are caused 
by the blood. There is almost no 
relation between skin diseases and 
the blood. Your rash is due to liv- 
ing in a room where the air is too 
dry. Put an air vent in the radia- 
tor in your bedroom and let steam 
blow into the air. If you will keep 
the air so moist that the windows 
are always sweating your eruption 
will stop. 




Fig. 244. — Crab Louse (pediculus pubis). 



Cuban Itch. — M. writes: "I hope that you will give the public some 
data as to the nature and particularly the characteristic symptoms of a 
highly contagious eruption called sometimes 'Cuban itch'; also some sug- 
gestions as to treatment and prevention." 

Eeply. — Cuban itch is smallpox. It came into the United States from 
Mexico about the time our troops were returning from Cuba. Some- 
one jumped to an unwarranted conclusion and dubbed this brand of small- 
pox Cuban itch. The Cubans tell us they never heard of Cuban itch. 

Cuban itch should be cared for in the smallpox hospital. It requires 
no treatment. The disease gets well spontaneously in about ten days. 
Treatment then consists in intelligently "standing by." 

Bath Itch Relief. — B. writes: "I wish to tell you of my experience with 
bath itch and the relief I have had from it lately. I spoke of my trouble 
with bath itch to a doctor, who said he had been troubled the same way, and 
told me how he got relief. After bathing, rub one portion of the body 
thoroughly with a perfectly dry towel before drying another portion. Use 
two bath towels, if necessary. This doctor said that a good deal of bath 
itch was really chapping from not thoroughly dicing the body. I have 






HIVES 725 

tried this for a year, dusting with powder afterwards, and can now go to 
bed after my hath without the annoying itching sensation of old" 

Reply. — Readers will note that this is for bath itch, not winter itch or 
dry air itch. 

Wrong Kind of Itch. — M. J. L. writes: "I sympathize with A. T. C, 
who is troubled like so many others with winter itch. I have suffered from 
it for years, but I have found an absolute remedy at last. It is a tablet 
composed of reduced iron, 1 grain; arsenous acid, 1-50 grain; strychnin 
sulphate, 1-60 grain. I take one .after each meal for three or four days, 
and begin one day before a hot bath is indulged in. The itch always 
follows a hot bath." 

Reply. — You have had a bath itch and not winter itch. Yours was 
due to too little grease in your skin. It may be your iron-arsenic-strychnin 
has cured you, as you think. It may cure others ; probably not. 

Nails Have Diseases. — E. A. writes: "Hay I ash you to give a few lines 
concerning the cause, but more especially, the cure for brittle finger nails? 
My nails are so brittle that I am obliged to keep them cut down to the 
quick, because if allowed to grow longer they soon split or crack and become 
annoying. My thumb nails are so troublesome that I am obliged to wear 
adhesive plasters on them for months at a time. If one of these plasters 
comes off in the night I have to get up and put on a new one, as the nail is 
otherwise sure to catch in something and tear the tiny rent farther down. 
The nails grow slowly." 

Reply. — The nails have about as many different diseases as the other 
parts of the skin. If you can discoYer any disease of your skin around 
the root of the nails ha Ye that attended to. If you ha Ye diabetes, gout or 
Raynaud's disease haYe that looked after. If you work in a place where the 
air is extremely dry see that the air is humidified. 

Keep your nails well greased. Once a day at least soak the ends of your 
fingers in water for a half hour or more; then dry them and grease your 
nails. Grease them well. Repeat the greasing process seYeral times a day. 

Can you not work out a way to protect your nails that will harm them 
less than adhesiYe plaster ? AdhesiYe plaster is good enough for them in 
that it protects them; otherwise it harms them, it makes them more 
brittle. 

Ingrowing Nail Treatment. — J. R. H. writes: "I have been troubled 
with an ingrown nail for over a year. I have been to several chiropodists, 
but they do not seem to do me any good. I shall appreciate a little of your 
valuable advice, as I believe you can help me, as you have helped others." 

Reply. — Shoes that press against the nail gradually push it to the side 
of the toe. As the front end is more easily displaced than the root end the 
nail comes to run somewhat diagonally from the root toward the side of the 
toe. In some of the toes the flesh OYerlaps the nail at the side. In these 
toes' tight shoes cause ingrowing nails. In other toes they cause displace- 
ment of the nails but not ingrowing nails. In the light of these facts, 
what is to be done? 

1. Adjust the shoes so that they do not push the toenails to one side. 

2. Use cotton to lift the edge of the nail so that it rides aboYe the bed 
along the side — the bed that the nail is irritating and that it sometimes 
causes to be infected. Lifting the edge of the nail so that it no longer 
irritates cannot be done in a day. The corner can be lifted and a Yery 



726 THE SKIN 

small bit of cotton inserted today. Tomorrow the pledget may be a bit 
larger. In the course of a month it may be materially larger. The nail 
has consumed months in swinging to the wrong position; months will be 
required to get it into an unoffending position. 

Keep Nails Oiled. — J. T. M. writes: "My finger nails are ridgy and 
continually crack and become so sensitive that I can scarcely button my 
clothes. What is the cause of it, and what is the remedy?" 

Reply. — The nails are subject to diseases. It is possible that you have 
one of these. If your nails get brittle in cold weather only, it is probably 
because they dry out. Even the outside air in zero weather contains little 
moisture. Room air is a Sahara, of course. 

Do the best you can to find moist air to live in. Keep your nails well 
oiled. 

Split Finger Nails. — 8. writes: "For several years I have had trouble 
with my finger nails splitting. They divide into layers, split down often 
half the length of nail, and break off until they get very uneven. The top 
of the nail is rough. Will any outward application help?" 

Reply. — This condition develops especially in people who are under 
mental strain. It is much more likely to occur in winter than in summer. 
Care of the nails is of prime importance. Keeping the fingers warm is of 
importance. It is advisable to wear loose, woolen, fleece-lined gloves or 
mitts. A kid glove that binds or lets the hand get cold is harmful. To 
grease the nails helps. 

Run-Around. — B. C. W. writes: "What can I do for a felon or run- 
around? I have had one on my thumb for three weeks. It started with a 
white spot under the nail which has worked to the end of my thumb and 
has broken and pus has come out of it. I have put flaxseed poultices on 
it, and iodin, but they do not seem to do any good." 

Reply. — Stop the poultices or you will never stop the run-around. 
Clean it with soap and water and then with peroxid. To paint the nail and 
skin with tincture of iodin occasionally may be of some service. Keep 
pockets of pus drained out. Put a light, loose, clean, aseptic gauze bandage 
around it. Let plenty of air get to it. A run-around treated in this man- 
ner will get well of itself in a few days in nearly every case. When the 
infection gets around the root and bed of the nail it may be necessary to 
slit or even remove the nail. In that event you had better not try to go 
farther on your own hook. 

Removing Tattoo Marks. — 0. E. B. writes: "Can tattooing be removed 
from a persons arm and is it painful or serious to have it done?" 

Reply. — To a limited extent it can be done. Rarely is one justified in 
•having it done. 

Spots on the Face. — W. F. writes: "During the cold spell this winter 
I came in one evening and white spots were visible on my face. I rubbed 
them with snow and my face did not get sore, but since then my face gets 
black and blue when the least bit cold or on a windy day and at all times 
a white spot is visible and my face looks so red. Is there anything I can 
do to cure this?" 






HIVES 727 

Reply. — Did you read the article on Raynaud's disease? Read the 
article on the subject in Osier's "Practice of Medicine" in the public 
library. You probably will have no trouble during the summer. 

Bad Complexion Cause. — E. R. writes: "What is the cause of catarrhal 
jaundice? Does eating much sugar or sweets have anything to do with a 
yellow complexion?" 

Reply. — 1. Infection and inflammation of the gall bladder and bile 
ducts. The inflammation shuts off the narrow bile tube leading from the 
liver to the intestines and the bile, instead of flowing out, is absorbed by 
the blood. 

2. Eating too much of anything and exercising too little in the open 
air are important causes of a bad complexion. Particularly does open air 
exercise in bad weather help the complexion. Sugars and sweets in mod- 
eration are no worse than other foods. 

Will Discolor the Skin. — Constant Reader writes: "Will ammonia and 
peroxid discolor the skin if used for a certain length of time to destroy 
superfluous hair?" 

Reply. — Yes, to some extent. 

Bleaching the Skin. — Actress writes: "Would it he safe to use peroxid 
of hydrogen for bleaching my arms? If you think it is too strong, please 
tell me how to dilute it. Do you think this will whiten my arms?" 

Reply. — It will be safe in the sense that you will survive. You might 
use it for a year or so without harming your skin. In time it will spoil 
your skin. It will bleach what it can easily reach. Why not powder your 
arms? It will do less harm. 

Liver Spot. — K. X. Y. writes: "When I was 6 years old I was sick 
with some kind of bowel trouble for three or four months. After I got well 
there appeared a brownish spot on the right side of my nose. It is now 
about the size of a dollar. Can you tell me the cause and how I can 
remove this disfiguring mark?" 

Reply. — This is probably one of those chloasma spots usually called 
liver spots. They do no harm. If the appearance is objectionable per- 
haps a skin specialist can bleach it fairly well. Unless it disfigures your 
face you had better let well enough alone. 

White Spots on Body. — E. M. writes: "For years I have noticed small 
and large white spots appearing on my hands and neck, some small ones 
on my body. At times they are more pronounced than other days. Lack of 
pigmentation, I am told. Is there no cure for them, and is there any danger 
to life?" 

Reply. — No doubt you notice these spots more than anyone else does. 
There is nothing to be done. They will never endanger your life. 

Brown Patches on Face. — L. E. writes: "What is the cause of brown 
patches upon the neck? Can they be removed by external application? Is 
it liver or kidney torpidity or what?" 

Reply. — Brown patches on face and neck are due to constipation or con- 
gestion of the liver. External applications are of no value. The heart 



728 THE SKIN 

should be examined. Proper treatment under the care of the family 
physician should be taken for the underlying conditions. 

Sweating Arm Pits. — Subscriber writes: "How can I prevent excessive 
sweating in the armpits? I am a man of 19. Every day I sweat under 
my arms down to my waist, during the cold weather more than when it is 
hot. It goes through my clothing, destroying the suit." 

Reply. — The sweat glands are influenced by the mind to an exceptional 
degree. To watch for and dread this phenomenon makes it worse. To 
wear rubber sweat shields also makes things worse. Try dusting the arm- 
pits with powdered tannin. 

Chapped Hands. — F. 0. V. G. writes: "My fingers chap, or crack open. 
I work at an editorial desk in a steam heated but well ventilated room. 
I live in a hot water heated house, also well ventilated. I have tried 
many lotions, camphor creams, vaselin, and other remedies, with only 
temporary relief. What would you suggest?" 

Reply. — As you refer to the heating I assume that your trouble mani- 
fests itself only in the winter. To keep the humidity of your rooms over 
50 will help but probably will not wholly remedy the condition. Various 
obscure conditions relating to the nourishment of the skin of the hands, 
such as Raynaud's disease and allied conditions, get worse in winter. The 
temperature and humidity conditions are to them important contributing 
causes. My guess is that the main cause lies in some ductless gland per- 
version. Why not let your physician try thymus, thyroid or adrenal 
on you ? 

Cure for Cracked Hands. — E. J. J. writes : "My brother froze the back 
of his hand three years ago. During the summer it seems to be healed, but 
every winter the sores become renewed and keep cracked open all winter. 
He has used patent salves and prescribed medicines, but they do not help 
him." 

Reply. — The circulation in the skin of the back of his hands is poor. 
The skin nutrition is bad. When the cold makes the skin anemic and the 
cold air dries it further, it cracks. Patent salves will do no good. To keep 
the hands warmly covered all the time is the only remedy. Out of door 
work is better than indoor work when the hands can be kept warmly cov- 
ered ; otherwise indoor work is better. If indoor work is done the air must 
be kept moist. 

Psoriasis. — Inquirer writes: "What is psoriasis — the cause and symp- 
toms?" 

Reply. — Psoriasis is a chronic, patchy, scaly eruption of the skin. The 
patches are reddish or brownish and covered by dry, silvery scales. There 
is slight itching. There are no symptoms except as noted above. People 
with psoriasis are healthy and happy, or ought to be. Nobody knows the 
cause. 

Treatment of Psoriasis. — M. K. writes: "Do you know of any remedy 
for psoriasis? I am not constipated, eat moderately, seem to be in good 
health, but every two or three years I have a general outbreaking of 
psoriasis." 

Reply. — There is no remedy for psoriasis. At the same time, psoriasis, 
taken care of, causes little disturbance and sometimes disappears for years. 



HIVES 729 

It is well to wash the patches thoroughly and grease them with a mildly 
stimulating ointment — oxid of zinc ointment or one somewhat more stimu- 
lating — tar or creosote ointment. Sometimes a simple diet such as a gouty 
person would follow is advisable. Most cases of psoriasis do not call for 
any attention. 

Not a Bar to Marriage. — Reader writes: "Is psoriasis a bar to mar- 
riage? Have been troubled with it for about sixteen years and have been 
told there is no absolute cure. I have been taking Fowler's solution of 
arsenic in doses ranging from five to ten drops. Is there danger in taking 
arsenic?" 

Reply. — Psoriasis is not a bar to marriage. Do not take Fowler's 
solution as a matter of routine. Occasionally it helps psoriasis but that 
does not mean that one should take it in a routine way. 

Psoriasis Not Hereditary. — C. S. writes: "In a recent issue you say 
that psoriasis is incurable. Is there no internal remedy that will affect 
the condition of the skin sufficiently to make at least a temporary cure? 
Will climate affect the disease? Is it hereditary?" 

Reply. — Temporary abatement of psoriasis, in a certain sense a cure, 
is frequently brought about by care of the habits and of the skin and by 
the careful use of local applications and internal medication. Climate 
sometimes helps in a general way. It is not hereditary. 

Peroxid and Psoriasis. — J. J. D. writes: "I have been afflicted with 
pso?'iasis for a number of years. By accident, I spilled a quantity of 
hydrogen peroxid on the affected area. The peroxid ate up the scales, and, 
while it has by no means effected a cure, it has reduced the frequency of 
appearance of the scales, and destroyed irritation/' 

Reply. — While curing psoriasis is difficult, keeping the patches in con- 
dition is not exceedingly so. The use of peroxid occasionally is one way. 
Occasional use of wet packs is another. 

Pityriasis. — Chicago writes: "Is there any possible cure for phthiriasis 
of a number of years standing?" 

Reply. — I suppose you mean pityriasis — a scaly, scurfy eruption some- 
times attended by itching. It is of no particular consequence. Nobody is 
liable to die from it nor is it found in people in poor health. Use sulphur 
ointment regularly. 

Have It Removed. — C. A. A. writes: "I have had a wen on my head 
for a long time. Do you think it is harmful? If so, how could I get 
rid of it?" 

Reply. — A wen on the head is about the most harmless of tumors. 
Have it removed with the knife. 

What Ringworm Is. — I. R. writes: "What is ringworm? Can it be 
cured? If so, please outline the best and surest treatment for it? Is a 
doctor able to cure it through some specific remedy?" 

Reply. — 1. Inflammation of the skin due to a parasite. 

2. Yes, the best and surest method of cure is the use of X-rays. A 
good method is to pull out the hairs in and around the ringworm patch 
and to keep them pulled out. Wash the patch twice daily with soap and 



730 



THE SKIN 




Illinois Medical Journal. 

Fig. 245 — Ringworm of the Scalp. 



water and then paint with iodin or rub in a sulphur and mercury oint- 
ment. Spend at least ten minutes rubbing the ointment in. 

3. Ringworm cannot be cured by anybody in a short time. Patient, 
persevering thoroughness is a necessity of treatment. It matters little 
what drug is used. It matters much that patient, thorough care be 
given. 

May Be Ringworms. — Mrs. G. N. writes: "Will you tell me what three 
or four bright red patches on a man's scalp might be? They are covered 
with a crust and are of a month's duration. He says they do not itch, but 
he is constantly scratching them when home. 

"The scales 
are showing in 
his hair. He 
'poohs' at the 
idea of their be- 
ing anything, but 
his mother has 
had eczema all 
her life and other 
members of his 
family have had 
the disease, and 
now his 10-year- 
old daughter 
shows a spot sim- 
ilar on her scalp 
and he laughs at the coincidence. This man won't be careful about using 
others' combs or put his wash rag out of the children's reach. Should he? 
"He also has a hard lump on the bach of his neck. When it gets uncom- 
fortable he squeezes bad smelling matter out of it. It does not pain him." 

Reply. — These patches may be ringworms, psoriasis or eczema. Some 
of the scale patches are contagious, others are not. Individual brushes 
and combs, rags and towels should be the rule where there is no scalp or 
skin disease; doubly so when there is a skin disease. You should make this 
family see a skin specialist if you have to tie them down to accomplish it. 
The lump is probably a sebaceous cyst. It should be treated at the same 
time. 

Cures for Ringworm and Warts. — G. B. writes: "I know from experi- 
ence that iodin will kill ringworm and chromic acid will kill warts with- 
out pain." 

Cure for Ringworm. — F. R. of Cleveland writes: "For the last ten 
years I have been troubled with ringworm on my lower legs. One physi- 
cian prescribed tincture of iodin and another a white mercury ointment. 
They seem to do the work temporarily. What do you think is the cause? 
I bathe daily — that is, a shower bath — and eat regularly. My bowels are 
regular, with now and then a little constipation. My meals are light. Am 
a traveling man and my business requires me to do a great deal of walking, 
which I consider plenty of exercise. I weigh 175 pounds, height 5 feet 
6 inches. My general health is good. I was examined for life insur- 
ance seven years ago and passed as extra fine risk. Is ringworm con- 
tagious?" 



HIVES 731 

Reply. — If you have ringworm it is contagious. You could suffer a 50 
per cent reduction in the present excellent state of your health and still 
be above the line when the general health has any effect on ringworm. 
Ringworm can always be cured by: (a) persistent cleanliness; (b) per- 
sistent use of iodin, mercury ointment ; or in bad cases (c) use of a vaccine 
on or in the skin. However, I doubt if a cleanly fellow like you would 
have ringworm for seven years even though you are a drummer and not 
long enough in one place. Haven't you psoriasis or some other sticker? 
If so, it is not contagious and one's physical condition is of importance. 

Scars and Their Removal. — Reader writes: "Can scars be removed? 
About a month ago you said in an article that they could not be re- 
moved, but I read some time ago that whenever a criminal had scars he 
could go to a specialist and have them removed. Can real small scars, 
such as little holes made by pimples and blackheads, be removed?" 

Reply. — 1. Scars can be removed. I presume you refer to some reply 
in which I told someone his scars could not be removed. If it would be 
necessary to skin a man to get rid of his scars that man should content 
himself with his scars. 

2. Massage will minimize acne scars. Beyond this it is not good judg- 
ment to go. 

Warts and Moles. — R. C. C. writes : "Kindly tell me what will remove 
warts and moles. Also could you tell me how to make 'sage tea and sul- 
phur tonic for the hair?" 

Reply. — 1. Ordinary warts can be removed by any one of the following 
plans so they will not return : Run a redhot needle through the wart. 
Clip the wart with scissors and burn the bleeding point with a little nitric 
acid on a match. Apply salicylic acid as in corn salve. 

2. Do not do anything with a mole. If a mole is touched at all it 
should be completely removed by a surgeon. 

3. The sage tea and sulphur combinations as advertised are merely 
blinds for the sale of a patent medicine. Sage tea and sulphur is not good 
as a hair tonic. Use soap and water, rubbing and brushing. 

Wrinkles' Can Be Reduced. — J. F. wants to know: "1. If it makes any 
difference which direction the head is when sleeping at night? 

"2. She is nearsighted. Her face is beginning to wrinkle around the 
eyes. What causes it? Is there a cure? 

"3. Does massage with cream prevent wrinkles?" 

Reply. — 1. No, if you mean with regard to the points of the compass. 

2. Your eyes are being strained. The remedy is glasses which relieve 
the strain. 

3. In some measure, yes. Wrinkles come because (a) the under- 
lying muscles fold the skin so continuously that it becomes adjusted to 
the new position; or (b) the fat and water absorb from the space just 
below the skin so that the skin no longer fits; or (c) the natural elasticity 
of the skin is lost. 

Cure can be brought about : 1. By getting fat — the loose space fills up. 
2. By preventing the muscle contraction which wrinkles the skin. 3. By 
rubbing it into a smooth position, remembering always that a few minutes 
each day rubbing out wrinkles cannot offset twenty-four hours of wrinkling 
by muscular action. 



732 THE SKIN 

Wrinkles Defy Lotion. — J. G. writes: "Will a wash lotion made by 
dissolving one ounce of powdered saxolite in one-half a pint of witch hazel 
eradicate lines and wrinkles in the face? If not, what will? Would this 
lotion be harmful to the skin?" 

Reply. — It will not eradicate lines and wrinkles. Getting fat will. 
Massage will be of some service. No lotion will be of any service. 

Shingles. — 8. A. L. writes: "1. What causes shingles? 2. Is it con- 
tagious? 3. Will alcohol and cold baths cure it?" 

Reply. — 1. It is a form of neuralgia. 

2. No. 

3. Yes, anything cures it; that is to say, it gets well automatically. 
A purge and light diet with proper attention to the cleanliness and care 
of the blisters is the best treatment. 

Shingles Not Dangerous. — Mrs. S. writes: "Kindly give me some 
information regarding the shingles — what causes them and how they 
affect a person? Are they dangerous for an old person, and what are 
the effects they leave? How long does it take to get over them?" 

Reply. — Shingles is a form of neuralgia. The condition is not danger- 
ous and leaves no after effects. Purgatives, local applications and neu- 
ralgia medicines effect a cure. 

Cause of It Not Known. — Sufferer writes: "Will you kindly give me the 
following information: 

"1. What is the cause or origin of ichthyosis? 

"2. What relieves or cures it? 

"3. What work on the subject, easily obtainable and intelligible to a 
layman, should I read? 

"J+. Is it a common ailment?" 

Reply. — 1. Ichthyosis is a congenital disease the cause of which is not 
known. 

2. Nothing cures it. 

3. You can understand all the essential points in any textbook on skin 
diseases. 

4. No. 

Boils. — A. J. 0. writes: "What causes boils? My husband, who is 57 
and has never had a boil before, has just had five inside a month. He does 
office work and is always studying and reading, so he gets little physical 
exercise except walking. We eat no meat during the three summer months 
and only three or four times a week the rest of the year. We have fruit 
three times a day the year round. I have 160 quarts canned now for this 
coming winter. There are only three in our family, and husband eats fully 
half the fruit. Can fruit eating be overdone? We use no coffee. Husband 
drinks tea for breakfast and lunch." 

Reply. — There are germs capable of causing boils on the skin all the 
time. Occasionally some of these travel down a hair shaft or into a grease 
gland and set up an infection called a boil. When such an accident occurs, 
usually something in the internal economy is wrong. Where a man — a 
heavy eater of canned fruits — gets a succession of boils the first thing to 
be thought of is diabetes. If an examination shows diabetes not present 



HIVES 733 

the next suggestion is low opsonin index as regards the pus cocci. This last 
calls for a vaccine. I assume that the toilet of the skin is properly done, for 
both before the boils and during their existence wet, soggy poultices foul the 
near-by skin and thus help to cause secondary crops of boils. Fruit eating, 
particularly sweetened, preserved fruits, can be overdone — leading to indi- 
gestion, glycosuria — a form of diabetes — and boils. 

Don't Poultice a Boil. — H. K. writes: "Kindly inform me if there is 
anything besides hot flaxseed poultices that is as effectual in relieving and 
maturing boils/' 

Eeply. — A boil will get well whatever is done for it. A flaxseed poul- 
tice is a bad thing to use on a boil as it often causes secondary boils to 
come. The hot, wet, dirty mess occasionally infects the near-by skin. Crops 
of boils and fresh boils around the old boil were frequent when poultices 
were in vogue. If you want to apply heat use a hot boracic acid solution 
pack made with gauze and covered with rubber tissue or well bandaged, 
or use a hot water bottle. 

Carbuncles. — J. F. writes: "I have been troubled with carbuncles on 
the bach of my neck. What is the cause of them? Can I take something 
that will keep them from returning? What should I eat? I use no tea, 
coffee, or any alcoholic drinks. I am 70 years of age. Are carbuncles 
dangerous?" 

Eeply. — Carbuncles may be dangerous, especially in a man seventy 
years of age. First find out if you are a diabetic. If so regulate your diet 
accordingly. If you are not diabetic eat about what you have been ac- 
customed to eating. Look well to the cleanliness of your skin. That 
means be firm in refusing to use poultices. Some of your friends will 
want to poultice your neck. Fight them off. A poulticed neck is a dirty 
neck and a dirty neck will mean more carbuncles. Carbuncles are due to 
an infection of the deeper tissues beneath the skin with pus germs that 
have traveled down from the surface of the skin. Keep in the open air and 
keep your secretions right. 

Cause of Pimples. — C. L. W. writes: "What causes red pimples, which 
are hard under the skin, to break out continually on my face?" 

Reply. — It is due to fat and debris that accumulate in and around the 
sebaceous follicles of the skin. This fat and debris, being foreign bodies, 
irritate the skin and when not removed cause inflammatory lesions — '''red 
pimples" — such as you complain of. 

Having resorted to minor measures for relief you would do well 
to have a careful doctor examine you and advise as to plan of treatment. 
He may give you the vaccine treatment. He may have you wash your face 
night and morning with lukewarm water and soap, rinse well, dry thor- 
oughly and then apply freely and rub briskly with equal parts of alcohol 
and a saturated solution of boracic acid. He will also direct you as to diet, 
exercises, baths and habits of sleeping. 

Blackheads. — Anxious Mother writes: "Please give me advice as to 
what to do for my daughter. She is 15 years old. For the last six months 
she has been greatly troubled with pimples and ugly blackheads on her fore* 
head." 



734 THE SKIN- 

REPLY. — The skin is filled with grease glands. They are necessary. 
When they clog up, the secretion is called a blackhead. Yon should see that 
she does not overeat, that she is not constipated, above all that she exer- 
cises in the open air. Keep her face clean and keep the blackheads squeezed 
out. You could not stop the secretion of these glands if you tried and you 
should not try. 

Cause of Whiteheads. — R. L. writes: "I am troubled with whiteheads. 
I press them out. How can I get rid of them?" 

Reply. — There is no way except the one you are using. The pores of 
the grease glands are liable to be grown over by skin, especially when 
spectacles press or where the skin forms fine wrinkles. When the duct is 
overgrown the secreting gland causes the small accumulation of white 
grease called a white head. 

Acne. — C. C. A. writes: "The face of a friend is in a very pimply con- 
dition and has been for a number of years. It is not itchy, merely covered 
with red spots. Some time ago I had another friend troubled in a similar 
manner. He went to the sea and bathed in it every day, and when he re- 
turned home his skin appeared in a perfectly healthy condition. If not sea 
or salt water, what do you recommend in the former case? He has been 
talcing blood medicines." 

Reply. — I judge your friend has pimples or acne. Blood medicine will 
not be of any service. His skin is probably greasy and if so salt water or 
sea water will help. In the main, however, reliance must be put on such 
measures as limiting the diet, correcting constipation, keeping the skin 
clean, expressing blackheads, and vaccine in cases when it is needed. 

Pimples and Blackheads. — F. A. S. writes: "I am troubled with pim- 
ples and blackheads. Please suggest a remedy for them." 

Reply. — In some cases, squeeze them out, then wash vigorously with 
soap and hot water and dry with rough towel. This materially aids in 
keeping the grease glands open, the closing of which has much to do with 
the cause of the blackheads. Apply alcohol morning and night at the same 
time rubbing the face vigorously with the hands. See that the bowels move 
freely and regularly each day. Eat sparingly of meats, especially greasy 
meats, but eat freely of fruit, especially apples, prunes, figs, dates, cran- 
berries, and the like. If this does not cure you, have your family physi- 
cian direct you to some reputable skin specialist. 

To Prevent Pimples. — "1. Will you be kind enough to tell the causes 
for pimples on a young man's face, and how to prevent them? 2. Does 
electric massage help any?" 

Reply. — 1. (a) Wash the face with soap and water and then with alco- 
hol often enough to keep it clean, (b) Squeeze the blackheads out. (c) 
Eat less and exercise more, (d) Cure your indigestion and constipation. 

2. No. 

Acne Vaccine. — W. G. writes: "What is acne vaccine and where can 
it be procured? Can it be used without consulting a physician?" 

Reply. — Acne vaccine can be had from the large manufacturing phar- 
maceutical houses direct . or through local druggists. It can be made 
from germs grown from the patient's pustules. Most of the laboratories 



HIVES 735 

make vaccines after this plan. It cannot be used except by a physician. 
No good would be accomplished. 

Alcohol for Blackheads. — G. of Kenosha, Wis., writes: "1. In spite of 
my daily baths and fairly good digestive system, my face is filled with 
blackheads and it breaks out with pimples, especially on my chin. Will 
you please tell me what will remedy this? 

"2. In school I notice after about an hours work my hands become 
cold and clammy. What is the cause of this?" 

Reply. — 1. Eat less, keep the blackheads squeezed out, keep your face 
cleaner, use alcohol if necessary. 

2. Exercise more in the open air. Control nervousness. 

Pimples Not Blood Disease. — G. H. R. writes: "The writer has been 
troubled with acne [so the local doctor calls it] for some five or six years. 
At times the face will clear off altogether and then pimples will break out 
afresh. I have been advised to leave off eating greasy foods and pastries, 
but it seems that does not help, for the skin will break out just the same. 
I have also tried dieting. Does dieting help or hinder the ailment, or 
should it be treated locally? Is it caused by bad blood or is it merely a 
skin disease? Do different foods affect or help the disease in any way, or 
will it gradually go away of its own accord?" 

W. C. H. wants to know if smoking causes pimples on the face. If not, 
what does, and what can be done to get rid of them? 

Reply. — Smoking does not cause pimples. When it comes to answering 
your other questions the difficulty is greater. Certain glands of the skin 
secrete grease. This grease normally oozes out on the skin and keeps it 
pliable. Sometimes these glands stop up. The top of the gland may grow 
together, the gland may be plugged by dirt or some grease may become 
hard and plug it. Such glands distended with grease are usually called 
blackheads. 

Skin bacteria frequently get into these distended glands and cause little 
boils, called pimples. So, back of the pimples lie the blackheads; back of 
the blackheads lie the state of general nutrition and the state of the skin. 

Before we go further there is one thing that should stand out clear. 
Pimples is not a blood disease. They are not due to a condition of the 
blood. They have nothing to do with the blood — certainly not in the sense 
in which the statement is commonly made. Broadly speaking, skin dis- 
eases have less to do with the blood than any other diseases. 

Pimples usually develop in the middle of the teens — the boy or girl 
eating too much and exercising too little. Some of the food which should 
be burnt up into energy is going into fat. Some of this fat is stored 
under the skin. Some of it is stored in the liver. Some of it goes through 
these grease glands. 

So the first step in the cure is to exercise more and eat less. The second 
step is to scour the face with soap and water and occasionally with boracic 
acid and alcohol. After the case gets to the pimple stage, the person af- 
fected had better quit following general advice and get individual counsel 
and follow it persistently. 

Serum Treatment for Acne. — "A Reader" writes: "I am 22 years old 
and have had acne for six or seven years. It seldom shows upon my face, 
but my shoulders are always covered with large pustules. I have taken 
quite a lot of blood medicine, but it seems to do no good. I tried the serum 



736 THE SKIN 

treatment last summer, taking two treatments of staphylo-acne bacterin. 
During this treatment the pustules disappeared rapidly, but after a month 
or two they returned and are now worse than ever. Is there any cure for 
acne?" 

Reply. — The vaccine did you more good than anything else. Use it 
again. Keep it up longer than you did before. Keep blackheads pressed 
out systematically. 

Cause of Hives. — L. W. D. writes: "What is the cause of hives and 
general itching of the skin? What is the remedy?" 

Reply. — Hives is the result of eating some article of food which is 
poisonous to that particular person. To another person the food may be 
wholesome. To cure hives someone recommends painting the patches 
with collodion. A purgative should be taken. To prevent hives avoid the 
foods which disagree. 

I do not know just what you mean by general itching of the skin. 
Hives is not a general itching. 

Cause and Treatment of Hives. — E. P. A. asks cause of hives and 
how to get rid of them. He asks if there is any kind of diet for them 
and how long they last. 

Reply. — Hives is an eruption of the skin in the nature of a neuralgia. 
Just as behind the eruption there is neuralgia so behind the neuralgia 
there is a cause. There are many different causes of hives. Sometimes 
one is responsible, sometimes another. There is no cause of hives that is 
common to every case. The thing to do is to find what has been the cause 
in each individual case. Probably food poisoning is the most frequent 
cause. Sometimes the food which has caused it is of good quality, at other 
times it is spoiled. The most frequent cause is a hypersensitiveness to cer- 
tain foods. 

How to Avoid the Hives. — W. A. writes: "Would you kindly state the 
cause of hives? About every month or two I break out with them. I have 
thought that it was something that I eat, but what it could be I do not 
know." 

Reply. — Hives generally are caused by some disturbance of the alimen- 
tary canal. Certain articles of food, such as shellfish and strawberries, 
often produce hives. The treatment generally consists of a good purge 
and bathing the affected parts with baking soda and water. Find out what 
foods cause hives and avoid them. 

Freed of Hives. — R. L. writes: "For years I suffered from hives in 
summer, and I accepted it as a summer trouble of some kind. My brother 
also suffered from it every summer. Several years ago I was advised to 
eliminate meat that summer and eat all the fruit I wished. This I did, and 
from that day to this I have never been troubled with the hives. I never 
eat meat more than twice or three times a week at any time of the year, 
but in the warm weather I do not eat it more than once a week. My 
brother also follows the same course in summer, and he is no longer troubled 
with the hives. To eliminate meat from one's diet means gravy, meat 
soups, and meat fats. Eat nothing fried in meat fats or made with lard 
or suet. Substitute butter, cream, milk, cheese, and eggs. Vegetable soups 



HIVES 737 

and cream soups made without meat are good. I have had only one cold 
in four years, which improvement I also attribute to the change in diet." 

Reply. — Some will benefit from following your plan; others will not. 

Treatment for Hives. — W. F. N. writes: "My wife is troubled with 
hives. New irritations have been coming daily for a week. We have 
applied camphor spirits and they have given her local but only temporary 
relief. She is not an abnormal eater of pork, and it is not the strawberry 
season. Her appetite is so normal and healthy that it is difficult to dis- 
cover any cause in her diet. What other things may cause the disturbance, 
and what remedy should we apply?" 

Reply. — Hives usually results from eating something that disagrees. 
The food that causes hives in one person may be the most wholesome of 
foods for the average person. Buckwheat, fish, salmon, oysters, straw- 
berries and pork are among the more frequent offenders. 

Have your wife take a large dose of castor oil. Have her go on a 
bread and milk diet and gradually increase her diet list. 

How to Prevent Hives. — A. R. writes: "Will you kindly tell me the 
cause of hives? Is there any cure?" 

Reply. — Hives is a nervous eruption due to some kind of food poison- 
ing. A good dose of a purgative cures it. The purgative may have to be 
repeated. Foods which cause it must be avoided. They may be entirely 
wholesome for other people; the peculiarity is in the person rather than 
in the food. 



CHAPTER XLI 

The Teeth and Hair 

THE TEETH 

THE TEETH AND HEALTH 

The thumb sucker has a face that tends to narrow just below the nose. 
The arch of the palate is high and the front teeth, especially in the upper 
jaw, point forward. Over them the upper lip must curve and in consequence 
it appears shortened. 

The mouth breather has a long and somewhat lantern- jawed face. The 
lower jaw tends to narrow and the mouth hangs open. Once you have seen one 
or more mouth breathers you will have little difficulty in picking them out. 

However, if you are intent upon thus employing your idle thought you 
must be up and doing. The purpose of nature is to fit the face to a certain 
inheritance. Thumb sucking and mouth breathing interfere with the plan. 
But nature stays on the job and in time the deformity may be remedied. 
Many beautiful women and handsome men had thumb sucking and mouth 
breathing stamped on their faces in childhood as plainly as one of these new 
style advertising signs. 

When nature fails all is not lost. The dentist remains. The parent 
whose child was neglected until a bad "bite" was acquired can make amends 
in part by having the dentist push and draw the teeth until the "bite" is 
right. Ordinarily this is not done until the permanent teeth are out — say, 
when the child is ten to fifteen years old. 

In one sense that is a good period to do the work — just before and at 
puberty. Certain biological changes are taking place. In consequence the 
bones are changing form and shape in many particulars. It is therefore a 
propitious time to mold jaws and rearrange teeth. 

A better beginning time, though, is when the baby teeth are still in 
place. As the jaw is molded in the days of baby teeth it is apt to grow. 

A proper "bite" is necessary for health. A good digestion is dependent 
on good chewing. When the "bite" is poor it is difficult to keep the teeth 
clean, and, finally, teeth that grind against other teeth are much more liable 
to keep sound and to set still and firmly in their sockets than useless ones. 
Nature does not long tolerate teeth or anything else that does not do work. 
A proper "bite," then, has health relations as well as dental relations. 

The teeth are not dead structures. They are always undergoing change. 
The horse trader judges of the age of a horse by the shape of the grinding sur- 
face of its teeth and the shape and size of a certain dark area on that grinding 
surface. 

A horse is constantly grinding off the surface of its teeth. It grinds 

738 



THE TEETH 



739 



through the enamel into the dentine, whereupon the dentine gets enamel-like 
in its hardness and denseness. It grinds down to the pulp chamber, where- 
upon the pulp chamber fills up with dentine and gets, as hard and dense as 
enamel. 

The small, dark area by which the dealer judges age is the former pulp 
chamber. In the pulp chamber are contained the arteries, veins, nerves and 
lymph vessels of the tooth. Bacteria have been known to travel from the 
pulp down into the neighboring tissue. 





Fig. 246. — Uncared for Teeth Showing Food 
Particles, Which, Fermenting, Form 
Acid. {Dental Summary.) 



Fig. 247. — Uncared for Teeth. Acid At- 
tacking the Lime in the Enamel 
Rods. {Dental Summary,) 



A number of years ago the elk in Lincoln Park, Chicago, got lumpy jaw. 
The infection was manifest in the glands of the neck just below the jaw. But 
Cy De Vry found that the teeth contained great cavities and that the cavities 
were filled with infected food. The lumpy jaw infection had traveled as 
ordinary infections travel. 

The preferred route is down the side of the tooth to the lymph spaces in 





Fig. 248. — Uncared for Teeth Showing 
Decay Attacking Dentine. {Dental 
Summary.) 



Fig. 249. — Uncared for Teeth. Fur- 
ther Progress of Decay — Tooth 
Begins to Ache. {Dental Summary.) 



the socket. From this area the germs go into the neighboring lymph glands. 
In the lower jaw the glands most frequently infected are those just below 
and just to the side of the chin. These glands seem to be almost in the floor 
of the mouth. 

Another set of glands that get infected through the teeth and their sockets 
are those at the angle of the jaw. 



740 



THE TEETH AND HAIE 



The infection can also travel into the cavities opening off the nose — the 
antra. Most of the cases of so-called catarrh are due to chronic infection 
of these antra and some of these cavity infections are due to absorption from 
the teeth. Among the infections that may get in by this route are tubercle 
bacilli. When these locate in the glands of the neck the condition is known 
as scrofula. 

Scrofula was called in the old days "king's evil." In human history kings 
got into the field before dentists. Had the dentists got the spotlight first 
scrofula would have been known by another name than king's evil. The kings 
would have had first call on the dentists and the poorer man's teeth would 
have been the routes of infection. 

However, the possible infections through and around the teeth are not 
limited to tuberculosis. Colds, scarlet fever, diphtheria and measles — in fact, 
pretty nearly every infection can travel this route. 





Fig. 250. — Uncared for Teeth. Under- 
mining and Breaking Down of the 
Enamel Walls, Exposing Large 
Cavity Which has been Forming, 
Unsuspected, for Months. (Dental 
Summary.) 



Fig. 251. — Uncared for Teeth. Death 
of Dental Pulp or Nerve. Forma- 
tion of Pus and Gas in Pulp Cham- 
ber. (Dental Summary.) 



The finger of probability is pointing toward bacteria as the cause of rheu- 
matism. There are as many kinds of rheumatism as there are kinds of 
catarrh. Two of them seem to be due to infections through the mouth — or- 
dinary acute inflammatory rheumatism and some forms of rheumatoid 
arthritis. It is especially in rheumatoid arthritis that the indications point 
to the teeth as the route of infection. 

Nobody has been able to say just why teeth decay. We know that they 
decay in youth rather than in maturity; that young people lose their teeth 
from decay, old people from pyorrhea; that decay is more liable to start on 
certain surfaces than on others, in certain teeth than in others. A few facts 
like these are known but certain important facts are still unknown. 

It is generally held that the teeth decay because the lactic acid bacilli 
produce acid which eats out the lime salts. There are more than fifty kinds 
of germs in the human mouth and many of these are alkali producers. The 
saliva is often alkaline because the alkali producers are in excess. 

Hopkins found that about one-fifth of the mouth bacteria are lactic acid 
producers. He could never grow these bacteria so that they would make more 
than one-half of 1 per cent acid. On the other hand, he kept teeth for months 
in one-half of 1 per cent lactic acid solution and they were not harmed by it. 



THE TEETH 741 

• 

While the scientists are at work on these problems of chemistry and bac- 
teriology the man whose job is to keep his teeth sound and in his head can 
succeed by following the simple plan of keeping his teeth clean and having 
them inspected by a dentist twice a year. Following this plan, no infection 
at least will go through his teeth. 

Of more importance from the health standpoint is pyorrhea. — the disease 
which deprives grown people of their teeth. It has much to do with ill health. 
In this disease the teeth are loose and the gums are sore. 

To chew well is out of the question. The food must be bolted; nothing 
else is possible. On top of this there goes more or less systematic poisoning 
from the suppurating, discharging gums. 

It is possible, as Khein suggests, that several different conditions are 
called pyorrhea. Not infrequently the disease is developing just at the time 
when it is natural for the ridges around the teeth's sockets to begin to absorb 
and disappear. 

There are two schools of scientists on the pyorrhea question each school 
fighting for its position. One contends that the important condition is a gouty 
or some other sort of a constitutional state; the other that the important 
condition is an infection. 

Here, too, the man who wants to keep his teeth has a line to cling to. 
If he will have his teeth periodically examined his pyorrhea will be discovered 
in the early stages and it can be cured or held stationary for twenty years 
or more, which comes to nearly the same thing. 

In late pyorrhea the gums are inflamed and pus sockets burrow down 
by the side of the root of the tooth. There are dentists who go down into 
these pockets and clean them out. Some even go so far as to take the tooth 
out, clean it and stick it back. 

Many of these late cases of pyorrhea can be cured but it takes time 
and money. It is like late consumption — somewhat curable but only for 
those with fortitude and patience. 

The proper plan is to watch so systematically as to detect the disease 
when cure is within the reach of all — when cure is cheaper than plates and 
bridges. 

The teeth make up a part of the facial neuralgia equation. Sometimes 
the pain of facial neuralgia is felt in the teeth even when they are sound. 
Sometimes the cause of facial neuralgia is found in the teeth. 

The nerves of the teeth come off the same stem as do those of the other 
structures of the face. Their hurts will not stay separate. 

Unfortunately as we go hunting around for relief from pains in the 
face we frequently turn the wrong doorknob. We go to the office of the 
physician when we should go to the office of the dentist and vice versa. 

We are made to feel the desirability of Magitol's dogma. All dentists 
ought to be doctors and all doctors ought to be dentists. In facial neuralgia, 
Prinz says, we are apt to join sincerely in this wish of Magitol. 

IMPORTANCE OF GOOD TEETH 

Infection can get into the body only through the mouth and nose. To 
this statement there are a few exceptions, albeit very important. Bacteria 



742 THE TEETH AND HAIR 

do not remain long on the smooth, free surfaces, for food, drink and air 
sweep them away. It is in inaccessible places, in pockets, corners and crev- 
ices, that they get a chance to multiply. 

Everybody has read of the absorption from pockets in tonsils and adenoids 
and the cavities which open off the nose and throat. Few have thought of 
the teeth as harbor ers. 

It is not by absorption that bacteria in teeth cavities do harm, for while 
teeth can take up stains the power of absorption is so slight that it may be 
forgotten. The germs multiply in tooth cavities and recesses from which 
they are carried by food into the stomach causing disturbance of digestion, 
and by the saliva to the outside, spreading infection. Whether a man is an 
infection spreader is in part determined by the teeth he keeps. 

I suppose nothing is more natural than to blame someone else or some- 
thing else for one's own shortcomings. In consequence indigestion and 
dyspepsia are charged up to foods when they should be charged to the feeders. 
Almost anybody can eat anything which is clean, wholesome and fresh, pro- 
vided he will limit the quantity eaten, take plenty of time to eat and keep his 
mouth and teeth always clean. It is the method of eating rather than the 
things eaten which causes indigestion — aside from those cases which are due 
to mental impulses — and a part of the method of eating is the condition of 
the teeth. 

About the best cleaning they get is from polishing by food, in which 
process bacteria from the cavities and food particles, decomposing for hours 
or days in the cracks, are swept down into the stomach. The stomach being 
pretty capable takes care of itself under ordinary circumstances but every 
now and then trouble results. 

Clean teeth, free from cavities, are attractive. They do not decay or 
become painful so promptly as dirty teeth; they are not so prone to harbor 
infection; and, on top of all this they do not pass harmful substances into 
the stomach. 

Food can be chewed with decayed teeth but it takes more time. We 
so begrudge the time needed to eat with good teeth that we are certain to un- 
duly hurry the job when we try to eat with poor ones. In consequence we 
swallow food which is not well broken up. 

Now the gums are set with "ivories" devised for the purpose of breaking 
%p food, while the stomach is a simple, muscular bag. A few minutes of 
tooth work will break up the food more than hours of stomach work. 

One thing is certain — the food must be broken up, and the only ques- 
tion is whether a few additional minutes will be consumed in doing this 
efficiently with the teeth or an hour or more consumed doing it inefficiently 
with the stomach. A man's indigestion is largely determined by the teeth 
he keeps. 

Still decayed teeth are not the most frequent cause of faulty chewing 
and faulty chewing is not the most important result of decayed teeth. Teeth 
are especially prone to decay in childhood — just the time when the jaws 
are developing and taking shape — and their premature loss causes the 
jaws to develop irregularly and the uppers and lowers not to meet so as 
to make a good chewing surface — the most important cause of poor diges- 
tion. 



THE TEETH 



743 




Fig. 252. — Points Usually Neglected in 
Brushing Teeth and Where Decay 
Begins. {Dental Summary.) 



CARE OF TEETH NECESSARY 

Man having learned to soften his food by cooking is not so good a 
chewer as some other animals; in consequence his teeth and gums do not 
automatically keep themselves as well as those of other animals — all of which 
means that the man who leaves the care of his mouth to automatic agencies 
loses his teeth. 

In this narrow sense human teeth 
are not the best. But nature has en- 
dowed him with knowledge and judg- 
ment to compensate him for his loss in 
other directions. The man who cares 
for his teeth with judgment and dili- 
gence keeps them better than does 
any other animal. The combination of 
human brains and teeth is the fittest 
and the best. 

It is a far stretch from the enamel 
with 96 per cent inorganic matter 
and 4 per cent water and organic mat- 
ter combined to a soft, pulpy organ 

such as the spleen which is nearly all water and organic matter. The peculiar 
chemistry of the enamel means that it is very resistant to bacteria as well as 
all sorts of chemicals. 

CAVITIES IN TEETH 

When acids and alkalies derived from food are eliminated from the 

causes of decay of teeth nothing remains but bacteria. There are more 
than thirty varieties of bacteria naturally in the mouth. 
They are not present when a baby is born but they begin 
arriving very soon and are present ever after. In addi- 
tion to those which are universally present, so to speak, 
there are others such as the pneumonia and diphtheria 
bacilli which are present in some mouths but not in 
others. 

The ordinary bacteria secrete alkaline substances 
which do not harm the teeth; but there are a few acid 
producers and these cause decay. The enamel being com- 
posed of inorganic matter will not support germ life. 
Therefore they must live on food remnants. A little bit 
of food refuse or food detritus lodges in a crack, fissure 
or some shielded place and into it some acid-producing 
germs find their way. 

They grow and secrete acid and when this dissolves 
the enamel a cavity results. The larger cavity means more 

detritus, more bacteria, more acid and more decay. 

The point to the story is that decay comes from acid acting in one place: 

acid comes from germs; germs feed on food detritus. Moral: If the teeth are 

kept microscopically clean there will be no decay. 




Fig. 253.— Growth 
and Multiplica- 
tion of Bacteria 
in Such a Tooth. 
(Dental Summary.) 



744 THE TEETH AND HAIR 

Decayed teeth, like swollen tonsils, mean an advanced process. The 
cavities must be cleaned out and filled just as the tonsils must be removed. 
But the wise procedure with each is to keep the mouth so clean that the 
process will not advance to the stage where filling or cutting will be required. 
This means cleaning several times a day with toothpicks, floss, powders and 
soaps. 

The ordinary brushing cleans the parts of the teeth which do not 
need it much since eating is so efficient as a good cleaner. Cleaning means 
emptying the pockets, the little crevasses, the fissures — these are the places 
which count — and do the best one can, periodic cleaning by the dentist will be 
required. 

Commonly adults keep their teeth clean enough to hold decay down. 
It is children that need dental care. Theirs are the teeth which should be 
daily picked, flossed, brushed and polished, and which periodically should 
be gone over by the dentist. Above all, care should begin with the first 
set of teeth because when these drop out before their time the result is 
some sort of a twist in the jaw. Children would gain if mothers would put 
some of the time on washing the teeth that they now put on washing faces 
and ears. 

IRREGULAR JAWS 

Once there was an old woman who could not be thankful for riches 
or looks or anything else worth while and yet determined to thank the 
Lord for something she said: "I have but two teeth, but, thank heaven, 
they meet/' 

When teeth do not meet properly they are not satisfactory to chew on; 
food is commonly swallowed without being thoroughly chewed, chewing 
does not clean them even average well and they are more prone to decay. 
The pressure of chewing falls on them at improper angles and, therefore, 
they are more apt to become loose and, eventually, to be the seat of pyorrhea. 

All in all, teeth are more secure and digestion averages better when the 
teeth meet normally, each tooth striking the exact place in which it belongs. 
If any one is out of that position an eighth of an inch the system is spoiled, 
the links in the chain disarranged. 

The system in the human mouth is more complicated than in that 
of the lower animals. The animals which eat vegetables have one kind of 
teeth throughout. If a tooth in the upper jaw strikes the wrong tooth in 
the lower jaw it still strikes its kind. The animals which eat meat have but 
one kind of teeth throughout. But in man teeth for vegetables are near to 
teeth for meats and when the bite is wrong it may throw teeth adapted to 
tearing in opposition to teeth adapted to grinding. 

When an engineer starts a tunnel from the both sides of a mountain 
and so calculates that the tubes meet just as planned the world applauds as it 
should; but that is simplicity itself compared with the plan by which the 
jaws of a forming child start from separate centers and grow in a complicated 
way until they reach exactly the right positions. It is expected that this 
development will work out right and when it does nothing is said. When it 
fails we search for something to blame. 

It is after the child is born that the jaws go wrong. Summer complaint, 



THE TEETH 



745 



contagious disease, enlarged tonsils, month breathing, thumb sucking, scurvy, 
rickets, syphilis, decay— these are the things which cause jaws to over- 
grow, undergrow or to grow irregularly. A wise dentist looking in the 




SATj 



Fig. 254. — Temporary and Permanent Teeth: 1,1, temporary central incisors; 2, 2, tem- 
porary lateral incisors; 3, 3, temporary canines; 4, 4, temporary anterior molars; 5, 5, tem- 
porary posterior molars; 6, 6, permanent central incisors; 7, 7, permanent lateral incisors; 
8, 8, permanent canines; 9, 9, permanent first bicuspids; 10, 10, permanent second bicuspids ; 
11, 11, first molars. 

mouth can tell just when the blighting illness or neglect came and in 
many instances its cause. Of greater importance is his ability to regulate 
jaws and teeth so that they "meet." 



EROSIONS 

There is a very peculiar condition of the teeth called "erosions" which is 
not of much consequence but which I am writing about because of its peculiari- 
ties. Occasionally it causes a tooth to fall out or to break off but generally 
it does little harm. It causes a furrow near the gum margin and running 
parallel with it. This triangular furrow, about one-tenth as deep as the 
tooth, is thick and usually runs in a straight line across several teeth. It is 
not a decay and it does not result in pyorrhea. It comes in those who have 
been undergoing severe nervous strain — financiers in times of panic and 
soldiers in time of war. 

A tooth is simple in its arrangement. In the center is a pulp carrying 
a few blood vessels, a few nerves and a little tissue — like the marrow of 



746 THE TEETH AND HAIR 

bone; around this is the dentine, a bony mass having few vessels, few nerve 
filaments, few cells, few spaces, and these of small size — changing a little, 
but very little; set over this like a cap is the enamel — hard, resistant, negative 
to everything, with few cells, small spaces, no vessels, no nerves and in- 
capable of change. 

Now teeth are supposed to be as immutable as the mountains; as they 
erupt so they remain. But they are not so changeless as is generally believed. 
The orthodontist moves them around over considerable latitude. The dentist 
treating pyorrhea may pull one out, clean it, and put it back. 

As the enamel wears the underlying dentine and the pulp becomes dense, 
the nerves, vessels, cells and spaces disappear, the worn surface of an 
old tooth has a dentine and pulp zone as eburnated, hard, shiny and bony as 
enamel. The fact is that the teeth adjust themselves to their work just as 
does everything else. 

In the light of this the furrows which worry may plow in teeth and 
which we call erosions, are not so difficult to understand as they were when 
we regarded teeth as Gibraltars. Nevertheless, among human diseases 
erosions remain the great mystery — the Egyptian sphinx — which tells us 
some things but leaves us much to guess. 

PYORRHEA 

For a long time the man with pyorrhea notices that his gums are softer 
and flabbier than they once were ; and between the gums and enamel the necks 
of his teeth can be seen. In this stage cure is easy. The patient goes to his 
dentist who cleans the teeth not only above the gums but as far down the 
roots as a deposit is found, after which the patient keeps the teeth and 
gums well rubbed. The art of cleaning and rubbing the teeth he learns from 
the dentist. 

The next stage is that in which the teeth are loose, the gums are flabby 
and more of the neck is exposed. In this stage the disease is curable but more 
time and care is required. 

In the last stage the gums are soft and spongy, the teeth loose, and 
pus oozes up beside the roots. Cure is now difficult. The added factor 
of pus infection makes treatment much more complicated and greatly 
decreases the possibility of cure. 

See how the parallel with consumption continues : after the consumptive 
has got a pus infection of his lungs on top of his original disease cure is 
impossible or for it long, patient and expensive open air treatment is re- 
quired. 

Even after the teeth are so loose that they can easily be moved by the 
fingers and pus oozes from around the roots thorough removal of all deposits 
from the roots and applications to the gums followed by banding of the teeth 
so that they cannot rock will be effective — except when the bony socket has 
been absorbed. 

There are those who think constitutional diseases such as gout, rheuma- 
tism, diabetes and senility have much to do with pyorrhea and there is 
some truth in these ideas. There are those who believe pyorrhea is a cause of 
rheumatism and other constitutional diseases. But pyorrhea usually can 



THE TEETH 747 

be cured without paying much attention to the constitutional state and it is 
important enough to stand on its own base. 

The important tiling to know is that spongy gums falling away from the 
teeth with deposits below the gum margin mean pyorrhea which, taken care 
of then and rightly, can be cured but which, neglected, means toothlessness — 
before the period of "lean and slippered pantaloon, sans eyes, sans teeth, sans 
everything/'' 

ANEMIA AND DIRTY TEETH 

The surgical operating room is a perfect machine. From operating 
surgeon through assistants, nurses, instruments, walls, floors — all down the 
line the technic and equipment spells 100 per cent efficiency. What efficiency 
engineers talk about is seen in daily operation in the highest grade surgical 
amphitheaters. 

The technic of asepsis in the surgical ward is not 100 per cent, as in 
the operating room, but it is much nearer so than is that in the medical 
ward. Time was when the surgical ward reeked with pus infection and 
from it infection extended over into the medical ward. Now the surgical 
ward is aseptic and the effort is to prevent infections overflowing from the 
medical ward. 

From sources here and there is heard a plea that medical cases be sur- 
rounded with the same aseptic conditions that prevail in the case of surgical 
cases. Of these was the argument of Hill before one of the meetings of the 
Canadian Public Health Association, that infection would lessen as cases of 
infectious diseases, scarlet fever, diphtheria and the like were treated asep- 
tically. 

The strongest plea that I have read is that of William Hunter of 
England. His argument is for clean mouths — oral asepsis. He does not 
discuss the theory that a dirty mouth promotes the decay of teeth. That 
needs no argument — nor that diphtheria, scarlet fever and similar infections 
are spread by the mouth secretions. 

His argument is that the continued absorption of such bacteria as 
staphylococci and streptococci and their secretions from tartar accumulations 
around the teeth and from pockets in the gums is responsible for rheumatism, 
joint troubles, heart troubles, stomach troubles and severe anemia. 

Any physician will tell you that William Hunter is a world authority 
on severe anemia. In his argument he cites a list of cases of profound 
anemia, some of which would be called pernicious anemia, which were 
due to foul mouths and which got well when the mouth was kept clean. 

In some of the cases the absorption of pus was from some pocket other 
than the mouth. One was a case of catarrh due to an accumulation of pus 
in the frontal sinus. One was a pus absorption from a pus pocket in the 
lung in a case of consumption. But oral sepsis as a cause overshadowed 
all others. 

TOOTH BRUSHES 

In the spring of 1913 Dr. Anglemire, then a contagion inspector in 
Chicago, now health officer of Saugatuck, Michigan, was sleuthing an epi- 
demic of diphtheria in a Jewish orphan asylum. He caught Abe C. spreading 



748 THE TEETH AND HAIE 

the disease. Abe was innocent of wrong intent. His sore throat was just an 
ordinary everyday sore throat so far as ordinary appearances went but 
cultures from his throat showed that the cause of his ordinary sore throat 
was diphtheria bacillus. 

Dr. Anglemire had had several years of sanitary training, so he stuck 
to the trail. In the boys' toilet room he found the tooth brushes of 100 
boys arranged in regular order. It was decided to make a culture from 
Abe's tooth brush. Diphtheria bacilli were found. 

In the meanwhile cultures from the throats of every child in the school 
had been made. Diphtheria was found in the throats of twenty. Investigat- 
ing, it was found that the twenty tooth brushes nearest Abe's belonged to the 
twenty boys whose throats harbored diphtheria bacilli. Cultures showed 
that there were diphtheria bacilli in twelve of these brushes. 

Maybe the brushes gave the disease to the boys and maybe the boys 
gave the disease to the brushes. Dr. Anglemire thought that the fact of the 
infected brushes being so closely bunched was proof of the brushes. In ad- 
dition Dr. Anglemire thought that "in the bristles of the brushes were the 
media and moisture, and the steam heated room had the proper tempera- 
ture for bacterial growth." He recommended the following method for car- 
ing for tooth brushes. (The method would be a good one for your tooth 
brush and mine.) 

"A simple, hygienic method of keeping a tooth brush would be, first, 
to keep it clean and free from debris, boil it occasionally; or better yet, 
sterilize it. An easy way of doing this would be to procure a one-quart 
jar, or a glass candy jar, cut a piece of blotting paper to fit in the bottom 
of the jar. About once a week saturate the blotting paper with a teaspoonful 
of formalin, place brushes inside, bristle ends up. By this method you can 
have a sterile and sweet smelling tooth brush. 

"There appears to be another advantage in this : As formalin is a tissue 
hardener, it will be found that the slight traces present upon the bristles de- 
posited by the fumes will abort easy bleeding gums. The brushes should 
be rinsed after taking from the jar, as too much formalin would be harmful. 
It is also possible that the presence of a small quantity of formalin upon the 
brush each day also may be a deterrent to the terrific onslaughts of pyorrhea 
alveolaris, from which most everyone suffers." 

Pyorrhea Curable Disease. — M. J. B. writes: "My dentist has been 
treating a mclar, which has been loose for several months, but only lately 
discovered pus organisms. The upper front teeth are separating, and 
there is a slight discharge from the lower gums in front. He tells me that 
he can do nothing, for pyorrhea cannot be successfully cured. Is this cor- 
rect? Is it a systemic disease? I went to see a specialist who says that 
while the molar will never be a sound tooth he can save it for years and 
cure the others. He asJcs $100, which seems an exorbitant price, especially 
if it cannot be permanently cured. My experience with specialists in 
medicine has not given me confidence in high-priced men. Is the per- 
centage of persons troubled with the disease high?" 

Eeply. — Pyorrhea is a curable disease. However, long neglected pyor- 
rhea cannot be cured. It is the results of neglect which are incurable 
rather than pyorrhea. It is a local disease. It is not systemic. It is 



ft 



A . _ 

DENTAL CLINIC \ 







iM'^JlM llllM'i. 



|ll«! 




New York State Dept. of Health. 

Fig. 255. — First and Second Lines op Defense Against Dental Disease. 



749 



750 THE TEETH AND HAIE 

responsible for most of the loss of teeth in grown people. It affects sound 
teeth and those with cavities without discrimination. 

The way pyorrhea progresses is as follows : As people grow older the 
bony processes which hold the teeth to the gums absorb to a slight extent, 
whereupon the gums do not grip the teeth as firmly as before. Saliva oozes 
down into the spaces left. From it small concretions form both above and 
below the gum line. These lime deposits irritate and inflame the gums and 
in consequence they pull away from the teeth and leave increasing room 
for deposits. 

Bacteria are always all around the teeth even in health. When there 
are irritated gums, deposits and cracks everything has been made ready 
for bacterial infection. Therefore the next stage in pyorrhea is the pus 
stage characterized by pus welling up to the gum margin from the sockets 
of the teeth. 

Pyorrhea Not Contagious. — E. A. B. writes: "Will you please tell me 
what is pyorrhea? Is it curable? Is it contagious?" 

Reply. — 1. Pyorrhea is a chronic inflammation of the gums. Falling 
away of the gums from the teeth characterizes it. Early in the disease 
deposits occur on the teeth, the bony processes around the teeth are ab- 
sorbed, pus oozes up from around the roots and loosening of the teeth 
occurs. 

2. Yes, in early stages; in late stages, no. 

3. No. 

Pyorrhea Often Factor. — J. B. writes: "Would the removal of ap- 
parently healthy tonsils he a benefit in a case of rheumatoid arthritis? 
Would pyorrhea be a factor in producing it?" 

Reply. — If the absorption is taking place through the tonsils they 
should be removed. Pyorrhea is often a factor. Have the physician in 
the case diligently search for the point where infection is entering. 

Pyorrhea Cures. — Reply to C. C, C. A. W., and others: 
Each of you knows of a remedy which has cured a case of pyorrhea. 
The pyorrhea cures seem to be nearly as abundant as the consumption 
cures. Perhaps there is the same reason. These diseases are frequently 
curable, sometimes spontaneously, sometimes with ease, sometimes with 
difficulty. In consequence almost everybody knows of a cure and if it 
happens that some particular treatment was used that treatment is given 
credit for the cure. To draw conclusions from a single experience is always 
likely to mislead. Karl Pearson says that about 6,000 experiences are 
necessary to eliminate error. While this may be unattainable more than 
one is necessary. Better go early to your dentists and persist in doing 
what they tell you to do. 

Bleeding Gums. — Miss 8. 8. writes: "Please advise me how bleeding 
gums can be cured. I have gold crowns in my mouth which bother me. 
When there isn't bleeding there is a rather bad taste, seemingly coming 
from beneath the crowns. What will cure this? The mouth is kept clean, 
but no amount of scrubbing and rinsing will correct this tendency." 

Reply. — Bleeding gums may mean pyorrhea or scurvy or some one of 
a few other conditions. Aside from what it may mean the condition is of 



THE TEETH 751 

no consequence. Go to your dentist and have him find out why your gums 
bleed and then have that underlying condition attended to. 

Unclean Dental Tools. — A Citizen of Chicago writes:, "I went into a 
dentist's office a few days ago to have some work done. I noticed the tools 
were not clean. I would not sit in the chair until the tools had been thor- 
oughly toiled. The dentist informed me that out of some sixty of his fel- 
low dentists there were only about three who had a method of boiling for 
disinfecting the instruments, and that many of them never attempted to 
do aseptic dentistry" 

Reply. — A person who notices that his dentist's methods are not cleanly 
should change his dentist. Clean dentists are easy to find; dirty ones 
should not be supported. 

Decaying Teeth. — E. H. S. writes: "I have been troubled for two years 
with decaying teeth, and, considering the habit of care for them instilled in 
me by my mother since infancy, I cannot understand this except that my 
teeth are not so hard as they should be. I am 25 years old. Is there too 
much acid in my system, and if that is the cause, what should I take to 
correct itf Also are there foods which will harden my teeth at my age?" 

Reply. — There are no medicines that you can take. All you can do is 
to keep your teeth clean both through your own efforts and those of your 
dentist. 

Pulling Wisdom Teeth. — H. L. writes: "1. Should gas be taken to have 
two wisdom teeth pulled? 2. What should I do to remedy dullness of 
hearing, lost sense of smell, and tenderness of upper air passages? I am 
not able to go to a specialist." 

Reply. — 1. You can have your teeth pulled without gas but it will hurt 
unnecessarily. Gas is safe and wisdom teeth are well rooted. 

2. Beyond question you have an old, long-standing infection of your 
upper air passages. If you have allowed it to continue until your "hearing 
is dull and your sense of smell is lost" you cannot be wholly relieved. If 
you cannot pay for the treatment go to the nose clinic at the medical col- 
lege nearest you. 

Some Good in Fletcherizing. — Mrs. P. W. writes: "I noticed an article 
headed 'Fletcherizing as a Preventive for Pyorrhea.' Would you please 
tell me what fletcherizing is, as my teeth get loose and fall out?" 

Reply. — Fletcherizing is chewing food until it is thoroughly masti- 
cated. Fletcher advises that chewing be kept up until the mixture slips 
down the throat semi-consciously — as saliva usually does. It will be of 
some service in pyorrhea though it will not do away with the necessity of 
having the roots of the teeth cleaned. 

Consult Your Dentist. — C. D. C. writes: "Almost at will I can draw 
blood from some place in my mouth or throat. I have tried to learn 
whether it comes from the throat or gums, but am not certain, although I 
think it comes from the gums. My mouth is seldom free from canker 
sores under the tongue, on the roof of the mouth, inside the lip, or on the 
gums. Sometimes a period of a week or ten days will elapse without a 



752 THE TEETH AND HAIE 

canker. The sores last two or three days and disappear. I am in fine 
physical condition, as far as I know. There is no trouble whatever from 
the stomach. The bowels are regular, and I take plenty of exercise. I 
had appendicitis about two years ago. What do you think is the matter? 
What causes the sores in the mouth, and from where does the blood come?" 

Reply. — Canker sores mean a badly balanced diet. You must change 
your eating habits. Just how is for you to work out. 

Bleeding from the gums may be due to scurvy, which also results from 
a badly regulated ration. It may be due to pyorrhea. If so you are 
probably in an early and curable stage. Have your dentist examine your 
mouth. 

Go to Dentist. — Mrs. B. J. writes: "How about the care of teeth of 
pregnant women? I understand there is a preparation to counteract an 
acid secreted in the mouth during this period which is harmful to the teeth. 
I have asked my physician what precautions I should take to preserve my 
teeth, and he advises just keeping them clean and being more particular 
than usual about brushing them. I would appreciate your advice on this 
subject, as I am now six months pregnant, and, if not too late, will take 
further precautions if necessary." 

Reply. — In the main the advice is good. Frequent and careful clean- 
ing is the proper plan. However, go to see your dentist, have him put 
your mouth in order and then see him again about your teeth at least once 
during the next three months. 

Hardening the Teeth.— M. L. writes to E. H. S. : "I saw your letter to 
Dr. Evans in regard to soft and decaying teeth. I was once afflicted as you 
state. I took to eating whole wheat bread, well chewed nuts, and fruits 
freely and I noticed at once a marked change in my teeth for the better. 
They became hard as flint. I have cut out all sweets save honey from my 
diet, as well as all flesh foods, and I clean my teeth thrice daily. I have 
used this diet for fifteen years, and at 7J/- am pronounced in many ways 
similar to men twenty years younger/' 

Reply. — This suggestion of M. L.'s may help some who have soft teeth 
and bad gums. 

Keeping the Mouth and Nose Clean. — E. F. D. writes: "I have made 
a practice for some time of gargling my throat and rinsing out my mouth, 
night and morning, with a solution of about 25 per cent of peroxid and 75 
per cent of water, the idea being to offset the effect of any germs which may 
be taken in with the dust of this disgustingly dirty city. 

"Is this good practice? Is the solution used effective for the purpose, 
and is it harmless? 

"I also wash out the nasal passages with clear, warm water, using a 
douche which is operated by placing one tube in the nose and another in the 
mouth, blowing gently on the latter. This causes the water to go up one 
side of the nose and out the other, without getting into the throat. 

"Is here any objection to this form of douche? Is it good practice? 

"Would salt water or some antiseptic fluid be better?" 

Reply. — The plan which you have adopted is excellent. It is just as 



THE TEETH 753 

necessary to keep the mouth clean as it is to keep the face clean. Most 
infections occur through the mouth and nose and any reasonable effort to 
keep these clean is advisable. The solutions which you use are good. 

Consult Your Dentist. — H. G, R. writes: "What causes a brownish 
(sometimes reddish, resembling blood) discharge from my mouth while 
sleeping? I have noticed for a year or more that my pillow is so stained 
every morning. My general health is excellent. This discharge cannot 
originate with my lungs. I have suffered from catarrh for many years" 

Reply. — The blood is not from your lungs. It is probably from your 
gums. Have you pyorrhea or scurvy ? Have your dentist find out. If not 
it is probably a chronic infection or subinfection of your nose or some 
cavity opening into your nose. 

Loose Teeth. — E. 8. writes: "I have three or four teeth in the lower 
jaw which are loose. They are not decayed. Have tried several drug store 
remedies. Is there anything that will tighten them?" 

Reply.— You have pyorrhea. Drug store remedies cost money and are 
useless. A good dentist may be able to clean, scale and anchor those teeth 
and thereby save them for you for several years. Pyorrhea is like consump- 
tion, easily curable in the early stage and incurable after years of neglect. 

Sore Gums. — W. E. L. writes: "About three months ago my physician 
told me that I had symptoms of a gum or tooth trouble called pyorrhea. 
He advised me to consult a specialist and I did so. This man did nothing 
but clean my teeth apparently. My gums ache seriously when I chew my 
food and my teeth feel sore. My throat also feels a bit sore sometimes 
when eating. If you will let me know what is the matter with me I will 
thank you." 

Reply. — Your gums might be sore from neuralgia. If a physician who 
saw you said you had pyorrhea, that probably is the cause of your pain. 
Talk with the dentist who saw you and get his opinion as to whether you 
have pyorrhea. If you have it you need something in addition to one 
simple cleaning. 

May Save Teeth. — A. B. C. writes: "I have had the same dentist con- 
tinuously for twenty years and he sees my mouth two or three times a year. 
Several months ago I discovered that my gums were becoming diseased 
and called his attention to the matter. He told me that the trouble was 
invariably incurable and that there was nothing for me to do. So I was 
greatly surprised to read your statement that pyorrhea is easily cured in the 
early stage. None of my teeth is at all loose, but in several places the 
gums are receding somewhat. Please tell me what I can do to cure or to 
arrest the disease." 

Reply. — Ask your dentist to send you to some dentist who treats 
pyorrhea or to take counsel with some pyorrhea dentist as to the proper 
course for you to pursue. By starting care early you will save your 
teeth. 

Tumor of Gums. — Miss H. S. writes: "Immediately bach of where my 
two front teeth join there is a tiny cleft in the roof of my mouth, which has 



754 THE TEETH AND HAIK 

been there ever since I can remember. For several months it has been sore 
and seems slightly swollen. It bothers me considerably when eating and I 
have difficulty in biting anything but soft food. It is in the way when 
my mouth is closed. My lower jaw fits so that my front lower teeth just 
rest there, but it is so painful I have to bring the lower jaw behind it. 
Should I ash a physician to clip it off, or do you think it will eventually 
lose its inflammation and cease to bother me?" 

Reply. — I judge you mean there is a little projection there. Projections 
at this point are frequent. The two plates forming the roof of the mouth 
grow together there and in consequence defects and errors occur. Have a 
dentist or physician remove the little tumor. 

Lime Water and Gums. — Reader writes: "Is it advisable to use ordi- 
nary commercial lime in water so that it may be used by the tablespoonful 
in milk and bread for hardening loose teeth?" 

Reply. — I presume you mean for the purpose of hardening your gums 
and making your teeth immovable. If so no form of lime will be of 
service. Have your dentist clean the roots of your teeth and anchor them 
wherever possible. Have him treat your gums at the same time. 

Fletcherizing as Preventive. — B. L. D. writes : "In reading your article 
'Pyorrhea Curable' I became very much interested, as I had a very bad 
case of it. All my teeth were loose, and two fell out during the night, but 
now my teeth are as strong as ever. March 16, 1911, I was taken to a 
hospital and was confined there until June 9, 1911. All they gave me to eat 
was milk toast, soups, cereals, weak coffee, and stewed dried fruit. I spoke 
to the chief physician of my trouble, but he ignored it. I consulted my 
dentist on my return home, but did not have the money to spare for treat- 
ment at that time. The last week in August I made a business trip to 
Battle Creek, Michigan, and there met an ardent admirer of Horace 
Fletcher. He invited me to his house for supper. I could not refuse, so 
accepted the invitation. They had for supper beef tenderloin with mush- 
rooms, potatoes, lettuce salad, dessert, and black coffee. Being humiliated 
on account of my teeth, I said, 'Here goes, if all my teeth fall out.' Doctor, 
I never enjoyed a meal so in my life. I had been craving for meat, but 
could not chew it. I learned to fietcherize that night, and today I can eat 
anything." 

Reply. — Fletcherizing will do much to prevent pyorrhea. I doubt if 
it can be relied on to cure well developed cases. 

Treatment for Pyorrhea. — G. writes: "Please give me some remedies 
for pyorrhea and ulcers of the mouth." 

Reply. — 1. Pyorrhea — Dentists cure pyorrhea by painstaking attention 
to the gums and teeth, supplemented by vaccines or emetine according to 
the case. Where bony processes have been absorbed the teeth must be lost. 

2. Ulcers of the mouth result from eating an ill balanced diet. When 
the diet is readjusted the ulcers quit coming. 



THE HAIR 755 

THE HAIR 

BALDNESS 

Baldness, premature and permanent, is caused by the hat. 

It is not due to the weight, texture, stiffness, or heat of the hat so 
much as it is to the fact that the hat girdles the head like a band inter- 
fering with the circulation of the blood and starving the roots of the hair. 

Baldness can be prevented. Doubtless it will be prevented when it 
comes to be generally understood that the hat commonly worn by men and 
boys is the cause practically of all the premature and permanent baldness 
of the male sex. Frequent reference to the hat as the cause of baldness is 
made in the literature of the subject but not in a way to reach the public. 

The blood supply necessary for the growth and nutrition of the hair is 
received by the scalp between the skin and the bony skull, principally in 
front of the ears and also at the sides of the forehead and behind the 
ears. 

That some men are bald and others are not although all wear hats 
is due to the difference in the shape of the head. Baldness appears to be 
peculiar to some families while others are exempt. This gives rise to the idea 
that baldness is hereditary. It is the shape of the head that makes the differ- 
ence and it is the shape of the head that is influenced by heredity. 

Some heads are so cone-shaped that a hat fits like one length of stovepipe 
over another making pressure not only on the sides but all around the 
head. This class becomes bald most frequently and earliest. Other heads 
are so shaped that the pressure of the hat does not come upon the blood 
vessels on the sides of the head. These do not become bald or at least do not 
become so until the nutrition of the hair bulbs is impaired from some other 
cause. 

I have observed that the heads that are full in front of the ears and 
with rounded foreheads are most frequently bald. This is because the 
blood-vessels in front of the ears and at the sides of the forehead are sub- 
ject to the pressure of the hat while the square forehead which only permits 
the pressure of the hat on each temple and on the back of the head leaves 
the sides free from pressure and the hair free to be nourished. 

Every horseman knows that if a horse's tail be kept tied up for a week 
or ten days the hair at the end of the tail will fall off, and most of them 
know that this is because the blood circulation is interfered with. A 
wart may be made to drop off by tying a ligature around its base thus cut- 
ting off its blood supply; similarly if the blood supply of the scalp is cut 
off the hair will fall out. 

Baldness begins in the area where the blood supply is weakest — usually 
at the top or upper back part of the head, because the pressure on the 
vessels in front of the ears (the temporal arteries) and on those at the 
side of the back of the head (the occipital) is most frequent. If the 
pressure be on the vessels above the eyes (the supra-orbital) the baldness 
will be of the "high forehead" type. Usually the head becomes bald above 
the line of pressure by the hat, but not below that line. 



756 THE TEETH AND HAIR 

The foundation of baldness is often laid in boyhood, since pressure upon 
the blood-vessels at that time retards their growth and prevents their perfect 
development. This accounts for occasional baldness in the twenties. The 
inference is that children should not wear any covering for the head except in 
inclement weather and then only a cap that rests upon the top of the head 
and does not grip the scalp. 

Women are less subject to baldness than men regardless of the shape 
of the head; first, because their "crowning glory,' 1 more luxuriant than that 
of man, forms a cushion which protects the scalp from pressure; and 
second, because a woman's headgear does not constrict the scalp but rests 
on top of the head. 

The hat accounts for the baldness of men and the exemption of women. 
It accounts for the baldness of civilized men and the exemption of savages. 

On reflection it seems that the hat is more for ornament than utility 
anyway. A good head of hair is all the protection that is required except in 
severe weather. 

So-called "restorers'' applied to the seal]) to remedy hat baldness are use- 
less. Rubbing the scalp with the fingers or a brush stimulates the circula- 
tion and is useful. Too much washing destroys the natural oil of the hair 
and renders it brittle. 

Forms of baldness other than hat baldness may follow the debility 
caused by exhausting febrile diseases and local diseases of the scalp. It is, 
however, as a rule, temporary. Baldness in old persons is due to the im- 
paired general circulation of the blood common to the aged. All baldness 
except hat baldness may occur in people of any nationality and in either sex. 

Has Scalp Disease. — J. R. H. writes: "I am 29 years old. For a number 
of years I have teen troubled with a sore scalp, which has caused most of 
my hair to fall out. Now I am almost bald. I am troubled with dandruff, 
and when the scalp gets dry it is itchy. Also after using any hair tonic it 
gets so itchy that I am forced to pick dandruff out, causing the scalp to 
have red blotches. Please tell me what causes my head to be sore. Is it 
possible I have had some disease, and do not know it? My health is good." 

Reply. — Evidently you have a scalp disease. Probably, though not cer- 
tainly, you have seborrheic eczema. Mild cases resulting in dandruff can 
be cured by persistent cleaning and brushing and by using sulphur or 
resorcin ointment. You apparently have a more severe case and had better 
see your physician. 

See a Skin Specialist. — J. M. K. writes: "My hair has been falling out 
in spots for the last two months. It appears to be growing again, but of a 
decidedly light color. My hair is brown. Is this caused by a germ? Have 
had my hair clipped close. Will this help? Are any of the advertised hair 
restorers of any use? My health is good." 

Reply. — It probably is due to an animal parasite, though sometimes 
other diseases cause it. You had better see a skin specialist. 

Care of the Hair. — Jo writes: "Is there any truth in the assertion that 
dry salt copiously sprinkled over the scalp and vigorously and frequently 
brushed through the hair promotes its growth?" 



THE HAIE 757 

Keply. — No. The same amount of plain brushing and cleaning would 
do just as well. 

Bald Head. — Subscriber writes: "Should a bald-headed man have his 
head covered while sleeping in cold weather in a small bedroom with the 
window open?" 

Reply. — In very cold weather, yes. In ordinary weather, v.o. 

Care of the Hair. — Reader writes: "My hair is falling out rapidly. 1 
am advised by friends to apply a weak salt water or brine about twice a 
week. If I use this regularly will it be beneficial? What proportion of salt 
to water?" 

Reply. — It will be all right if you will use it thoroughly enough to keep 
your scalp clean, will use a little grease afterward, and brush your hair fre- 
quently and well. In other words, care will save your hair. Salt water 
washing will be a part of the care given. The proportion is not a matter 
of consequence. Use a tablespoonful to a pint of water. 

Dandruff. — E. H. writes: "What is the cause of dandruff, and how can 
it be cured?" 

Reply. — Dandruff is a variety of seborrheic eczema — the skin disease, 
possibly bacterial in origin, which is responsible for much of the premature 
baldness. It is a mild condition which if neglected leads to loss of hair 
but if cared for usually yields to treatment. It can be cured by frequent 
washing of the scalp followed by mild greasing. The hair must be brushed 
frequently and well. 

To Remove Dandruff. — L. 31. writes: "Will you kindly tell me of a* 
scientific method for removing dandruff?" 

Reply. — Avoid sources of infection such as toilet articles in common 
use, and keep the scalp clean. To keep the scalp clean wash it two or 
three times or even more each week with a good tar or sulphur soap. Cor- 
rosive sublimate soap may be used on an unbroken scalp. 

In some cases the free application of alcohol will cleanse sufficiently. 
If the alcohol leaves the scalp and hair too dry add five or six tablespoon- 
fuls of castor oil to each pint of alcohol. After the scalp is cleansed a 
resorcin or sulphur lotion should be applied and well rubbed in. 

Superfluous Hair. — Mariak writes: "Please advise me what to do to 
stop growth of hair on my chin. A few months ago only two or three hairs 
grew out. These I pulled out and was advised to use peroxid and ammonia 
as a remedy, but this only stimulated the growth." 

Reply. — Nothing stops it except the electric needle and that does not 
succeed unless it is used so as to kill the hair bulb. Pulling them out 
makes them worse. 

Removal of Superfluous Hair. — C. B. writes: "Will you advise if, in 
your opinion, the use of the electric needle for removing superfluous hair 
from the face is perfectly safe — that is, if scars are apt to result or any 
growths form under the skin after its use, or is there any other suggestion 
you could offer in the way of removing these hairs permanently?" 



758 THE TEETH AND HAIE 

Eeply. — When in the hands of a skillful operator no scars or growths 
will follow the use of the needle for the removal of hairs. 

Bald in Spots. — Reader writes: "About a month ago three little bumps, 
each the size of the tip of the little finger;, appeared on my head. They 
were sore to the touch. I have just noticed that one of these bumps has 
gone completely bald. Is there any danger of all my hair coming out? 
What would cause the bumps to appear? I am a woman of 22" 

Reply. — You will not lose all your hair in any event. Alopecia areata 
is a disease which causes the hair to fall out in spots. Ringworm is an- 
other. Have your physician tell you which you have and what to do. 

Bald Spots. — A. C. writes: "I am 23 years old and for the last three 
months my hair is coming out in bunches. Please let me know of any 
remedy that will cure it." 

Reply. — If you mean your hair is coming out in patches you should see 
a skin specialist. Bald patches may be due to any one of several skin dis- 
eases each of which is of consequence. 

Thin Hair. — M. K. writes: "Is there anything one can do to make the 
hair grow thick? My hair is thin and oily." 

Reply. — I doubt if anything can be done. If you mean that your hair 
was always thin certainly nothing can be done. If it has been gradually 
falling out you can stop it by washing, brushing and rubbing it well. 

Gray Hair. — E. P. H. writes: "I am much interested in the replies on 
gray hair. Can it be that, considering what medical men and scientists 
have done and are still doing for humanity, what seems to be much 
simpler is baffling them? The majority of people go through the greater 
part of their lives with gray hair. Cannot someone solve the problem?" 

Reply. — Members of certain families turn gray young. To avoid marry- 
ing into those families is one thing that can be done. The next most 
important cause of gray hair in relative use is worry, anxiety and emotion. 
To live with equanimity is another thing that can be done. The subject of 
gray hair, these two factors being eliminated, becomes the same as senility. 

Measures effective for the postponement of senility are effective against 
gray hairs. These are embodied in a normal, wholesome life, lived from 
childhood up. Medicines to change the color of the hair are dyes by what- 
ever name they are called. To dye the hair is to cheat. If a man is pre- 
maturely gray and is discriminated against on account of gray hair he is 
being cheated. The remedy is to carry his birth certificate and not to dye 
his hair. 

Why Does Hair Turn Gray? — N. W. writes: "What is the cause of hair 
turning gray at 30? My health is good, I am not given to worry, and it is 
not hereditary that I know of, yet my hair is rapidly turning gray. I am 
trying massage with vaselin, but it does not seem to help any. Do you 
think that the taking of iron and sulphur internally would have a tendency 
to stop the graying ?" 

Reply. — No, as to iron and sulphur. Nothing will stop it. Metchnikoff 
found that white blood cells entering the hair roots caused it to turn gray. 






THE HAIR 759 

This is a step toward an answer but not an answer. The next question is, 
Why do the white cells enter the roots? 

Hair Turning Gray. — H. D. writes: "What can I do to prevent my hair 
from turning gray? Does it come from the blood? Am only 21+ and 
anemic. My scalp is scaly and sore." 

Reply. — Get your scalp in good condition and keep it so and you will 
do about all that you can do to keep from turning gray. Wash your scalp 
frequently — every day or three times a week until you get rid of the scales. 
Rub in a little grease after washing. If you have much dandruff probably 
a sulphur ointment will be better than a plain grease. Spend some time 
each day brushing your hair. The condition of the blood has no especial 
influence on the hair. Anything that profoundly influences the nutrition 
including profound anemia will affect the hair ; slight anemia will not. 

Keep Hair Clean. — M. E. writes: "I am 30, and my hair is becoming 
white. Would you have the kindness to tell me how I can bring bach my 
original dark hair?" 

Reply. — There is nothing that you can do except wash your scalp often 
enough to keep it clean and brush your hair frequently and thoroughly, 
using a little grease if required. 

Nothing except dyes ''brings back" the color and they do harm. 

Hair Dyes Injurious. — 0. B. writes: "1. Are preparations for the pre- 
vention of gray hair or coloring injurious to the eyesight? 2. Can you 
prescribe a wholesome hair preparation? 3. Is it better to discontinue the 
use of these preparations at once or to do this gradually, and let the hair be 
restored to its natural color? k- Is a glass of salt water before breakfast 
helpful?" 

Reply. — 1. No, but they are otherwise injurious. Read the article in 
"Nostrums and Quackery" (published by the American Medical Asso- 
ciation) on hair dyes. 

2 and 4. No. 

3. At once. 

Dyes Not to Blame. — Interested Reader writes: "Would the use of a 
hair dye or one of the so-called hair restorers be any cause for, or in any 
way relate to the extremely nervous condition of a person, such as sleep- 
lessness, irritability, etc.?" 

Reply. — I have heard of inflammations of the scalp and severe head- 
aches from the use of these advertised hair dyes but never of sleeplessness, 
irritability and a nervous condition. I do not think the use of the dyes 
is responsible. 

Wash Scalp Daily. — Young Subscriber writes: "What causes the terri- 
ble itching of the scalp, especially when one gets out under the sun? I am 
in my twenties, and my hair is gradually losing its color, turning gray. 
Can you suggest a remedy?" 

Reply. — You have a scalp condition which you should remedy by care 
of your scalp. Wash your scalp well with soap and water every day. If 



760 



THE TEETH ANT) HAIR 



the hair is too dry rub in a little grease after washing. Brush your hair 
thoroughly with a clean brush several times a day. 

Little Absorbed by Scalp. — B. writes: "Will you kindly tell me whether 
the use of cantharides as an ingredient of a hair tonic could lead to any 
injury to the health?" 

Keply. — None. Very little will be absorbed. 



CHAPTEE XLII 

The Feet 

CARE OF THE FEET 

Several years ago when a certain city made a physical examination 
a part of its civil service test for positions on the police and fire department, 
it was found that a rule against flat foot practically barred negroes from 
the service. 

Inquiry as to the ability of whites and blacks to walk and stand without 
discomfort did not show the same disproportion. The conclusion was that flat 
foot is not so disabling as is generally supposed. When the test of the arch 
of the foot by impression on paper is made in a routine way it is found 
that there are lots of people with high arches and painful feet and lots of peo- 
ple with flat feet who suffer no discomfort. 

Now whenever the calf muscles cramp, pain, ache or tire easily or the 
feet burn or hurt something is the matter with the feet. On the other hand 
when the foot is flat one must go slow about announcing that the foot is 
inefficient or predicting that painful feet will ultimately develop. 

In the problem of the feet there are many elements that enter in besides 
the arch. There are twenty-seven bones and all the ligaments that tie them 
together, a lot of muscles and many more tendons, a multitude of blood vessels 
and a myriad of nerves, for the foot is a regular meeting of the ways. 
Think of the tracks in the most complicated railroad yard you ever saw and 
then remember that all that complication of rails is simplicity itself as com- 
pared with the trackage of the foot. 

If in the railroad yard a single rail slips six inches out of its groove, 
trouble results. If in that foot yard a nerve slips a fraction out of its groove 
or the bone tilts a wee bit wrong trouble results. 

I have sometimes wondered why those men who were building up schools 
of medicine around pinched nerves did not use the foot nerves as the basis 
of their theory since foot nerves are so frequently pinched, pressed upon 
and "nagged." Instead they use the nerves coming from the spine — nerves 
that are buttressed like one of Scott's armored knights. 

The practice is to cramp and bind the feet for years until the twisted 
toes, displaced bones, atrophied muscles and lax ligaments make a condition 
past remedying and then to attempt some superficial, ill considered remedy 
too tardily for any good result. 

The real remedy is to encourage children to go barefooted wherever 
hookworm will permit; to encourage them to wiggle their toes and to take 
exercises that will develop the calf muscles and those lower down; to study 
where the shoes wear (both heels and soles) for what we can learn of the 
foot mechanism that we seek to conserve; to study the toeing in or the 

761 



762 



THE FEET 



toeing out to discover whether it means wrongly made feet or whether it 
means that the trouble is beyond the feet in the legs. 

As most of the people now complaining of their feet were children in 

the 70's and 80% years when men were 
thinking a great deal about the Hotten- 
tots but little about their own feet, most 
of the sufferers will exclaim: 

"Advice to wiggle the toes and ex- 
ercise the calves is all right; but our 
toes will not wiggle. How about metal- 
lic arches ?" 

Such people know that they can 
never score 100 but would like to 
know if insole arches will help them to 
make 50. 

A foot arch held up by a metal arch 
tends constantly to get weaker. Its 
muscles become flabby, its fat absorbs 
and its tendency is downward. Never- 
theless some people require a metal arch. 
Those who can get relief from felt pads 
had better do so. 




SLEW-FOOTED" OR 
TOED" 



PIGEON- 



Mr. Webster seems never to have 
heard of it but "slew-footed" is a com- 
mon term for those who walk with the 
toes turned out. For some reason those 
who walk with the toes turned in are 
called pigeon-toed. Notice people walk- 
ing the streets and you will find that a 
large percentage of them walk with their 
toes pointed out or in. 

Every person unconsciously finds 

his own method of walking. You can 

be certain that however foolish it may 

seem for any man to go down the street 

walking slew-footed it is really the 

best way for that man to walk. For him 

to try to turn in his toes would mean speedy tire. On that basis, slew-footed- 

ness, his bones are shaped and set, his tendons are placed and his muscles 

developed. To walk according to one's bony parts is wisdom. 

If you will inquire more closely you will find that athletes are never 
slew-footed. A slew-footed runner or a slew-footed jumper would be a seven 
days' wonder. 

The meaning of this is that while walking slew-footed is the most 
efficient way for a slew-footed man to walk slew-footed people never walk, 



Fig. 256. — Bones of Right Foot. 



FLAT FEET 



763 



run or jump at high efficiency. Their best is always below the other fellows 
best; also their average is below the other fellow's average. Observation 
will convince yon that the ordinary slew-footed man cannot walk so much 
without tiring excessively as can the average man. 

I have sometimes thought a military training made for slew-footedness. 
The soldier is re- 
quired to keep his 
heels together. As 
his shoulders are 
broad, this makes 
his base much nar- 
rower than the 
shoulder zone five 
feet above the 
ground. No animal 
ever stood that way 
naturally since the 
upward climb from 
the Stone Age be- 
gan. 

The natural 
way to stand 

with the heels separated several inches and thereby with the base line 
broadened. But the army men having decided on "heels together" the base 
line must be broadened somehow so out go the toes. Gradually the mechanism 
of the feet and legs come to adjust themselves to the basis of "toes out." 
This, however, is not of much consequence. 

Usually military life does not catch the men young enough to change the 
mechanism greatly — at least not army life. It should make a difference 
with those boys who are going through a preparatory school where they have 
military discipline. 





Fig. 257. — Shoe to Prevent 
or Cure Bow-legs in 
Children. (By courtesy of 
Best & Co., New York.) 



Fig. 258.— "Toe-in" Shoe. (By 
courtesy of Best & Co., New 
York.) 



FLAT FEET 



The work of the heel is to bear the weight of the body. The work 
of the toes is to push it forward. In order that the toes may work to the 
best advantage and that the nerves, tendons, muscles, and blood vessels under 
the bottom may not be pinched with each step there 
are arches in the foot. One is the instep ; another less 
well known is that at the ball of the foot running across 
from the big to the little toe. 

When these arches are not just right, muscles 
and ligaments are put under improper strain and the 
bones, joints, nerves and blood vessels are pinched. 
There is not only aching feet and legs but tire of the FlG 259. — Ankle and 
whole body. A smallpox epidemic comes once in thirty Arch Supporting 
years but every night thousands go home all worn out ^°i s ' t ^ y c COUT N Sy 
from tired, aching feet. York.) 




764 



THE FEET 



Painful feet, 
A shoe with a 





Fig. 260. — Print of Foot 
with High Instep (A) 
and Print of Flat Foot 
with Pinched Toes. 




In maintaining the arches the muscles are the key to the situation. 
Flabby, weak foot muscles have more to do with broken arches than stretched 
tendons. The muscles concerned are those which wiggle the toes. This 
being true the way to prevent flat-foot is to develop the muscles which move 
the toes. 

Now toes are becoming useless, rudimentary, distorted, 
broken arches and "flat-foot" are increasing at the same rate, 
high heel tends to break 
down the foot arches 
because it pitches the 
weight from the back 
where it should be car- 
ried to the ball of the 
foot, where it causes un- 
due strain and tire. If, 
in addition, the toes are 
pinched or the ball com- 
pressed the arch is almost 
certain to give. 

The method of pre- 
venting flat-foot and of curing it in its earlier stages follows: 

1. Children should be allowed to go barefooted or to wear sandals. The 
foot muscles — those which move the toes — must be kept vigorous, strong, in 
use and under control. 

2. Adults must build up their foot muscles by walking, running, jumping 
and also by room exercises which bend the foot and particularly move the toes. 

3. The shoe heels should be low, flat and broad; the toes wide and the 

shoes roomy enough so that the 
foot can give naturally as the heel 
catches the weight and the ball 
pushes the body forward. 

If you would avoid tired feet 
keep your toe muscles in good con- 
dition. 




Fig. 261. — Weak Feet — Seen 
Behind. 




Fig. 262. — Weak Feet — Seen in Front. 



LOW HEELS 

The girls are walking low 
now. Maybe they have given heed 
to all this talk about foot arches 
and painful feet. Maybe the writer 
who told them that high-heeled shoes were making the toes do what the 
heels should do has been heeded. And then maybe not. 

However, why discuss the reason for it? The fact is here— the correctly 
dressed girl is wearing a broad soled, no heel shoe. 

The present type of shoe is a good one but the change has come about 
too suddenly. There will be a reaction. When a person has walked on 
high heels for years the bones have become adjusted to the position. 



FOOT HABITS 



765 




When the rear end of the long heel bone is raised the front end is 
pitched downward. The leg bones come to sit on the forward, slanting sur- 
face. The foot bones in front of the heel bone join the heel bone at a 
new angle. Much of the weight of the body is carried to the toes without the 
accustomed spring. 

The ligaments readjust themselves : the muscles and tendons lengthen or 
shorten as needed. After this mechani- 
cal adjustment has been working for 
a long time it cannot be suddenly 
changed without causing trouble. 

When the heels are left off the 
shoes the rear end of the heel bone 
drops down an inch or more. The pitch 
is backward, at least it is more so than 
it was. The facets of the bones must 
readjust themselves. New facets must 
be fashioned, and while the process is 
going on the bones move on each 
other with some friction and heat — 
and pain. 

The length of tendon and muscle required is not the same for the two 
positions. The muscles running from the calf to the sole are not quite 
long enough. 

In consequence the girl tires easily. As a result of fatigue the muscles 
of the calf ache or spasmodically contract from time to time. 

The change for the time results in loss. To bring about the same result 
by gradual change is another matter. To have lowered the heel bit by bit, 
giving the muscles time enough to elongate, and the bones time to readjust 
their facets gradually, would have been wise. 

There is not the same objection to the rapid widening of the sole but 
there, too, something would have been gained by a more gradual change. 

The quarrel, then, is not with the change but with the suddenness «* it. 



Fig. 263.— A, Print 
of Normal Foot. 
B, Print of Flat 
Foot. 




Fig. 264. — Modified 
Thomas Heel. 



FOOT HABITS 



As age advances and the weight increases a naturally normal foot may 
and generally does become worked out of shape. A foot that is constructed 
to bear a weight of 130 pounds must yield in time, if the weight is increased 
to 200 or 250 pounds, and become more or less flat. 

With increasing years and weight the necessity of toeing out to main- 
tain the balance while standing is apt to become the habit so that in middle 
life most people will toe out too far in walking. This brings the strain of 
raising the heel on the inner and longer side of the foot and makes an undue 
strain upon the tendons that support the arch. It also turns the large toe 
in and in time the joint of the big toe becomes enlarged from the strain and 
projects inward toward the other foot. 

The spring of the foot in walking should be on the outer and shorter 
side of the foot for the reason that the smaller and shorter bones of the foot 



766 



THE FEET 





are more elastic and springy and the motion of raising the heel requires less 

effort. 

In running one unconsciously toes in so as to take advantage of the 

shorter and more springy part of the feet. To toe in, then, is the natural 

and correct way to walk. Toe- 
ing out is a habit and one that 
should be avoided and can be 
corrected by giving the subject 
attention. 

With this knowledge we can 
understand why high heels give 
a degree of comfort to the flat- 
footed. They throw the weight 
on the outer and smaller bones of 
the feet and take the strain off 
the arch on the inner side of 
the foot. 

The natural way to walk is 
barefooted, and in considering 
footwear for a normal foot the 
one thing to consider is to so 
arrange the shoe or stocking that 
the tread of the foot and its 

natural action will not be interfered with. This probably will take us back 

to the moccasin of the aborigines, to the sandal of the Orient or to the sneaks 

of the children. 

The shoemaker should make the shoe with the sole broad enough for the 

bottom of the foot to rest on a 

flat surface instead of having the 

outer edges of the foot on a 

rounded surface as is the case 

when the sole of the shoe is not 

so broad as the sole of the 

foot. 

Trouble comes to many from 

wearing stockings that are too 

short and too small, which con- 
stantly prevent the spreading of 

the foot when the weight is put 

upon it and which tend to curl 

the small toes under. They are 

frequently as much to blame for 

corns and for ingrowing nails as 

the shoes. 



Fig. 265. — Shoes Should Have a Broad Toe. A 
line from the inner side of the front of the great 
toe along the inner side of the ball to the inner 
side of the heel should be straight. 





Fig. 266. — A Harmful, Narrow-Shaped Toe. 



COVERING OF THE FEET 



Whether the lodging-house inmate be a tramp or a seasonal worker, if 
he be wise he will keep himself equipped with warm socks. Yet Flynt 



COVERING OF THE FEET 



767 




Fig. 267. — Toes 
Pressed out of 
Position, Weak- 
ening Both the 
Instep and the 
Ball of the Foot. 



tells us that the tramp's poorest equipment is with footgear, both shoes and 

socks. He frequently has no socks, and when he has them they are full 

of holes and dirty. 

The key to the man's situation is his feet. For one thing he uses them 

a good deal. For another, they frequently "go bad on him." When he rides 

on the bumpers or in a freight car in winter he is liable 

to freeze his feet. When he gets to middle life he is 

always a hobbler. 

Keeping equipped with water-tight shoes is not an 

easy job. One can always pick up shoes on dumps and 

in alleys but such shoes are not water-tight. 

The lodging-house man will do well to do the best 

he can as regards shoes. Whenever he can he should wash 

his socks. When the socks are wet or their mesh is filled 

with dirt the heat of the body travels from the skin 

through the socks and shoes to the ground almost as fast 

as though the feet were bare. 

One cannot be expected to make heat enough to warm 

the ground. Clean, dry socks hold the heat in; so the 

lodging-house man should spend some time in keeping his 

socks clean and dry. If he cannot get hold of socks he should try to wrap 

his feet in some warm, dry, clean cloth. Sometimes he can get a piece of 
oilcloth or a piece of paper worked in in such a way 
as to help. 

A newspaper is of great service in "keeping out the 
cold," especially when the wind is blowing. Spread on a 
floor, it keeps out cold air. Slipped in between garments, 
it keeps the wind from blowing away the warm air from 
next the skin and replacing that warm air with cold. 
Clean clothes are warmer than dirty ones. Every 
lodging-house now has some facilities for bathing and 
some of them have a tub or so for the men to wash their 
clothes in. 

If the feet get nipped they should be thawed out 
slowly with as much rubbing as they will stand. The 
skin must not be broken. For chilblains the feet should 
be plunged frequently into cold water containing salt or 

a little ammonia or bathed with kerosene oil ; they should be dried thoroughly 

and rubbed gently; and should be dusted with talcum powder. 

Woolen stockings should not be worn and the feet should be kept away 

from heat. The feet should be painted with two coats of iodin, the first 

coat being allowed to dry thoroughly before the second is applied. 

Aching Feet. — Reader writes: "What causes one's feet to burn at night 
when to the touch they do not feel hot? The feet pain generally in the ball 
of the foot, also at the heel, and standing is painful during this time." 

Reply. — Have your urine examined to exclude Bright's disease, a fre- 
quent cause of swollen feet. Have your heart examined to exclude heart 
disease, another frequent cause. These having been excluded, there is 
left "painful foot," an unpleasant condition and one difficult to remedy. 




Fig. 268.— A Nar- 
row-Toed Shoe 
and the Natural 
Shape of the 
Foot When Sup- 
porting the 
Body. 



768 



THE FEET 



It seems to me most of the cases result from improper care in childhood 
and youth and the condition as it presents itself in middle life cannot be 
remedied. The feet have not been encouraged to grow. Rather they were 
cramped in the years of growing. In consequence they are not large 
enough to carry the weight of the body. Tight shoes have caused a loss of 
power over the toes. The toe muscles have atrophied. In consequence of 
this group of influences the foot bones slip just enough to pinch nerves. 
Your only hope of relief, as I see it, is through a good shoemaker and 
physical culture. Perhaps some reader can offer help to this considerable 
group of sufferers. 

Broken Arch Remedy. — Mrs. 0. B. wants to know if tight shoes break 
down the arch. What can be done for a broken arch? 

Reply. — The important arch is the instep arch. In the natural arrange- 
ment the heel carries the weight. If the shoe heels are high the weight 
pitches forward to the ball of the foot. If the ball can spread out this 

shifting of the 
weight is taken care 
of; if the shoe 
pinches it is not so 
easily cared for. 

If the toes are 
pushed, distorted 
and pinched around 
the arch is endan- 
gered ; first, because 
in any arch, if any 
of the elements, 
even those at the 
ends, are displaced 
or changed the arch 
Fig. 269.-Cross Section of a Corn. is wea kened; sec- 

ond, because good 
muscles in the foot are necessary for a strong arch and many of the foot 
muscles have as their work the moving of the toes. When the toes, per- 
petually unused, become useless the muscles which work the toes also go 
out of business. 

The remedy: Build up the general muscle system by exercise. Build 
up the foot and leg muscles by exercise. Wear shoes which are "easy in the 
toes" and support the instep. 

Treatment for Chilblains. — E. 0. writes: "As soon as the cold weather 
approaches I am bothered with chilblains, or frosted feet. I have tried 
several things, but nothing has helped me. Kindly let me know how to get 
rid of this affliction/* 

Reply. — Plunge the feet frequently into cold water containing salt or a 
little ammonia ; or bathe with kerosene oil. Dry thoroughly and rub gently. 
Dust with talcum powder. Do not wear woolen stockings and keep away 
from heat. Paint with two coats of iodin, allowing the first coat to dry 
thoroughly before applying the second. 

Danger in Using Acid. — L. A. S. writes: "Is there any danger in using 
nitric acid in removing corns, for instance, on the little toes, and down 
fairly close to the bone, provided it is done gradually and without causing 
bleeding? Would blood blisters on the same toes be caused from the acid 




COVEEIXG OF THE FEET 769 

or from new patent leather shoes? Is it practical and a good way to remove 
corns by electricity?" 

Reply. — 1. Yes, one would have to be quite skillful to remove corns 
with so powerful an agent and not do harm. 

2. Might be due to either. Probably is due to acid. 

3. Do not think so. 

How to Cure Bunions. — K. G. writes: "Please tell me what to do for 
inflamed bunions" 

Eeply. — Eest and hot foot baths followed by the application of hot com- 
presses of witch hazel will afford immediate relief. If it is necessary to 
use the foot the first thing to be done is to wear a shoe large enough for 
five toes instead of four, with a straight line on the inner side. The ap- 
plication of camphor or carbolated salves on a piece of old linen protected 
by covering with rubber, chamois or buckskin washers will often afford 
relief. Where the pain persists and the affected part continues to enlarge 
it is wisest to consult your physician. 

Bothered by Great Toe. — B. F. writes: "Can anything be done to re- 
move the tendency to bunion swelling beyond wearing of proper shoes? 
Such a tendency was started in my case by shoes a trifle short. Of course 
I abandoned these when trouble developed, but still have trouble. Are 
patent contrivances for the straightening of the big toe of use when there 
is no great deformity present?" 

Reply. — 1. A light splint to pull the toe inward, worn at night, and 
methodical manipulation of the toe together with massage of the affected 
parts will strengthen the muscles, hasten absorption and often restore 
normal conditions. 

2. In selected cases especially it is desirable to force the toe inward ; a 
toe post may be used to advantage. I advise you to get expert help. You 
can scarcely work it out for yourself or with general directions. 

For Tender Feet. — E. J. C, M. D., writes: "You ash suggestions as to 
what to do for painful feet. I have a patient who is wearing the first 
leather shoes he has worn for over twenty years. I took him to a shoe dealer 
and had him buy a pair of shoes three sizes too large. Then I directed 
the cobbler to cut out a pair of insoles from cowhide, and cut or scoop out 
holes in the insoles to match the enlarged tender places." 

Reply. — This suggestion is excellent. I have written and will write 
again on the harm of tight shoes and the advantage of loose shoes. In 
addition to the advantage of looseness your plan gains a soft, padded sole 
surface. 

For Perspiring Feet. — A. B. writes: "I am troubled greatly with perspir- 
ing feet, accompanied by an offensive odor. It necessitates a change of 
stockings every day and keeps my feet, around the toes, tender and sore. 
What is the probable cause of this, and could I do anything to benefit it?" 

Reply. — Wash the feet night and morning with soap and water and 
rinse. Then apply freely a solution of alcohol and salicylic acid in the pro- 
portion of one quart of alcohol to one tablespoon of salicylic acid. Where 
the condition results from some disturbance in the general health have your 
family physician find the cause and prescribe. 

Effect of High Heels. — M. S. A. wants to know how high-heeled shoes 
break down the arch. Also if carrying weight breaks down the arch, why 
do not toe dancers have flat feet? 



770 THE FEET 

Reply. — Nature intended the heel to carry the weight. High heels 
pitch the weight on the toes. Toe dancers have exceptionally strong foot 
muscles. All their muscles are strong. Broken arches are found in soft, 
flabby people, particularly, however, in people with rudimentary distorted 
toes and poor foot muscles. 

Aid for Flat Feet. — G. A. B. writes: "Is flat-foot and weak ankles 
hereditary and can it be cured?" 

Reply. — No doubt there are inheritance factors in these conditions, 
but I do not know of anyone who has worked them out. I think that both 
flat-foot and weak ankles are as much dependent upon weak and poorly 
developed muscles as upon changes in the shape of bones. Proper exercises 
for the feet and lower legs and shoes that permit the toes to be moved and 
do not push, cramp and bend the toes are the proper means of prevention. 
Cure of cases where the condition is well established sometimes can be 
done but it is slow and tedious. 

Reason for Flat Feet. — M. C. writes: "Will you kindly tell me the best 
treatment for flat-foot or broken arch? Is the origin of the trouble rheu- 
matic? Is it curable by the shoe made with arch support in it?" 

Reply. — Rheumatism may be a contributing cause. Tight shoes is 
another. Poor muscle tone is a third. To prevent flat-foot follow the exer- 
cises given for the feet. To cure a broken arch is difficult. Arch supports 
may help some. They often relieve symptoms. 

Wear Easy Shoes. — Reader writes: "I am suffering from bunion and 
corn formation and don't find a quick remedy to relieve me at once and 
for all." 

Reply. — Remove the excess of dead tissue with a knife or any of the 
corn removers. Wear easy shoes with cork insoles. That is all that you 
can do. Corns are a habit — a skin habit. The habit is incurable. The 
skin got the habit of thickening up because back yonder in the habit- 
forming days of youth you had the habit of wearing tight shoes. The 
only solution of the corn question is proper shoes before the corn days. 
You are doomed to hobble on. Do what you can to better things for your 
children. 

Chilblains. — F. W. M. writes: "About three years ago the toes on my 
left foot were frostbitten. One of the toes became infected, probably from 
the dye in the stocking. I consulted two reputable physicians, neither of 
whom gave me any relief. After about a year and a half the sore appar- 
ently healed of its own accord and for six months gave me no trouble. 
It has recently broken out again and seems to be spreading. It starts as a 
blister or cluster of blisters and the rubbing of the shoe irritates and breaks 
the skin, then it becomes a raw sore from which oozes a yellow liquid con- 
tinually. It itches a great deal and burns when anything touches it or when 
put into water, either hot or cold. Will you kindly advise me what the 
trouble is and how to overcome it?" 

Reply. — You have chilblains I should say. From time to time I ad- 
vise the following for chilblains: Plunge the feet frequently into cold 
water containing salt or a little ammonia, or bathe with kerosene oil. Dry 
thoroughly and rub gently. Dust with talcum powder. Do not wear woolen 



COVERING OF THE FEET 771 

stockings and keep away from heat. Paint with two coats of iodin, allow- 
ing first coat to dry thoroughly before applying the second. 

Itching Feet. — Mrs. 0. E. A. writes: "My father, aged Ik, HI only once 
in his life and recently from acute indigestion, suffers horribly from 
'burning' and itching feet. What can be done for him?" 

Reply. — Commonly the advice is to wash the feet in boracic acid 
water and then to dust them with boracic acid powder. The advertised 
medicines for aching feet are composed of boracic acid in the main. It has 
always seemed to me that it is the result of pinching and pressing the 
nerves and that arch supports, cushion soles, or easy shoes are a more 
promising plan. When tight shoes have been habitually worn the bones 
get pushed around into all sorts of bizarre positions and nerves that nat- 
urally run in protected grooves get jammed into exposed places. 

Causes of Cold Feet. — R. S. W. would like to Jcnow what to do for the 
trouble he has in keeping his feet warm. He says he wears heavy woolen 
socks and yet if the weather is the least bit damp or his feet get cold at 
all he is unable to get any life in them for a long while. 

Reply. — Cold feet may be caused by any one of several diseases. It 
would be good judgment for you to see your family doctor and have him 
examine you to determine whether there is any organic disease in your 
case. 

If there is none you have nothing to complain of except inconvenience 
and there is nothing so good for inconvenience and discomfort as com- 
placency. 

The wearing of cork or cushion-soled shoes is a great help. But the 
principal thing to do is to make more heat and to get more of it in your 
feet. 

This means active physical exercise. When the feet are cold deep 
breathing for a few minutes will put the body in a glow. The feet should 
be bathed in cold water each night. The cold bath should be followed by 
brisk rubbing. 

Treatment of Feet. — 8. F. J. writes: "I have suffered for years from 
excessive perspiration and mattering between the toes. I have tried every- 
thing that has been suggested by friends, but to no avail. I consulted a 
chiropodist and he called the condition 'hoof rot,' and merely prescribed 
walking barefooted as much as possible. Will you give me the benefit of 
your advice?" 

Reply. — Walking barefoot is good enough but it cannot be made use 
of by many. Try the following: Wash the feet night and morning with 
soap and water and rinse. Then apply freely a solution of alcohol and 
salicylic acid in the proportion of one quart of alcohol to one tablespoonful 
of salicylic acid. 

Change Style of Shoe. — W. S. writes that he has noticed the soles of his 
shoes split at the instep. Does that mean his feet are out of shape? 

Reply. — It means that your instep arches too high for your shoes. 
The top of your instep pulls hard on the sole and finally splits it. The 
remedy is to wear shoes higher in the instep, for if the foot lifts hard 
against the sole the sole pulls down on the instep equally hard. 



772 THE FEET 

Cold Hands and Feet. — J. A. B. writes: "What is the cause of a per- 
son having cold hands and feet continuously when the thermometer is below 
70? During cold weather the finger nails and hands turn purple. I am 
twenty-four years old and have been troubled with this for four or five 
years. I am not a hearty smoker or drinker and do not keep irregular 
hours." 

Reply. — If I were such a person I would get the advice of the best 
clinicians possible as to whether I had a modified mild form of Raynaud's 
disease. 

Trouble with the Feet. — E. K. writes : "I am troubled with my feet and 
at times it seems as if I am walking on the bones. I have corns and 
bunions. Do you know of any shoe that would give me relief?" 

Reply. — The cause of bad feet goes back to improper shoeing of chil- 
dren and youths. Oliver Wendell Holmes said the proper treatment of a 
disease should begin with the patient's grandparents. The proper treat- 
ment of foot ills may not go back of the youth of the suffering individual. 
But the present is all we have in mind in your case. If loose shoes and cork 
insoles or soft insoles as a part of the shoes do not help you your proper 
founts of help are shoemakers who study the foot and then build a shoe 
to conform to conditions as they can best be conformed to or even condi- 
tions which have been rectified sometimes. 

Need of Arch Support. — W. F. V. writes: "What can be done for 

broken-down arches in the feet?" 

Reply. — A simple remedy for a broken-down arch is to slip an arch 
supporter into the shoe. If this does not suffice you should see a shoe- 
maker expert on apparatus — very much better, an orthopedic surgeon. 

Look Out for 
Heels.— H. S. L. 

writes: "I have a 
very bad case of 
fallen arches; in 
fact, am fiat-footed. 
I have pains in my 

Fig. 270.— The Rocker Fig. 271.— The Flat Sole insteps, and my 

Sole (Whitman). (Whitman). right ankle pains 

me severely at 
times. I stand a great deal during the day. I wear arch supports. I 
would like to know if there is any possible cure. What would you advise 
me to do?" 

Reply. — Be certain that your shoe heels are of the right height. Some 
people wear them too low, some too high. Get shoes which pitch your 
weight on the outside of the ball, rather than on the big toe side. Stand 
and walk pigeon toed. Nothing saves the arch more than to walk toeing 
in. Nothing strains it more than to walk toeing out. 

Treatment of Cold Feet. — 0. C. B. writes: "I see that R. S. W. has 
been appropriately answered regarding cold feet, but let me add a bit of 
personal experience. 

"Several years ago I discarded woolen clothing next the skin. I sub- 





COVERING OF THE FEET 773 

stituted linen and cotton. On my feet I wear cotton socles, the year around, 
fleece-lined in the winter. 

"Woolen absorbs and holds the moisture or perspiration of the feet, 
and so surrounds them with damp clothing, which is a promoter of chilli- 
ness. The leather clothing of the feet prevents a proper ventilation; hence 
low shoes are better than high laced ones. But in any case, cotton socles 
keep the feet in a drier condition. 

"Every night and morning I rub my feet and legs some fifty times or 
more, taking care to rub up from the toes. There are valves in the veins 
which prevent the blood from going back to the extremities. Rubbing up 
draws arterial blood through the capillaries into the veins. This produces 
circulation and warms the feet. 

"I find this rubbing of the feet has lessened the thickening of the toe 
nails and has reduced that numb feeling of the bottoms of the feet which 
is apt to come on with old age. 

"As to shoes, I wear those that are roomy with low heels or with no 
heels at all. The tyranny of the high-heeled shoe is a wonder, especially 
among women. It is a question which is the worst — the bound feet of the 
Chinese or the high-heeled shoes of the American women, with the inevi- 
table accompaniment of cramped, misshaped feet, and painful corns and 
bunions. Nature made the human foot to rest flat on the ground. We cant 
improve on the beautiful feet of a baby." 

Cure for Sore Feet. — P. 8. writes: "Water sets my toes afire, if used 
too often and the toes are not dried thoroughly." 

To which A. F. replies as follows : 

"For sore feet, such as scalding and cracking between the toes — keep 
clean, but do not wash oftener than once a day. Dry thoroughly between 
the toes. Drying is important. When ready to put the shoes on sprinkle 
powder between the toes and interlace white tape with the toes. Begin 
by putting the tape under the little toe, over the next toe, under the next 
one, till you run out of toes. This is to give space for air to circulate. 
The tape will not interfere in any way with walking. This cured my feet 
and may cure others." 

Support the Instep. — M. R. writes: "1. Kindly advise me whether it is 
inadvisable, in cases of fiat-foot, to wear heelless shoes, such as gymnasium 
slippers. 2. Are there exercises which are helpful to the muscles in such 
cases?" 

Reply. — 1. Heelless shoes are no better than low-heeled shoes but low- 
heeled shoes are much better than high-heeled. After flat-foot has devel- 
oped about as much as can be done is to support the instep. 

•2. Yes, in some measure. To prevent flat-foot, yes, in much greater 
measure. Exercise in which the toes and ankles are bent — rising on the 
ball of each foot at once, standing on the heels and bending the feet up- 
ward, bending the ankles backward and forward, exercising the toes — 
general muscular exercise. 

Has Flat Feet. — A. B. C. writes: "I am a girl of eighteen and have 
flat feet. My ankles are weak. The ankle of my left foot sticks promi- 
nently out, bending over towards the instep. Kindly let me know if there 
is a remedy for it." 



m THE FEET 

Reply. — If a loose shoe and an insole do not relieve you (and your case 
is probably beyond their reach) go to see an orthopedic surgeon. Any one 
of the large hospitals has an orthopedic surgeon on its staff. 

Best to Consult Doctor. — Mrs. W. C. H. writes: "I am a woman 6^ 
years of age, and for the last year I have been troubled with swollen feet 
and legs and pain in my back. The limbs are more than twice their nat- 
ural size and very hard, and pain when I use them any length of time. 
Have been to two physicians, but they do not seem to know what to do." 

Reply. — Swollen limbs may result from heart, liver or kidney disease. 
Have your physician find the cause in your case by examination of your 
urine, your heart and your liver. Have him tell you what to do for it, 
then follow directions. Nothing is gained by going from doctor to doctor. 
Much swelling of the legs in a woman of sixty-four is not to be trifled with. 

Swollen Feet. — J. C. writes: "What causes my mothers feet to swell 
at the instep and below the ankle, at various times, paining her dread- 
fully? She thought perhaps it was rheumatism. There are times when 
it is difficult for her to walk." 

Reply. — Rheumatism or gout could easily cause a painful swelling 
in the instep and below the ankles. Don't try to take care of a case of 
inflammatory rheumatism or gout by yourself. Have your physician see 
her. 



CHAPTEE XLIII 

Obstetrics 

PRECAUTIONS AT CHILDBIRTH 

,A woman writes to know what can be done by those in attendance 
on a woman in confinement in case the baby is born before the doctor 
arrives. Let us assume that the mother has been told what to provide and 
what to do and has followed instructions. 

When the earlier vague pains come on she should take a cleansing bath, 
put on clean clothes, and arrange her bed as she has been instructed. She 
should prepare a lysol solution, one teaspoonful to the pint, which she 
should use for local external bathing according to the instructions she 
has had. 

It is advisable that she should restrain from bearing down. It is better to 
go slow. She must not take chloroform in the absence of the physician. 
The danger is too great. 

The child having been born, is it advisable to cut the cord ? If the child 
and mother are doing well do not cut the cord so long as it pulsates. If either 
the child or mother gets into trouble cut the cord at once so that attention can 
be centered where it is needed. To cut the cord tie it twice with a piece 
of sterile string. 

The ligatures are tightly tied about four inches apart, the nearest 
being one inch from the child's body. Place a small piece of sterile cloth 
below the cord at the point of division and cut with scissors sterilized by 
boiling. When the head is born and the cord is found to be around the neck 
it must be drawn upon enough to permit it to be slipped from this position. 

So long as mother and child are doing well there must be no inter- 
ference. Let the afterbirth come away of itself. Do not pull on the cord. 

If at the end of two hours the afterbirth has not come away a cloth 
wrung out of cold water may be laid on the abdomen. If this fails the uterus 
should be gently rolled between the fingers and thumb of one hand. Through 
the limp abdominal walls the uterus can be felt deep in the abdomen. It 
feels like a hard lump. The fingers are to be pressed down behind this 
lump while the thumb and hand extend over the top and front. Very 
gently squeezed but not shoved in any direction the uterus contracts and thus 
expels the afterbirth. The same method stops hemorrhage. 

The woman must be watched for profuse hemorrhage, ordinary oozing 
requiring no attention. If there is such hemorrhage the foot of the bed 
must be raised and then the uterus must be grasped through the abdominal 
wall as described in the preceding paragraph. 

After the afterbirth has been expelled the mother should be allowed 

775 



776 OBSTETEICS 

to rest for an hour or so if she wishes. Then she should be bathed with 
warm water at least as much as is required, dressed in clean clothes and a 
previously prepared aseptic pad applied. The bed having been put in 
order the woman is ready for a quiet nap. 

Never touch a raw surface or a mucous membrane with the fingers 
or cloths that have not been made clean or aseptic. 

The meat of the answer to the woman's question on what to do is to do 
nothing! Labor is a natural process. When something needs to be done 
the something needed requires more knowledge than untrained persons have. 



TWILIGHT SLEEP 

By reason of the publicity given twilight sleep it became necessary 
for members of the medical profession to mature their opinions or, where they 
had none, to form them. 

Although the method was proposed in 1899 and many thousands of 
cases had been reported the method was not in general use. It was used 
in the main in large hospitals and the several thousand cases were in the 
services of a few men. 

A moderate number of obstetricians and surgeons had visited Freiburg 
and studied its use there. Of these the larger part had made no extended 
use of the method when the publicity precipitated a demand for opinions. 
Everywhere physicians were being asked: What is your opinion on twilight 
sleep? 

In an effort to supply the need medical societies have been holding 
discussions and medical journals have been collecting symposiums. A typical 
symposium is that in the Medical Times from which the following opinions 
are abstracted. Professor Lucke of Cincinnati wrote: 

"I am much in favor of giving the method a thorough test. I think 
there is something in it. The term 'painless childbirth' is in a measure 
misleading. All of these patients suffer during labor, but forget about it 
afterwards." 

Professor Polak of Brooklyn says: 

"Adoption of the method will do much toward reducing obstetric mor- 
bidity if properly done and intelligently administered. It is in practice in 
private practice — that is, outside of hospitals." 

He believes in giving morphin but once and continuing the effect by an 
injection of a half a dose of hyoscin every three or four hours. He thinks 
the harm to the babies is due to the morphin and if the dose of that drug is not 
repeated the babies get on all right. 

Dr. Knife of New York reports that in the Gouverneur hospital for 
several months a large proportion of their maternity cases have been given 
twilight sleep. 

"This has required considerably more attention from the staff physicians 
and nurses," he writes. "We have felt justified in devoting sufficient care to 
these cases because of the excellent results obtained both for the mother 
and child. . . . The method is practicable under proper conditions." 

He discusses four questions and answers them essentially as follows; 



TWILIGHT SLEEP 777 

As to the dangers to the mother his answer is that they are not of 
much consequence. As to the danger to the child his answer is that there 
is no especial danger that cannot be met. 

"The child is subjected to extra hazard," he says. "If too much of the 
drug is given the labor will be prolonged and the child will suffer. The chil- 
dren's breathing is liable to be interfered with. However, by not pushing 
the drug too far, by close watching and prompt action, the danger to 
the child will be small." 

The question : "Is the anguish and pain of childbirth of such a 
degree to warrant alleviation ?" he answers in the affirmative. He says : 

"Anyone who will compare the mothers who have had twilight sleep 
with those who have not had this aid must come to the conclusion that 
the absence of physical and mental exhaustion alone justifies the use of 
twilight sleep." 

To the question as to whether the difficulties of administering the method 
are so great as to make it impracticable he answers no. In this answer 
he assumes that the cases given twilight sleep must be more closely watched 
than labor cases now are. The basis of his answer is that practically 
all babies should be born in hospitals. Groups of neighboring physicians 
working together may carry out twilight sleep in their private practice 
through cooperation. 

Dr. Gellhorn witnessed the use of twilight sleep at Freiburg but was 
not sufficiently impressed by it to make use of it in his own practice. 

Dr. Schloessing of New York, formerly of the Freiburg clinic, thinks 
that the fact that the Munich, Heidelberg, Inbengin and Dusseldorf clinics 
have adopted the Freiburg method is proof that it is safe as well as other- 
wise advantageous. He says: 

"Women of today with their hypersensitive nervous systems are, as 
Prof. Kronig says, far removed from being natural and therefore we can 
no longer look on their labor as being physiological. The best proof of 
this is that out of one hundred women who are in labor ninety used to ask for 
chloroform and are now asking for twilight sleep." 

Professor Dehee says: 

"The drugs used in producing the twilight sleep carry inherent dangers 
which have not been completely eliminated, even in Freiburg. The general 
reemployment of the method — discarded ten years ago and again seven 
years ago — will result in the repetition of the bad experience of those times. 

"Practiced by specially trained obstetricians in a specially equipped 
maternity hospital with an abundance of trained assistants and nurses, the 
dangers to mother and child may be reduced to bring them to a point 
where one may well consider the advantages and disadvantages more nearly 
balance each other. 

"Even under these circumstances one will have to reckon with a 
certain toll of infants' deaths and injured mothers. For general use — 
especially in the home — the drugs are contraindicated." 

Professor Applegate of Philadelphia thinks the method has a limited 
place in obstetrics. 

"It usually prolongs the labor from three to six hours," he says. 
"While the full treatment of three hypodermics of morphia and hyoscin 



778 OBSTETRICS 

have been given not infrequently, the child is affected by twitching and stupor 
for a day or two after birth/' 

Where only one dose is given, whether because no more is required 
or as a starter for chloroform, he thinks much good and little harm 
results. 

Professor Hirst of the University of Pennsylvania does not approve of it 
as a routine procedure. He has witnessed its use at Freiburg and tried 
it a few times in his own practice. 

"Had it been a good method it would have spread throughout Germany 
and some outside/' he says. "The Germans who have had the best op- 
portunity to judge are not making wide use of it." 

In the opinion of Professor Hirst, if enough morphin is used to put the 
patient to sleep both the mother and baby will be endangered. 

Professor Booer of Washington thinks the method has a very limited 
place in obstetrics. He says: 

"It demands careful, continuous, and tedious observation on the part 
of the obstetrician. I believe it endangers the welfare of the infants." 

Dr. John N. Bell of Detroit says: 

"I see no objections to the use of twilight sleep in well regulated 
hospitals." 

Professor Charles M. Greene of Harvard opposes it because it en- 
dangers the baby and because the effect on the mother is uncertain. 

Professor J. Whitridge Williams of Johns Hopkins reports that in neither 
of two series of cases in which it was used in Johns Hopkins hospital 
was twilight sleep satisfactory. 

Dr. Charles B. Eeed of Wesley hospital, Chicago, has informed me that 
they have used it in a series of forty-five cases without any accident to 
mother or child. As the method has advantages and as in their experi- 
ences there have been no disadvantages so far as the mother and child 
were concerned they advocate the method. 

The twilight sleep method consists in the use by hypodermic injection 
of a freshly made solution of morphin and hyoscin. The dose of morphin 
given — one-sixth of a grain — is a small one. Larger doses than this are 
in common use. The dose of hyoscin given — one one hundred and fiftieth of 
a grain — is a small one. One one-hundredth of a grain is a frequent dose. 

Assuming that the twilight sleep method satisfies the patient, why is there 
any objection to it? When morphin and hyoscin are combined in a single 
dose the effect is increased unduly. A small dose of morphin plus a small 
dose of hyoscin is greater than the effect of double the dose of morphin 
or double the dose of hyoscin. 

In order to get a satisfactory result it is necessary to keep the patient 
in a state of contented somnolence for several hours. This degree of in- 
toxication with the drug prolongs the labor somewhat and somewhat en- 
dangers the child. 

Let us see how far the objections to the method hold against -other 
methods. The method is not painless since the women suffer during labor but 
forget about it afterwards. This is an objection urged against chloroform 
and ether. 

Either there is no register of pain or else there is no conscious recollec- 



TWILIGHT SLEEP 779 

tion of such registering. The test here is the after shock. The observers 
generally agree with the opinion of Dr. Knife that there is absence of mental 
and physical exhaustion in those who have had twilight sleep as compared 
with those who have been treated otherwise. 

As to the dangers to the child the authorities are somewhat divided. 
Among the authorities quoted above those who have had the most ex- 
perience with this method place least emphasis on this objection. Clearly 
the weight of evidence is to the effect that there is added danger to the child. 
Being born is a hazardous occupation. 

Between the accident rates of those born in high grade maternity hos- 
pitals and the accident rates of those born in the poorer homes there is 
a vast difference. The accident rate among babies born under twilight 
sleep is higher than the first and lower than the second. Where in be- 
tween it comes no one can say. Accidents happen under other forms of 
anesthesia. Of a comparative statement of these risks I do not know. 

Every authority quoted is agreed that morphin scopolamin should not be 
used except where there is a plentiful supply of nurses and attending 
physicians. This in the opinion of those quoted above comes to this: The 
method should not be employed except in equipped hospitals. 

Now the pressure is coming from a certain group of women. That 
group is willing to go to hospitals or to equip their homes with nurses and 
doctors as their physicians direct. 

The method was proposed as a method for surgical anesthesia in 
1899. After it came to be used as an obstetric method it was twice aban- 
doned. It will not down. This means that those who bear the pain are not 
altogether satisfied with chloroform. 

Recalling Professor Kronig's statement that "women of today, with their 
hypersensitive, nervous systems are far removed from being natural" we feel 
that at any rate they do not approach pain or bear it with the stoicism of 
the savage. 

Dr. Schloessing says: "Out of one hundred women who are in labor 
ninety used to ask for chloroform and are now asking for twilight sleep." 

The women are as they are. A large part of them have fearful dread 
of the pain of childbirth. Twilight sleep puts the woman in a condition 
of somnolent content. When through she shows less signs of shock and 
fatigue than do those who have had chloroform and those who have had no 
anesthetic. 

To a great many high-strung women the appeal made by this prospect 
will be mastering. The somewhat greater degree of injury to themselves 
and the definitely greater hazard to the child will not deter them. They will 
insist on twilight sleep. It will be the duty of the hospitals and their 
physicians to make the method safe. 

It may be that it is now safer than the methods of obstetric service 
prevailing in the general run of poorly equipped homes. But that is no 
answer. The method must be made reasonably safe and the ordinary 
obstetric service in poor homes is not reasonably safe. 

But there should be no great difficulty. There is nothing extraordinary 
about morphin and hyoscin. They are in common use. 

Nervous, apprehensive, high-strung women will continue to insist on 



780 OBSTETEICS 

twilight sleep and they will get it. The method will be modified to over- 
come its disadvantages. 

CARE OF NEWBORN BABY 

In a previous article I answered a correspondent who wrote asking 
what should be done in case the baby were born before the doctor arrived. 
The answer related what should be done to the mother. 

What should be done to the baby? 

If the child cries lustily upon arrival, breathes normally and appears 
to be all right nothing should be done for a while at least. It does no 
harm to leave a child attached to the cord for an hour or even two. As 
cutting the cord is a simple process it can be cut as soon as pulsation has 
stopped and before if the baby or mother needs attention. 

It is natural for a newborn baby to breathe at once and then to cry 
lustily. If the air does not cause the child to breathe it should be held 
by the feet, head down, and lightly slapped on the back with the palm 
of the hand. If this does not suffice the baby's body can be placed in warm 
water and then plunged into cool water being then removed at once to the 
warm. 

The use of alternating baths of warm and cold water is about as far as 
the friends can go without the doctor. Before starting efforts to make 
the baby breathe, the little finger, covered with a handkerchief, should be run 
into the baby's mouth and any mucus found should be cleaned out. Go as 
far back as possible into the throat. 

Assuming that the baby has breathed satisfactorily, that the cord has 
been cut and the mother is resting quietly the baby is to be cleaned. To begin 
with the eyes are to be washed with soft sterile cloths or cotton dipped in a 
saturated solution of boric acid. The cloth used on one eye should not 
be put back into the solution. A fresh cloth is used for each eye. In 
addition the doctor upon arrival will drop one drop of a 1 per cent solu- 
tion of nitrate of silver into each eye. 

The head and then the body and limbs are to be thoroughly greased with 
olive oil, vaselin or lard to remove the cheeselike matter and then with soft 
cloths, warm water and soap to remove the grease. The head is to be washed 
and dried before the body is washed. Pat the skin dry with soft cloths. The 
navel is to be dressed with sterile gauze. Previous to the bath and for a 
short time thereafter it is advisable to note the cord occasionally to be 
sure that there is no hemorrhage. 

As soon as the baby is dressed let mother and baby sleep for six 
or eight hours. Water can be given every three hours. The danger that 
too much will be done is fairly great; the danger that too little will be done 
is slight. 

SUPPLIES FOR CHILDBIRTH 

"If a woman is to be confined at home she should provide the fol- 
lowing : 

Two to four pounds of absorbent cotton. 



SUPPLIES FOR CHILDBIRTH 781 

One large package of sterile gauze (twenty-five yards). 
Four rolls of cotton batting. 

Two yards of stout muslin for abdominal binders. 
Twelve old towels or diapers. 
Two old sheets. 

Two yards of bobbin, or very narrow tape, for tying the cord. 
"Other things that may be needed are: 

One hundred bichlorid of mercury tablets. 
Four ounces of boric acid. 
One bottle of white vaselin. 
One pound of castile soap. 
One quart of grain alcohol. 
One douche pan. 
One stiff hand brush. 
One^ slop jar or covered enamel bucket. 

Three pottery or agateware basins, one sixteen inches and two eleven 
inches in diameter. 

At least three pitchers — holding one quart and upward. 
One and one-half yards of rubber sheeting, at least thirty-six inches 
wide, or one and one-half yards of white table oilcloth to protect the 
mattress. 

One two-quart fountain syringe. 
One medicine glass. 
One medicine dropper. 
One drinking tube." 
The above is quoted from "Prenatal Care." We can indorse all of it ex- 
cept possibly the advice to lay in 100 bichlorid of mercury tablets. 

This list is followed by detailed instructions on how to make and 
sterilize pads, sponges, pledgets and bobbins. 

"Prenatal Care" is a simple treatise on the care of the mother in 
pregnancy and during confinement and the care of the mother and child 
after confinement. Any woman can understand it. Every mother and 
every prospective mother should read it. The cost? Nothing. 

It is issued by the Children's Bureau of the United States Depart- 
ment of Labor and is No. 1 of the Care of Children Series. If you want 
it write for it. If the supply gives out write your congressman asking 
him to work for a new supply. That's what congressmen, congresses and 
governments are in Washington for. 

Books on Pregnancy. — Mrs. C. G. writes: "Will you give me the name 
of some good books on pregnancy? What boohs can I read to which I can 
give a great deal of thought and at what period of pregnancy will it have 
the most effect to influence or rather stimulate the child's mind? I am 
very much subject to constipation. Bran bread, cooked and raw fruits and 
even purgatives have little or no effect. My only relief is an enema." 

Reply. — 1. "Prenatal Care," published by Children's Bureau, Depart- 
ment of Labor; "The Prospective Mother," by Slemons. 

2. It is evident that you have been told that a pregnant mother can 
influence the mentality of her developing child by reading books. You have 



782 



OBSTETEICS 



been misinformed. Good books will be good for you, but they will not 
affect your child. 

3. Drink lots of water; try agar; try mineral oil. 

No Age Limit. — Mrs. E. T. writes: "Will you please state the age limit 
for a woman to bear her first child without endangering her own life? Does 
it make a difference if the mother is of slight build? Can a child be marked 
physically before birth?" 

Reply. — 1. There is none, if she is skillfully cared for. 

2. No. 

3. No, so far as birthmarks and deformities are concerned. 

Infection in Childbirth. — N. M. T. writes: "I am writing to you to 
know if when the mother has had gonorrhea will it infect her offspring? If 
so, in what way? She is very anxious, but in fear of infection. Her doctor 

says she has been cured, 
but is left with leukorrhea, 
which is bad. Should she 
be this way?" 

Reply. — If she is cured 
her offspring is in no dan- 
ger. The leukorrhea may 
be due to gonococcal infec- 
tion ; it may be due to other 
causes. If it is due to gon- 
ococcal infection her child 
is in some danger of de- 
formity due to infection 
before birth. Its eyes may 
be infected at the time of 
birth. If your inquiry relates to a child that has been born and no acci- 
dent has taken place infection may still occur from contact. If she will 
be very cleanly in her habits the child is in very little danger. 

Presumptive Symptoms. — R. B. writes: "1. What are the first symptoms 
of pregnancy? 2. Is it possible for conception to occur ten days before the 
menstrual period? 3. Does pain in the right breast indicate that condition? 
Jf. How soon do symptoms occur? 5. Is dancing dangerous during that 
time — that is, will it be apt to cause a miscarriage? 6. If menstruation 
occurs will it signify that the woman is not pregnant?" 

Reply. — 1. (a) Cessation of menstruation; (b) changes in the breast; 
(c) morning sickness; (d) irritable bladder. Slemons calls these the pre- 
sumptive signs. 

2. Yes. 

3. By itself it would not be a sign of much value. 

4. Varies in different women. In some women some one or several of 
these signs appear in a few days. Usually the first indication is the ces- 
sation of menstruation. Diagnosis within the first two months, even by a 
physician, is a good deal of a guess. A laboratory test known as the 
Abderhalden test is now being tried out. 

5. There may be a little danger within the first month. It is not great 
if the dancing be in moderation. 

6. Yes, though there are exceptions. 




Fig. 272. — Bed Rest and Table. 



OBSTETKICS 783 

Should Forget Worries. — Reader writes: "Will you kindly advise if a 
pregnant woman, who is weak and nervous, can undertake a long travel to 
the South or West without injury?" 

Reply. — This is a matter to be decided as the result of personal observa- 
tion. However, my guess is that you can. Traveling is comfortable and a 
pregnant woman can do about as other women. If you will forget your 
fears and worries probably the trip will not tax you greatly* 




Fig. 273. — Pregnant Uterus Containing Young Embryo, c, embryo; i, alimentary canal 
of embryo; r, p, m, m, various structures composing umbilical cord; q, n', q, a, placenta; m, 
a', q' , s, membranes surrounding embryo; n, n, lining membrane of uterus. 

"Marking" of Child. — Mrs. A. D. writes: "Will you kindly settle a 
question which has long puzzled us as well as many others. 

"1. Is it possible to 'mark' a baby through mental impressions of an 
expectant mother? 

"2. Is it true no nerves whatever connect mother and child, connection 
being entirely through the blood through the cord? 

"3. Will mental impressions of mother mark or disfigure a babe durin/g 
first two months of pregnancy?" 

Reply. — 1. No. 

2. Yes. 

3. No. After conception the mind of the mother cannot influence the 
child except indirectly. For instance, if she worries and in consequence 
is illy nourished the growing baby is less liable to thrive. That, however, 
is a matter of nutrition, not marking 

The Nipples. — Mrs. A. B. writes: "An expectant mother has as yet no 
pronounced nipples. What can be done to hasten development?" 



784 OBSTETRICS 

Reply. — Wash the nipples daily with alcohol, then gently pull them for 
a few minutes. The nipples tend naturally to assume the right shape. A 
little help suffices. 

No Harm to Child. — M. L. writes: "Can you tell me what can he done 
to prevent an expectant mother (six months) from being despondent? She 
wakes in the morning perfectly well but despondent, and falls asleep at 
night in the same condition. Will it affect the child?" 

Reply. — 1. Keep the bowels open. Exercise in the open air. Read 
entertaining, optimistic books. Keep with bright, cheery people. 

2. The condition described will not harm the child. There is nothing to 
worry about. 

Amenorrhea. — C. E. W. writes: "What is the meaning of 'amenor- 
rhea'?" 

Reply. — The accurate meaning is absence of menstruation. 
The accepted meaning is scant menstruation. 

No Bar to Marriage. — Miss M. writes: "I had one of my ovaries re- 
moved some years ago. Is it possible for me to have children? If not, 
would you advise me to get married?" 

Reply. — The removal of one ovary has no effect on one's ability to bear 
children. It is no bar to marriage. 

Is No Proof. — Mrs. J. M. writes: "Is the fact that menstruation takes 
place at all proof that the Fallopian tubes are not closed? Why? Would 
a nervous woman's chances of bearing children be greater if the external 
causes of nervousness were removed?" 

Reply. — 1. No. 

2. Menstruation is from the uterus and the tubes lie beyond that organ. 

3. Nervousness does not prevent a woman from bearing children. To 
relieve nervousness will not cause a barren woman to become child bearing. 

Abderhalden Test Tells. — Mrs. W. B. writes: "When a woman is preg- 
nant does menstruation stop? Can a woman's abdomen increase in size 
daily unless she is pregnant? Is there any way to tell?" 

Reply. — 1. Yes. The exceptions are too few to be of any importance. 

2. Yes. It may enlarge from tumor, from fat, or from increasing 
laxity of the wall muscles. 

3. Yes, an Abderhalden test; also physical examination. 

Hazard Is Decreased. — Mrs. D. A. C. writes: "Here is the case of a 
woman whose first baby was born when the mother was within a few days 
of 36 years of age. Before the birth the attending physician said, though 
the prospective mother was in perfectly normal condition, it was impossible 
to predict a safe first confinement in a woman of her age. Is this uncer- 
tainty or danger considered to exist in case of the birth of a second child 
to a woman beyond 38 or 39 years of age?" 

Reply. — There is some extra hazard with the first child. The extra 
hazard is somewhat less with the second. 

Danger Not Great. — A. B. writes: "Is it dangerous for a woman of Jfl 
to give birth to a child for the first time in her life?" 



OBSTETRICS 785 

Reply. — In a good hospital under good medical care the danger is not 
great. It would be less than the average danger of the average woman 
under average city conditions. 

When the Stork Is Expected. — G. F. writes: "How soon should a 
doctor be consulted regarding the arrival of the stork? Should the pros- 
pective mother be examined at regular intervals? Is there any benefit 
derived by rubbing to soften the abdomen? If so, would any pure oil do? 
Should the mother be given tonics to strengthen her?" 

Reply. — 1. About the fifth month if everything is going well; other- 
wise earlier. This visit should be for advice and counsel as to hygiene, 
sanitation, habits, what to read and what to do. It is of prime importance 
that mothers should know all about themselves and their expected babies. 

2. In the average case, in the sense of physical examination, no. Such 
physical examination as the physician may need to determine that every- 
thing is physiologically correct should be made. Beyond that the visits to 
the physician should be educational. 

3. Massage of the skin mildly done may add to the comfort. Any oil 
will do. It is scarcely worth while. 

4. No. Food and rest from hard work but with mild exercise is the 
proper tonic. 

Prospective Mother. — H. L. J. writes : "Would any of the following be 
injurious during pregnancy : Scalp treatments, examination and treatment 
for catarrh, having teeth attended to?" 

Reply. — No. 

Reply to M. W. — Let nature take its course. A woman is in no better 
condition to bear a child two or five years after marriage than in ten 
months after. She may be in worse condition. I expect that you have also 
seen many babies born three years after marriage. All you need to know 
you can learn in ten months. Write to the Child Welfare Bureau at 
Washington, D. C, for its pamphlet on prenatal care; or buy Slemons' 
"Prospective Mother." 

Reply to R. S. — Thirty is not too old to marry. It is generally agreed 
that children born of parents around thirty are better specimens than those 
born to parents under twenty. As to whether a nervous woman should 
marry, everything depends on what is meant by nervous. If she is now well 
her case is probably one of bad mental training. If so, it constitutes no bar 
to marriage. 

Can't Determine Sex. — J. H. J. writes: "A few days ago someone 
ashed if the parents could determine the sex of their child. I wish to 
state that Fowler says in his 'Sexual Science' that where there is no love 
there will be no conception, and if there is love on one side and none on the 
other there may be conception and the child will take the sex of the parent 
whose love for the other is the stronger." 

Reply. — Bosh! How did Fowler find that out? 

Will Do No Harm. — /. E. H. writes: "Is it harmful for a pregnant 
woman to wear maternity corsets?" 

Reply. — No, 



786 



OBSTETEICS 



Follow Doctor's Plans. — A. C. E. writes: "Eight years ago I had an 
operation for extra-uterine pregnancy, followed by infection, and have since 
had a stiffening and cracking in the joints that began in the ankles. It 
has reached the shoulders, elbows, and knuckles, and at times is exceedingly 
painful. For the last couple of months I have noticed a soreness in the 
cords of the back and sides of the neck. 1. Has the joint trouble anything 
to do with the neck? Is it a form of rheumatism? 2. Would any kind of 
diet help conditions? Do red meats aggravate? I also have a ringing in 

one ear,' much like the ef- 
> (^e^c^^^ feet of quinin. 3. Is this 

caused from the same trou- 
ble and is there any positive 
cure? I am J/.5 years old." 



Eeply. — 1. I judge that 
you have a rheumatoid ar- 
thritis. The neck and joint 
trouble are parts of the 
same disorder. In all prob- 
ability the infection caus- 
ing your joint trouble en- 
ters through your throat or 
nose and is related to the 
cause of the ear trouble. 
2. A good nutritious 
diet proportioned to the ex- 
ercise you take will do you 
good, 
much relation if any to your 
Cure is improb- 




Fig. 274. — Section of Ovary. 1, 2, 3, Early stage 
graafian follicles; 4, 5, 6, graafian follicles approach- 
ing maturity — ovum can be seen; 7, mature graa- 
fian follicle — arrow points to ovum; 8, corpus 
luteum. 



3. No. Your trouble probably has not 
operation. Have your nose, throat and teeth put in order, 
able, but by following a plan laid down by some sensible physician you can 
keep in good condition. 

No Legal or Moral Right. — J. M. K. writes: "1. When a woman becomes 
aware that another child is coming has she the moral right to determine 
whether that child shall be given the right to exist or not? 2. If it would 
be a horrible crime to deprive a child of life the day after it was born, would 
it be any less a crime the day before? 3. Or the month before? J^. Or at the 
first moment that the mother becomes aware of the existence of another 
life? As I understand it, eugenics and the modern sophists generally 
would have us believe that we know a great deal more than the God who 
made the laws of nature, and may complacently transgress them as we 
see fit." 

Reply. — 1. No, neither the legal nor the moral right. 

2. No. 

3. No. 

4. No. 

J. M. K. fails to understand eugenics. Control goes farther back than 
the questions in his letter indicate that he has in mind. I should think 
it impossible to find Scriptural warrant for the crime, injustice, immorality, 
disease, want and death to which improper mating and riot of passion 
foredoom some of God's creatures. 

No Need to Fear for Child. — S. 8. writes : "If a woman, marrying for 



OBSTETRICS m 

the first time at the age of JfS, should bear a child, would it be below normal 
mentally or 'physically, provided all conditions, except the age of the mother, 
were of the best?" 

Reply. — No, decidedly. Averaging 5,000 children born to women 43 
years of age with 5,000 born to women 25 years of age the first group would 
not equal the second but if those of the first group had a good inheritance, 
they would be far above average children. Advanced age of the mother is 
a factor but it is insignificant as compared with venereal disease, alcohol- 
ism, neurasthenia, hysteria or a score of other ills which might be men- 
tioned. 

Childbirth is more difficult and more hazardous for a woman of forty- 
three than for one of twenty-five; that is, averaging, say 5,000, and this is 
found to be true. But women in childbirth at forty-three now are safer 
than women at any age were twenty-five years ago. 

Such a woman with good obstetrical care is much safer than is the 
woman of any age who is cared for by a midwife. 

Need Not Worry. — Mrs. O. A. H. writes: "I have been pregnant for 
three months, and had the misfortune to fall, not injuring myself or even 
having pains. I was of course sore for a few days on the side on which I 
fell. A neighbor has told me she lost a baby just by slipping at this 
time." 

Reply. — Nothing for you to worry about. You ought to feel sorry for 
your neighbor but that is far enough to go. 

Marrying at 48. — R. writes: "Would it be possible for a woman marry- 
ing for the first time at the age of Jf-8 to become a mother?" 

Reply. — Possible but not probable. 

Medicine No Help. — Mrs. O. T. B. writes: "1. What is the cause of in- 
fantile uterus? 2. Will medicine of any hind help it? 3. Is it the cause of 
scant menstruation and continuous bach- and headache?" 

Reply. — 1. The cause is failure to undergo full development. 

2. No. Pregnancy is about the only effective cure. 

3. It is one cause. 

Fibroid Tumors Not Cancer. — Mrs. M. R. writes: "Will you tell me the 
nature of a fibroid tumor; also what causes it? When my baby came I had 
quite a large lump at my abdomen. It did not cause me any pain, only 
since I hnow it was a tumor it worries me. Most persons say tumors 
are cancers." 

Reply. — A fibroid tumor is a tumor composed of fibrous tissue. Fibroid 
tumors are not cancers. They are benign. Occasionally, though rarely, 
they become malignant cancers. Since fibrous tissue is to be found every- 
where in the body fibroid tumors are found everywhere. Yours is develop- 
ing from some pelvic organ. Sometimes fibroid tumors can be cured by 
radium, sometimes by X-rays applied in a special way. Usually operation 
is required. Get good surgical advice and follow it. Nothing is gained 
by worry. 

Treatment for Fibroid. — Parent writes: "1. Is a fibroid on the womb 
dangerous in a woman of 26? Does it grow, and is an operation advisable? 



788 OBSTETRICS 

7s there any cure other than an operation, and, if not, is the operation 
absolutely sure to cure? 2. What is the best method of handling a fistula in 
a child of 2 years?" 

Reply. — 1. Not necessarily. As it grows it may endanger life. Fibroids 
are liable to become infected, to strangulate or to produce hemorrhage. 
They are very liable to accidents. Operation while the fibroid is small is 
generally advisable. Some cures have been made by X-rays and by radium. 

2. While a fistula may heal spontaneously it is not good judgment to 
leave the condition to home treatment. You should take counsel. 

Operate for Fibroid Tumor. — E. M. G. writes : "Your article on uterine 
fibroid tumors was of great interest to me, as I am afflicted with a five- 
pound tumor. The surgeon who examined me said my tumor was a dense 
mass. Do you think it would be possible for my dense tumor to be re- 
moved by radium or X-ray treatments? I am 1^1 years old." 

Reply. — Possibly, though operation would be surer. 

Radium and Fibroids. — L. K. writes: "Some time ago I saw an article 
in which Dr. Howard Kelly of Johns Hopkins University was quoted as 
saying that '90 per cent of all fibroid tumors can be cured or relieved by 
radium.' Has that result been found by the Chicago practitioners also?" 

Reply. — Radium is still on trial. I doubt if it has enough penetrating 
power to reach a fibroid. The experience of Chicago practitioners with 
radium has been limited. 

Operation Will Relieve. — S. K. writes: "A friend has been troubled 
with falling womb for about ten years. Because she believed her condition 
incurable and did not want to distress anyone, she foolishly told no one 
about it, until it has become so aggravated that the womb is now wholly 
exposed. Can anything be done now? Would an operation be possible or 
advisable? If so, what would be the danger and the expense? The woman 
is sixty-seven years old and otherwise strong, though she has attacks of 
weakness with abdominal pains quite frequently." 

Reply. — The condition is not so infrequent as you think. It can be 
relieved by operation. 

Operations No Barrier. — Anna B. writes: "I am a girl of 18. I have 
had operations for growths. 1. Do you think it possible that I could have 
had a fibroid tumor? 2. Shall I have change of life earlier due to the op- 
erations, and at about what age? 8. Will I be prevented from bearing a 
child? Jf. Would my marrying early prolong change of life?" 

Reply. — 1. Fibroid is possible but not probable. 

2. No. The age for change of life varies. You probably will have it 
about the same age your mother did. 
3 and 4. No. 

Should Go to Hospital. — Mrs. S. G. R. writes: "I am $k years old; 
have one child, and expect to have another within three months. My 
husband thinks I do not get enough exercise. Will you answer the follow- 
ing questions: 1. Is two hours' brisk work every morning, making beds, 
dusting, putting to rights five rooms, enough exercise, or should I also 
take long walks? 2. Would the possible complications on account of my 
age make hospital preferable to the best of home treatment during con- 



OBSTETEICS 



789 




finementf 3. Please recommend some book that will be beneficial, some 
work on the care and feeding of a baby. 4. Please tell me if there is any 
virtue in the medicine called 'Mothers Friend' which is to be applied 
externally?" 

Reply. — 1. Go for a short, easy walk each day. You are taking enough 
exercise considering the 
stage of your pregnancy 
but you need some air. 

2. Yes, it is always 
to be preferred. 

3. There is nothing 
better than Siemens' 
"The Prospective 
Mother." Send to the 
Children's Bureau, De- 
partment of Labor, 
Washington, D. C, for 
the pamphlet "Prenatal 
Care." For the care of 
the baby get Holt and 
Kilmer. 

4. None. Fig. 275. — Massage of the Breasts, to Increase 

Their Size. (Herb.) 

No Danger to Off- 
spring— H. A. E. writes: 
"1. If a man of 60, in 
good health, should 
marry a spinster of 31, 
also in good health, 
would any of the pos- 
sible offspring be likely 
to suffer mentally or 
physically owing to the 
age of the father or the 
discrepancy in ages be- 
tween husband and wife? 
2. In other words, has a 
baby boy with a father 
aged 60 as good an 
equipment for life's bat- 
tles as though the father 
were only 30 f 3. How 

much is the danger of childbirth increased by the mother waiting until she 
is 31 years of age before marrying ?" 
Eeply. — 1. No. 

2. Yes. 

3. Say 10 per cent. 

Artificial Change of Life. — Mrs. J. F. writes : "Kindly tell me the cause 
of hot flashes, nervousness, overanxiousness, physical weakness, stupidity, 
laziness, and everything that tends to make up a human wreck. I had an 
operation some years past. The sexual tubes were removed. I had no 
trouble with the operation, which was quite a success, but since I have been 
on the verge of prostration and have had quite a lot of financial troubles 




Fig. 276. 



■Massage of the Breasts, to Decrease 
Their Size. (Herb.) 



790 OBSTETRICS' 

which worry me. I am as irritable as can be. I have palpitation of the 
heart terribly. I awake quite suddenly from really no cause. I have 
nervous indigestion. Is my case hopeless?" 

Reply. — My guess is that you are suffering from lack of ovarian secre- 
tion. Possibly you would be helped by the use of preparations of ovary. 

However, you will be helped more by cultivating poise. Your trouble is 
self-limited. It does not threaten your life. Therefore be cheerful. That 
will help you more than spoon medicine. 

Try Eating More. — W. A. M. writes: "Kindly let me know what you 
would advise in my case. I am 25 years of age and have had three chil- 
dren. The youngest is 11 months old. I have suffered with a sort of neu- 
ralgia ever since the birth of my second child. I had all my lower teeth 
extracted two months ago. It is not an acute neuralgia, but a nag, nag, 
nag. I generally weigh 90-odd pounds, but have only weighed 78 this 
summer/' 

Reply. — You need to feed up. Caring for three children, the youngest 
less than a year old, is hard work and you need to eat enough milk, bread, 
meat, vegetables, and fruit for the day's work and a little besides. 

If lessening your work and increasing your flesh does not stop your 
facial neuralgia see your physician. 

Evidently you are disposed to neglect yourself. That you had to have 
all your teeth pulled proved that. People who take care of themselves do 
not have to go through that ordeal. 

Not Too Late. — Mrs. C. M. L. writes: "I am thirty-six years old and 
have had thirteen children. The last one came four years ago. The baby 
was presented wrong and was born so, causing great suffering. I was 
lacerated and the doctor in attendance did nothing for me at that time. 
Is it too late now to have the work done? I know I woidd be better off 
could it be remedied. Otherwise I enjoy good health." 

Reply. — No. It is not too late. 

Affliction Not Dangerous. — L. M. K. writes: "1. Will you kindly let me 
know if a young woman of 28, unmarried, could have ulcers of the uterus? 
2. Are they dangerous? 3. What is the best treatment?" 

Reply. — 1. Yes. 

2. No. 

3. Local treatment. 

Pregnancy Test. — A. L. R. writes: "Kindly tell me if there is a positive 
test to determine pregnancy at three months. If so, where is it obtain- 
able?" 

Reply. — A physician can make the diagnosis. It can be diagnosed by a 
laboratory test. 

Difference Not Great. — Mrs. H. R. writes: "Will you please tell me 
what the danger is, if any, to a woman of 38 becoming pregnant for the 
first time, having been married nine years?" 

Reply. — The danger of accident during labor is somewhat greater than 
with a younger woman. However, the difference is not great. 



OBSTETRICS 791 

Leukorrhea. — W. B. writes: "What is the cause of leukorrhea?" 

Reply. — Leukorrhea is the result of infection of the lining of the uterus 
or Fallopian tubes or both. The infection may be with any one of several 
organisms. 

Need Not Fear. — Mrs. R. T. H. writes: "Will you kindly tell me if 
there is any danger for a woman of Jf3 to give birth to a child for the first 
time in her life?" 

Reply. — Labor probably will be a little more trying than with a younger 
woman. Cared for by a good physician, preferably in a good hospital, she 
need have no fears. 

Regularity Should Rule. — G. T. writes: "After a woman is curetted, 
having had a three months' miscarriage, how soon should she menstruate 
afterwards, and will she be regular?" 

Reply. — The next month. There is no reason why she should be 
irregular. 

Consult Your Physician. — M. A. L. writes: "Is it of any importance 
to a woman who is pregnant to show signs of flowing? I flowed slightly at 
four months and the same at six months. I am Jj.0 years old." 

Reply. — It is of importance. Frequently it occurs without meaning 
any injury to the child. My advice to you is to be very quiet when bleed- 
ing. Have your physician see you each month from now on. 

Operation Not Necessary. — D. A. writes: "A young married woman, 
aged 25, is anxious to become pregnant. For several years she has had a 
small hernia. During one winter only, when engaged in work that required 
much walking, it was large and painful. For the last year it has given 
no trouble whatever, but a slight swelling remains. Is an operation neces- 
sary before pregnancy?" 

Reply. — I judge not. It should not trouble you much more during 
your pregnancy than now. During labor, it should not be difficult to keep 
the hernia "up." Pregnancy will increase the inconvenience from the 
hernia somewhat but not much. 

Doctor's Guess Better. — M. B. S. writes: "Will you kindly tell me the 
first symptoms of pregnancy? How soon after conception can it be detected 
by such symptoms?" 

Reply. — Amenorrhea and nausea are early signs present in most cases. 
Women who have had children can usually sense the condition by illy 
denned changes in their feelings. Those trying to conclude from signs and 
symptoms will be wrong about as often as they will be right. Doctors 
guess at the condition before the second month. 

Nevertheless, a doctor's guess will be much better than yours and you 
had better proceed in that way. A highly promising new test is known 
as the Abderhalden serum test. It can be made only by a laboratory. 

Can Regain Ground. — B. M. F. writes: "1. Does the return of menstrua- 
tion six weeks after the birth of a first child (the mother nursing the 
child) indicate that the mother has overexerted herself after confinement? 
2. If menstruation recurs after another month, should she take anything to 
check it, providing the child appears to be unaffected by it? 3. If mother 



792 OBSTETEICS 

and child both appear to be in normal, healthy condition during these 
periods, is there any reason for deploring the fact that menstruation has 
returned? Slemons says: 'Many operations in later years are dependent 
upon imprudent exertion soon after the birth of the first child/ k> What 
would such operations be for? 5. If a mother has reason to suspect that she 
has worked too hard during and after the fourth week after confinement, 
can she, by proper care, regain the lost ground, or must she permanently 
suffer the consequences?" 

Eeply. — 1, 2, and 3. No. 

4. Subinvolution for one; that is, the uterus does not decrease to the 
normal size. Displacements for another. Incompletely cured infections for 
another. 

5. In most instances she can. 

Will Have No Effect. — M. E. S. writes: "I am a woman, 25 years of 
age, the mother of two children. I am now pregnant seven months and 
have had a slight menstruation every month. Otherwise the balance of 
the time I am well and strong. Kindly advise me what effect this will have 
on the coming child and also on myself." 

Reply. — It will have no effect on either of you. This opinion is based 
upon the statement that the hemorrhage is slight, and that it has come once 
a month for a few days and then has stopped. 

May Last Four Months. — Mrs. W. McG. writes: "What can be done to 
relieve the sick stomach of pregnancy? I do not vomit, but am weak, 
dizzy, and seasick nearly all day. Over how much of the period does this 
condition generally last? How early in pregnancy should one see a physi- 
cian?" 

Reply. — 1. Eat a little food, say two crackers and a peach, before getting 
out of bed. Dress leisurely, resting occasionally. Eat a light breakfast; 
keep the bowels free; exercise in the open air. Eat what you have an 
appetite for; do not eat what you dislike. Chew well; eat slowly. If you 
vomit you will probably be hungry soon after. If so, eat. 

2. It sometimes stops in one month, frequently in two months, gen- 
erally in four months. 

3. If the nausea is troublesome have a physician at least once in that 
period. He should examine the urine especially. Have the physician from 
time to time after the fifth month according to how things are going. 
Why not get Slemons' "The Prospective Mother"? 

Two Books Suggested. — Mrs. L. B. writes: "Please refer me to a good 
work on the subject of what a woman should know before and after giving 
birth to a child." 

Reply. — "Woman and Marriage," Stevens; "Chavasse's Advice to a 
Wife," Barnes. 

Read Slemons' Work. — Mrs. H. writes: "Kindly advise some good 
book for an expectant mother to read." 

Reply. — Read "The Prospective Mother," by Slemons. 

Be Examined by Physician. — J. B. K. writes: "Since the birth of my 
child, about seven years ago, I have been troubled with swelling of the 
legs, with considerable ache and pain accompanying. Sometimes the 



OBSTETEICS 793 

swelling leaves almost entirely; then again it shows in the face. What is 
the probable cause and can it be cured?" 

Reply. — Have an examination to discover the reason for this abnor- 
mality. Probably you have Bright's disease. 

Morning Sickness. — R. W. writes: "1. Does 'morning sickness' appear 
as early as fifteen to twenty-one days from beginning of pregnancy? 2. Can 
you recommend a good booh for a young prospective mother which will 
guide her in preparation for the coming child?" 

Reply. — 1. Yes, not infrequently. 

2. "The Prospective Mother," by Slemons, published by D. Appleton. 

Cause of "Blue" Baby. — C. R. writes that recently his wife gave birth 
to a "blue" baby. It died when a few hours old. What causes babies to be 
blue? Is the next baby liable to be blue? Both the mother and father are 
healthy. 

Reply. — The condition known as "blue" baby is due to blood passing 
through an opening from the veins at the heart into the arteries near by. 
In consequence, the dark blood of the veins does not pass through the lungs 
and is not changed into red blood. 

This opening is natural and is of service before the baby is born. 
It should close in order that the lungs after birth can properly do their 
work. It sometimes remains open. From certain deformities of the heart 
of this kind "blue" babies result. 

The cell starting out to build up a child in nine months has many com- 
plicated things to do. Sometimes it slips a cog, and some deformity results. 

Considering the wonderful complexity of the things which it does the 
wonder is that it does not slip a cog more frequently. 

We stand by a Hoe press and are amazed at how each thing nicks in at 
just the right time and place. A Hoe press is as simple as A B C com- 
pared with the development of an unborn baby. 

Heart deformities are not due to disease of, injury to, or mental con- 
dition of the mother. The machinery just failed to click right. 

There is no reason to fear the same trouble in the next baby. 

Should Not Overeat. — L. B. E. writes: "What is the proper food to 
eat, and what the correct exercise for a woman aged 39, whom the stork 
will visit for the first time in three or four months?" 

Reply. — Whatever is good personal hygiene for a woman under ordi- 
nary circumstances is good personal hygiene for her in pregnancy. The 
idea that a pregnant woman should eat for two is wrong. If she tries it 
she will get indigestion or both she and her baby will get too fat. An 
authority has said: 

"Prospective mothers neither want nor need to eat for two. The fact is 
more likely that enough for one is too much for two." 

Ordinarily too much food is eaten. This excess is ample to take care of 
the needs of the developing child. The little excess of starches and sugars 
needed in the last months will come from this excess. If a woman craves 
any special food let her have it. But be certain that she does not overeat. 

As to exercise, if the woman has been doing physical labor or factory 
work she should take it more easily during the last two weeks. Women who 
do not work out should get some out of door exercise. Nothing is better 



794 OBSTETRICS 

than the customary walk. Slemons says the daily walk should be more 
than two and less than six miles. 

No Need to Fear. — M. J. K. writes: "Could a woman 1$ years old 
become pregnant after years of married life? She has never had children. 
I have had hot flashes every fifteen minutes all summer and at present I 
think I shall lose my mind. I am nervous and think all manner of things 
are going to happen. Doctors have told me I have adhesions and that the 
womb is tipped backward. I eat well, but sleep at times fitfully on account 
of the hot flashes. What shall I do?" 

Reply. — A woman of forty-eight can become pregnant, but the chance 
is exceedingly slight. Evidently you are neurasthenic. The hot flashes 
mean change of life. You are not losing your mind; you need not fear 
that. Cease thinking about it, or harm from adhesions, or anything else 
that is dire. 

Pregnancy. — R. 8. writes: "A woman at the beginning of the eighth 
month of pregnancy develops severe dropsical conditions, convulsions 
set in and the child has to be taken. If she ever becomes pregnant again, 
are these conditions liable to occur if she is constantly watched by a com- 
petent physician?" 

Reply. — It is possible but not probable. 

Milk Leg. — G. S. writes: "1. What are the causes of milk leg? 2. What 
is the duration of milk leg? 3. What is the average result? 4. What is 
the most common treatment? I have had it three months. The pain has 
left, but the swelling remains about the same. 5. Do you think it is im- 
proving ?" 

Reply. — 1. Inflammation of the main vein of the leg. Usually there is 
a clot in this vein. Infection with mild germs is one cause. Extension of 
a clot from the uterine veins is a cause. 

2. Usually a few weeks; varies, however. 

3. Recovery. 

4. Keep the leg warm and comfortable. 

5. Keep your limb warm. Massage it carefully every day. Your acute 
condition has passed. The plugged blood vessel is permanently plugged. 
In time your other leg veins will get large enough to make up for the one 
now plugged. Exercise should help that on. 






CHAPTEE XLIY 

The Baby 

HELPING BABY LIVE 

The baby's hardest day is his first day. His hardest week is his first 
week. His hardest month is his first month. The men who study figures tell 
us that never again will baby have as many hazards as during the first month 
of life. 

Whether or not the baby is to live to be a month old depends upon inheri- 
tance and its experience in "gittin' borned." After it passes one month and 
until it passes two years, whether or not it is going to live depends upon the 
care it gets. 

After two years of age it has a pretty good grip on life and can live in 
spite of a good deal of neglect. 

This article deals with the period when care is of most importance — 
from one month to two years of age. 

Lately the Chicago health department published a table showing that 
the business of being a baby was an extremely hazardous occupation. 

In certain parts of the city being a baby is not so hard a job. For in- 
stance in a part of the city where good, homey conditions prevail, out of 
each 1,000 children under 2 years old only ten died from diarrhea in a year. 

On the northwest side, just north of the railway tracks, about 66 died 
out of each 1,000. Being a baby in that neighborhood is a harder job than 
being a baby in Russia — and that is supposed to be about the last word. 

This city bulletin tells us that a baby in certain parts of town has a 4 to 1 
chance to live; that a baby on the boulevards has a 100 to 1 chance. Why the 
difference ? 

The people in the one district can afford to and do secure for their babies 
such care as saves their lives. 

The people of the other district do not, and usually cannot, secure for 
their babies the care necessary to reduce the chances from 4 to 1 to 100 to 1. 

Now, what are the main elements in the needed care? The most impor- 
tant is that the milk be just right. Almost right, nearly right, will not do. 
What is needed is cranky care — the kind of care that will not have it unless it 
be just right. 

The bottles and nipples must be clean. Nearly clean, almost clean, clean 
enough will not do. A certain way to clean must be followed in minute detail, 
and doing it nearly the advised way will not lift the chances from the 4 group 
to the 100 group. When it comes to other details, more leeway is allowable. 

Perhaps the next most important element of care is to see that diarrheas 
are not neglected. If the bowels become loose, or green, or bloody, or mucous, 
see that proper measures are taken to correct the underlying cause. 

795 



796 



THE BABY 



NEW. YORK CITY (POPULATION 1915 - 5, 468,190) 
V///A STATE OUTSIDE OF NEW YORK CITY (POPULATION 1915-46*452$ 

6,000 

% 

^ 5.000 



4.000 



3 000 



2,000 



S 



000 









1905 1910 1915 

D/ARPHOEAL DEATHS UNDER TWO YEARS OF AGE IN NEW YORK 
CITY jAJWJN THE STATE OUTSIDE OF NEW YOPK CITY 

New York State Dept. of Health. 



Fig. 277. 



165 

160 



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^ 150 



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5 so 

^ 1904 '05 '06 '07 W '09 10 'II 12 '13 '14 '15 

INFANT DEATH PATE IN NEW YOPK CITY AND IN THE STATE 
OUTSIDE OF NEW YORK CITY 1904-1915 

New York State Dept. of Health. 

Fig. 278. — Comparison of the Health of City and Country Babies. 

It may be boiling the milk, or changing the food, or calling the doctor, or 
going to the baby tent ; whatever the need, see that it is promptly attended to. 



SAVING NEW LIVES 797 

Other elements of care are that the baby be dressed in a cool fashion and 
kept in a cool place; that flies be kept away; that the baby be kept clean, be 
given water, be kept free from nervous strain. 



SAVING NEW LIVES 

We judge of the baby welfare by the baby death rate. Nobody collects 
any health data about babies except the health department. It gets a full 
record of deaths. Its record of baby sickness is incomplete. Therefore all 
that we have to judge by is the baby death rate. 

In the first place, there is the total number of deaths — the deaths from 
diarrheal diseases, the deaths in the first month of life, and the deaths during 
July, August, and September. 

The total number of deaths, when we compare the records of the different 
years, gives us some information as to whether we are taking better care of 
babies than in former times. This group of figures tells us that things are 
getting better. 

The deaths during the first month of life are the result of birth accidents, 
bad maternity service, and neglect of the mother during the last months of 
pregnancy. This rate is not improving. 

The death rate during the first month of life has not fallen during the 
last ten years. The conclusion is that more pregnant women are having to 
work, that midwife and medical service is going back a little, and that the 
number of birth injuries and accidents, congenital deformities, and abnor- 
malities is slightly on the increase. 

The increasing complexities of society make the wagon roll downhill 
unless definite, proper action is taken to scotch it. The pivotal point in the 
baby situation is the hot weather care. Therefore the July, August, and Sep- 
tember death rate is that by which the community's efforts to save the babies 
are to be gauged. 

The New York milk committee report shows that most of the annual 
saving in babies in the last few years has been in these months. For instance, 
in 1911 the number of babies dying in the three hot months was only 30 per 
cent of the total for the year. Ten years ago it was well over 40. The actual 
number of babies dying in the hot months was 1,700 less than eleven years 
before, in spite of the increase in the size of the city. 

Philadelphia, Chicago, Boston, and Buffalo made the same kind of 
showing, although none except Buffalo did so well as New York City. 

This continued talking about clean, cold, fresh, pasteurized milk, about 
keeping the baby cool, and all this warning not to push the baby's growth in 
weight during the hot months are bearing fruit. 

Under the new plan the baby is within 10 per cent of being as safe in the 
hot months as in the cool. 

NURSING THE BABY 

A baby should always be nursed by its mother, unless the mother has 
tuberculosis or some other grave disease. The mother saves herself trouble by 



798 THE BABY 

nursing her baby. When she figures up the saving from diminished illness 
and adds to it the trouble of fixing the baby's bottle during the night as well 
as the day, she finds that she nets a gain by nursing her baby. 

During the first two days the baby should be nursed four times a day and 
once at night. From three days to six weeks the baby should be nursed 
every two hours during the day and twice at night; from six weeks to six 
months every three hours and once at night; from six months to a year, six 
times between 6 o'clock a.m. and 10 o'clock p.m., and not at all during the 
night. 

In addition to milk, babies require water from the very first. The old 
granny who gave the baby teas was a pretty good scientist, though she did not 
know it. Of course, the herbs which she used to make the tea had no particu- 
lar effect, but she was giving the baby sterilized, warmed water, and that was as 
it should be. 

After about the second month the baby should have some orange juice 
every day. The juice should be given freed from pulp. The amount should 
begin with two teaspoonfuls a day and should be gradually increased to four 
tablespoonfuls, especially where there is a tendency to constipation. It is 
much better to relieve constipation with orange juice than by enemas, and cer- 
tainly than by medicine, since babies need a little fruit juice to correct any 
tendency to scurvy and rickets. 

That the mother may give enough milk to supply the baby, it is necessary 
that she be free from worry and not called upon to do a great amount of 
physical labor. Emotion has more effect on the secretion of milk than does 
the food taken. Occasionally a woman will overeat until she becomes obese 
trying to give milk enough for her baby, and then worry so, fearing her milk 
will fail, that she gains nothing for her trouble. 

There are no special foods which make milk. Beer does not; neither 
does milk. Some women have the idea that milk taken as a food runs with- 
out much change into milk for the baby. This is not correct. A mother 
should eat good, nutritious, simple, staple food containing a good deal of 
fluid. 

That which she eats does not go directly to milk. It is digested and 
changed chemically thereby. It is absorbed and still further changed. Even- 
tually it is changed into milk. She should increase the quantity of food 
eaten, since for her own use she needs more than she usually does, and in 
addition she is eating for the baby. 

The average woman nursing one baby can supply the child with food out 
of her surplus if she will keep her mind calm, her rest unbroken, and not have 
too much work to do. The average woman who thinks she cannot nurse her 
baby can do so if she will try. 



NEW ZEALAND BABY RULES 

In 1914 New York City had a death rate of 9.46 per cent among its 
babies less than a year old. No other American city has ever had a rate any- 
where near so low. 

The New York state board of health reports that the death rate among 



WHAT WOULD YOU DO? 



799 




Fig. 279.— Shape 
of a Baby's Jaw. 



farmers' babies in rural New York is higher than the New York City rate. 
Probably the figures for New York State are not very accurate. At that, 
they are about the most accurate we have. The chances are that the rate for 
rural New York is about the same as that for rural Illinois. 

When we turn to Australia we find that they have found a way to reduce 
the sickness rate among farmers' babies. The New Zealand 
rate for 1910 was 5.1. The 1913 rate in Dunedin was 3.8. 
New Zealand comprises two thinly populated islands. 
The largest city, Auckland, has 110,000 inhabitants. There 
are three cities with between 50,000 and 100,000 and three 
with between 10,000 and 20,000. In the main the people 
of New Zealand are country people. 

There are several reasons for the healthfulness of babies in New Zealand. 
The laws are good. One gives $10 to each prospective mother, that she may 
have a little more rest and a little better food. A powerful factor is the 
Society for the Health of Women and Children. Through this society the 
newspapers carry a great many helpful articles on mothercraft. 

This society maintains hospitals, dispen- 
saries, and a corps of nurses — one for every 
sixteen people. They publish a series of 
small handbooks in popular form. Among 
these are "The Baby's First Month" and 
"Feeding and Care of Baby." 

They stand for a policy in baby core. 
Among the details in this policy are the 
following: 

1. The widespread adoption of clocklike 
regularity in the feeding of babies. 

2. The extension of the intervals between feedings throughout the early 
months to three hours instead of feeding every two hours. 

3. The entire abandonment of night feeding — that is, between 10 p.m. 
and 6 a.m. 

4. The early use of hard, dry, or tough foods needing mastication. 

Dr. Arthur Newsholme indorses the opinion that babies after the first 
month do better if fed every four hours and not at all during the mother's 
sleeping period at night. This society finds that under this policy the babies 
thrive better. An indirect good effect is that it increases the proportion of 
mothers who breast-feed. 

Another of their policies is to promote the use of pure, cold, fresh, out of 
doors air. 




Fig. 280, 



-Shape of an Adult's 
Jaw. 



WHAT WOULD YOU DO? 



Suppose you had a baby less than a year old ; you are without breast milk ; 
you have no icebox. What would you do? Forty-five per cent of homes are 
not supplied with ice. Fortunately a large percentage of the babies are borne 
by women who are able to nurse them. Not 45 per cent of the mothers are 
confronted by the problem of feeding a baby artificially when ice for keeping 
food is not available. 



800 THE BABY 

Another group of dry-breasted mothers lives in the country. They solve 
the question by keeping a cow in the barn and milking her whenever baby- 
feeding time comes around. More of them get fresh milk twice a day, which 
is not so good by far. 

After all these eliminations there remain thousands of dry-breasted 
mothers who can neither have fresh milk nor ice. Put yourself in place of one 
of these. What would you do? You would make an effort to get ice. But 
suppose you failed, what would you do then ? 

You might get a high grade clean milk to start with and then keep it 
wrapped with a cloth wet with tap water. Evaporation would hold the tem- 
perature several degrees below room temperature. But suppose the room 
temperature was 94° from 8 in the morning until midnight. Milk does not 
keep unless its temperature is held below 55°. A wet cloth wrapped around 
the bottle will not keep the temperature so low. 

The answer is that you would feed your baby on condensed milk, milk 
powder, or some form of baby food. The statisticians tell us that the heaviest 
mortality is among babies fed this way. The baby doctors tell us that babies 
should have "liquid milk," mother's milk, or, that failing, cow's milk. They 
are right, of course, but being without ice is a condition, not a theory, to bor- 
row the phrase made popular by Cleveland. 

If there is no ice, cow's milk for the city baby is ruled out. This is true 
whether it is certified milk, pasteurized milk, or plain milk. Put yourself in 
that position. Would you forget all about the better foods, now out of reach, 
and try to form a decision between what was left? 

As you could not have good cold milk to mix with the food, you would 
select one that required no milk. You would select one that did not contain 
too much sugar, but above all, you would select one that kept well. You 
would get the best advice you could on these points, but you would insist that 
your adviser stick to the points asked and not run off at a tangent and advise 
you to use what you could not get. 



FEEDING AND GROWTH OF BABIES 

A baby should weigh seven and a half pounds at birth. It should lose 
from four to eight ounces the first week of its life and gain every week there- 
after during the first year. During the first six months it should gain from 
four to eight ounces a week and during the second six months two to four. 
At three months it should weigh twelve to thirteen pounds; at five months, 
double its weight at birth; at six months, fifteen to sixteen pounds; at nine 
months, seventeen to eighteen pounds, and at twelve months, three times its 
weight at birth. The baby should be weighed every week until it is 1 year 
old and every two weeks when between 2 and 3 years old. 

The mother who prides herself on the weight of her baby and its weekly 
gain is pursuing the right policy in the winter. In the summer she should go 
slow. In hot weather fat babies are in special danger and feeding to increase 
weight is risky. 

If a mother cannot nurse her baby she is in an unfortunate position. It 
makes work for her and endangers the life and health of her baby. Of the 



FEEDING AND GROWTH OF BABIES 



801 






Fig. 281. — The Relative Length of Trunk and Legs in a Baby, a Youth and an Adult. 



artificial foods, cow's milk, properly diluted, is the best provided it is clean, 
young, and has been kept cold. As between dirty, old, and warm milk and the 
baby foods, the latter are 
better. The best of all 
cow's milk is that which 
comes from a healthy 
cow free from tubercu- 
losis and kept in a clean 
barn on the premises 
ivli ere the baby is. Such 
milk can be and should 
be consumed before it is 
twelve hours old. Next 
comes certified milk; 
next properly pasteurized 
milk. No city or town 
should allow its babies to 
drink the ordinary raw 
market milk or market 
milk which is claimed to 
be pasteurized and is not. 
No mother should 
feed any milk to her baby 
that she has not investi- 
gated. She should see 

how clean, young, and cold the milk is; how clean are the bottles; how clean 
is the milk depot, the farm, and the milkers. If the milk is sold as pas- 
teurized, is it? Some of this information is available at the health depart- 



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Fig. 282. — Rate of Growth of Babies. 



802 



THE BABY 



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Fig. 283. — Rate of Growth of Children. 

ment. No mother should feed milk to her baby unless she has got all the 
information which the health department has and as much additional as is 
within her reach. 



FRESH AIR FOR THE BABY 



Small babies are not "catchers." It is rarely that they have smallpox, 
diphtheria, and scarlet fever. Part of this good fortune is theirs because 
mothers are usually wise enough to keep small babies away from such dis- 
eases. They are not taken into crowds or on street cars, and they cannot run 
out on the street or mix with half cured children in schools. But these saving 
graces do not serve to protect them against measles and whooping cough — the 
two great causes of contagious illness in babies. 

Babies do not catch cold easily and this is luckiest of all. The habit of 
catching cold is acquired by wrong living. Babies have not had time to ac- 
quire the habit. As a general rule, they are not coddled so much as grown 
people ; they are seldom brought in contact with cases of "cold," and they have 
not had occasion to become chronic carriers of the germs of colds. 

If the baby is kept in a clean, well ventilated nursery, his chance of 
keeping free of cold will increase. The following rules should be followed : 

The nursery should be kept at 68°. Until the baby is 3 months old the 
night temperature should not go below 65°. When the baby is 3 to 12 months 
old the nursery temperature should go to 55°, and after that age 45° is 
proper. The nursery should be aired twice a day. The baby over a month old 
should have a daily airing in the room. After 3 months old he should have 
an airing outside in all except the worst weather. To sleep outside for a while 



DANGEK SIGN WITH BABIES 803 

each day gives the youngster a new impulse to live, grow, and become resistant 
and strong. 

The best use to make of physicians is to employ their services to direct 
the methods of living that there may be no illness or that right living may 
earn a cure for the disease brought about by wrong living. This plan is 
frequently followed in the treatment of consumption and certain nervous dis- 
eases. There is a growing disposition to use the services of physicians in this 
way in the rearing of babies. It is to be hoped that the reading of articles 
such as these and of books such as Holt's "Care and Feeding of Children" may 
induce people to follow the right rather than the wrong method. The present 
method is to pick up from advertisements, grannies, and neighbors, methods 
of care which are wrong about as often as they are right, and then to rush 
off to the doctor to have him rescue the baby from the position where wrong 
methods have put him. 



DANGER SIGN WITH BABIES 

Perhaps the time will come when it will be the custom to consult one's 
physician once or twice a year for direction as to keeping well. That is a long 
way off. Perhaps the time will soon come when a mother will take her well 
baby to the physician once a month during its first year that it may keep 
well. 

In summer it should be the custom to see the physician when babies' 
bowels get loose. _ Kilmer advises that all food be stopped, a dose of castor 
oil be given, and the doctor sent for. 

A baby may have loose bowels and be in good spirits, no more irritable 
and no more upset physically than a thoroughly well baby. Nevertheless, the 
mother has a harder time judging the right course to follow when the bowels 
are not just right. She will make fewer mistakes, if she will take counsel 
promptly. 

If the stools are green as well as loose, the hazard becomes greater. The 
baby may still pull through all right, in fact usually does; but it is quite 
risky for the mother to rely only on her own judgment as to what to do. 

If the stools contain mucus, either with or without green, the mother is 
certainly at a point where she needs help. Some mothers work it out success- 
fully without help, but the risk is too great. If there is blood, or if the baby 
has fever, or is exceedingly irritable, or is nauseated, it is imperative that 
counsel be obtained. 

Let us make clear these gradations : 

Any baby with diarrhea should be seen by a physician. In simple diar- 
rheas the risk in disregarding this advice may not be great. 

If there is blood in the stools, or the baby has fever, the risk in disregard- 
ing the advice is extremely great. 

As Kilmer says, as soon as loose bowels appear, food should be stopped 
and a dose of oil given. Water will usually satisfy for a while. 

Too much food in hot weather is almost as bad as bad food. After the 
system has rebelled against too much food, it will continue its rebellion against 
any food for a while. 



804 



THE BABY 



The diarrhea usually has an object, although it accomplishes that object 
in a harmful way. The object is to rid the digestive apparatus of something 
that is troublesome, and that is why the advice is to give a dose of oil to begin 
with. 

Neglected diarrheas are responsible for the heavy baby death rate. For a 
while after the diarrhea starts, the baby is not much disturbed. The condition 
is not serious. 

If neglected, the child slowly drifts downstream, and presently is caught 
in rapids from which there is no escape. 

It is the mild, neglected conditions of early summer that result in the 
severe, hopeless conditions of midsummer. Therefore the advice to the mother 
is not to try to manage the ship without help after things have begun to go 
wrong. 

BABY'S CRY 



There are several situations in which it is desirable that the baby cry. 
When first born the lungs are collapsed. A good cry is needed to expand 
them. If not expanded properly they may not get right for days; in fact, 

may never get entirely right. 

Therefore if the baby does 

not cry of his own accord, 

he should be made to cry, 

and the harder the better. 
If, later in life, baby is 

in a shock, or the feet are 

cold, nothing warms him up 

quick or better than a good 

hard cry. 

In some conditions of 

tension a good skin-warm- 
ing cry is good for baby. 
On the other hand in 

the great majority of in- 
stances the question is: 

What is the meaning of a 

cry and how can it be 
avoided? Kilmer gives a number of conditions which cause a baby to cry. 
They are: 

1. He is hungry. 

2. He is thirsty. 

3. He is in pain. 

4. He wants attention. 

5. He is sleepy. 

6. His napkins are wet. 

7. He is tired of lying in one position. 

8. He is frightened. 

9. He is exhausted. 

10. He is crying from temper. 




Fig. 284. — Correct 
Method of Hold- 
ing a Baby. (Kil- 
mer.) 




Fig. 285. — Incorrect 
Method of Holding a 
Baby. (Kilmer.) 



THE BABY'S NERVES 805 

The cry of hunger is continuous and the baby sucks ravenously at his 
fingers or anything else that gets in his mouth. After he begins to eat he may 
interrupt his meal to cry once or twice, but shortly he quiets down. 

A thirst cry is of about the same type as a hunger cry. It yields to a few 
drams of water. 

The colic cry is intermitting. When the pain is on the yelling is violent. 
Generally the limbs draw up more than in other cries. 

A cry from a pin prick is continuous and sharp. 
■ He wants attention. Kilmer's page on the folly of spoiling a baby is 
worth the price of the book. If a baby is not born with a rupture, crying will 
not develop one, Kilmer says. A mother will save herself trouble when the 
cry is because the baby wants attention by letting him cry it out. She will 
save the baby trouble. A crying baby heats his skin, cools his digestive ap- 
paratus, and invites summer complaint. A spoiled baby is the first link in a 
chain of spoiled beings — baby, child, youth, adult. 

A sleepy cry is to be diagnosed by the time since sleeping and the con- 
duct of the child. 

No cry is more trying than the feeble moan and fretful outcry of a baby 
exhausted by illness. The cry is an almost continuous, low call with occasional 
sharper sounds. 

Kilmer tells us that tears do not necessarily mean that the baby is crying 
from pain. Not infrequently a youngster will cry so hard from temper that 
the tears will flow. 

THE BABY'S NERVES 

A baby is born with an enormous brain and soon acquires an enormous 
appetite. This is about all there is to start with. The size of his brain as 
compared with his body is greater than it will ever be again. 

James Lane Allen in "Aftermath" makes Adam say of his newborn son: 

"If I could put forth one protecting prayer that would cover all his years 
it would be that through life he continue as wise as the day he was born." 

Parents should watch over the baby's digestion with even more care than 
they have been accustomed to, but nothing warrants them in leaving the 
nervous system untrained or training it improperly. The young baby seems 
to have so little mentality that there is great temptation to begin teaching 
him things, and then, when a little spark of intelligence is shown, the tempta- 
tion to build further and faster is almost irresistible. His brain is in the 
rough and needs to be properly trained just as his method of taking food and 
air is new to him and needs training. 

The foundation of much of the nervous instability of adult life is laid in 
the self-centering, nerve-racking methods frequently employed with babies. 
Holt says : "Babies under 6 months old should never be played with and the 
less of it at any time the better." 

When a baby has been nursed -he should be put down on the bed and 
allowed to go to sleep without rocking, patting, or attention of any sort. He 
should not be given pacifiers or soothing syrups. He should not be allowed to 
form the habit of sucking his thumb. He should be trained to lie quietly, 
unheld and unnoticed, when awake. He should be trained to sleep through the 



806 



THE BABY 




night with waking times prearranged according to age. If, at other times, he 
awakes and cries, he should be allowed to cry it out. 

At the worst only two or three nights are required to reestablish proper 
routine. He can be trained to proper bowel habits very early in life. He 
should not be stimulated to "take notice" or sit up or crawl or walk. If he 
is healthy he will get these things as soon as he is ready. He will walk when 
his legs are strong enough. It harms him to walk before. 

Distinctly from the standpoint of impressions, babies should be left alone. 
As it is, their brains are all out of proportion to their physical qualities .and 
the need is to go slow on nerves so that muscles and frame may grow to some- 
where near a balance. 

It is easy enough to tell a nervous baby. If the mother is at all observant 
she can diagnose the condition as well as the doctor. He knows more and 
has seen more babies, but she is on the job all the time 
and he is observing for brief periods. 

Nervous babies cry frequently or overhard or 
overlong. If old enough to laugh the laugh is ner- 
vous or excessive. The child wakes easily, jumps at 
noises, and seems on edge. A little excitement may 
cause vomiting. As nervous babies respond to being 
walked or jogged or other forms of attention they are 
apt to be spoiled. The nervous baby is apt to grow 
into the nervous child, and he in turn into the neuras- 
thenic or neurotic adult. 

What is to be done about it? Above all else 
these babies must be trained to regular habits. Feed- 
ing must be at regular intervals — four hours in the 
day and six at night. They must go to sleep at regular 
hours. They must not be handled, admired, or trotted, walked, or put to sleep. 
They must not be entertained. They must live in the open air. 

The diet must be carefully watched. As they do not digest sugars and 
fats well the diet must not have too much of these. As they stand starch well 
they can have a good deal of gruel. Nervous children over a year old do well 
on vegetables and cereals. Meat, eggs, and large quantities of milk are not 
well borne. 

Somewhat allied to the nervous babies are those with a tendency toward 
convulsions — general spasms or spasms of groups of muscles. The children 
who are very prone to croup belong to this group. 

Physicians who have had training in this work can test the nerves with 
an electric machine, and in this way tell which babies belong in the tendency 
to convulsions group and which do not. Even though the child is thriving, 
growing, and seemingly well poised, this test shows a nervous instability 
out of which some form of spasm is liable to result from any strain. 

This spasm tendency rarely develops in babies under six months of age. 
It rarely develops in breast-fed babies, showing another way in which a mother 
may spare herself trouble and her baby danger by continuing breast feeding. 
What is to be done for these babies? They must be kept in the open air. 
They must get a nap in the outside air every day that the weather is fit. 
They must be kept clean. 



Fig. 286. — Bones of a 
Baby's Skull Show- 
ing "Soft Spot." 

a, anterior fontanelle; 
p, posterior fontanelle; 

b, b, parietal eminences. 



FAT BABIES 807 

These children bear starches very well. This may be taken advantage 
of in feeding them. Dr. Grulee's book on infant feeding recommends milk 
curds suspended in arrowroot water. But the method of feeding to cure a 
tendency to spasm is too complicated for a mother to work out by herself. 
It is not wise for her to try it. She should leave it to a physician or nurse who 
has had training in this kind of feeding. 

It is a diathesis which is quite amenable to dietetic treatment. To limit 
what one tries to do to controlling the spasm is not enough. An effort must 
be made to feed the child out of the tendency. 



FAT BABIES 

What use has fat? There are two uses. When life was simple, animals, 
including man, ate a great excess of food in the season of plenty, laying up 
the excess as fat. In the season of little food the animal pieced out by using 
up the stored fat. We still see wild animals begin the winter round and 
sleek, and come out in the spring poor and scrawny. 

Fat is a poor conductor of heat. Fat animals suffer less from the cold 
than do lean animals. To assist in keeping the body warm in winter is then 
the second use of fat. 

Well, now let's see how that fits the baby case. No mother intends to get 
her baby through next winter without plenty of food. That, as a reason for 
fattening baby, does not work. 

In the hot weather the problem is to keep baby cool, not warm. The 
second use of fat as a reason for fattening baby does not work. 

There must be some reason that so many mothers want their babies to 
be fat. 

The reason is this : Most sick babies are thin ; therefore, as sickness and 
thinness go hand in hand, fatness and wellness must go hand in hand, reasons 
the mother. 

The fatness of her baby is proof of its wellness, and naturally every 
mother is proud to show her fat baby, because it m'eans that it is a well 
baby. 

This third use of fat — to serve as a measure of health, like a thermometer 
or barometer — works fairly well from October to June, but between July and 
October the mother had better substitute some other way of proving to the 
neighbors that she treats her baby wisely and well. 

In exceedingly hot weather fat babies suffer more than lean ones. In 
consequence they cry and fret more and thus make more heat. Heat makes 
them cry, and crying makes heat — a vicious circle. 

They are more subject to summer complaint. Milk that is just a little 
spoiled will make a fat baby sick, but will not harm a lean but healthy baby. 

The fact that a baby gets fat is proof that its digestion or its diet or 
both run to fat making, and that means to heat making. When things go 
wrong with fat babies they wilt quickly. They seem to have little resistance. 

The conclusion to draw is that a mother should slightly underfeed her 
baby from July to October. The weekly rate of growth in weight should be 
about half that of the winter. ; 



808 



THE BABY 



It will be well if the increase in weight is due to growth in length, 
baby will be safe if the dimples gradually disappear. 



The 



COUNTRY BABY DEATH RATE 





Fig. 287. — Hand-I-Hold Mitts to Pre- 
vent Thumb Sucking. (Courtesy of 
R. M. Clark & Co., Boston, Mass.) 



Country babies are not getting a square deal. The city babies are being 
safeguarded, and they are healthier in consequence. The census bulletin for 
1911 shows that every large city is taking better care of its babies than of 
yore. 

The decrease in the death rate is about 50 per cent in New York, Atlanta, 
and Los Angeles. The average was around 30 per cent. 

The only cities showing an apparent increase were Minneapolis, St. 

Paul, Syracuse, Rochester, and Port- 
land, and this apparent falling back is 
due to a change in the method of re- 
cording. 

In the few states where registra- 
tion is almost what it should be, the 
decrease in baby death rate averaged 
19 per cent. Michigan made the worst 
showing with a gain of 8 per cent. 
After allowance is made for the gain 
in the larger cities, 16 per cent in 
Detroit, the figures show that the rural 
districts lost. 

As the good things are being 
passed around, the city baby empties the platter, and the country baby gets 
none. Why is this? The mother in the country knows that her baby is safer 
than the city baby. Therefore she says, "My baby is as safe as it can be." Of 
course she is wrong. 

In the first place, there is not much difference any more between the 
safety of the city and country babies. There are a dozen cities in America 
where babies are safer than in rural Illinois, Michigan, or Iowa. In the 
second place, the country baby could be twice as safe as he is. 

I have before me an excellent "save the babies" bulletin, issued by the 
Iowa Board of Health. 

The country baby can always get milk fresh from the cow. There is no 
reason why milk more than ten hours from the cow should ever be given. 
As the cow is close at hand, the mother can always see that things are clean. 
On the other hand, flies are more abundant in the country. Doctors and 
nurses being harder to get, there is a greater chance that a mild diarrhea 
will be not attended to. 

Baby, living in the country, has disadvantages as well as advantages. 
The disadvantages are not so great as the advantages, and they can be sur- 
mounted. The mother of the country baby can learn from simple pamphlets 
such as the bulletin of the Iowa Board of Health, from simple books such as 
Holt's, Kilmer's, or Smith's, how to surmount these difficulties. 

It would be easily possible to cut the present rural baby death rate in half. 



HEAT KILLS BABIES 809 

The first need is that the mothers become dissatisfied with the policy of "let 
well enough alone." The second need is that the information "how to do" 
be carried to the country homes. 

HEAT KILLS BABIES 

It is heat that kills the babies. First get that in your mind. Swing on 
that as a definite fact, for, when we begin to make some modifications of the 
statement, the original idea may slip away from you. 

In a table of mean temperatures published by the Chicago health depart- 
ment July is shown to be the hottest month both in average mean temperature 
and in number of hot days. August is second in the list of bad months, June 
is third, and September fourth. May is fifth and October sixth. 

When it comes to death rate from diarrhea among babies, August is much 
the worst month. September is second, July third, October fourth, June 
fifth, and March sixth. The death rate curve is not parallel with the tempera- 
ture curve. 

What is the reason? There are several. Diarrhea is seldom rapidly 
fatal. The rule is that the disease wears down the vitality for a month or 
more and then kills. October has a high death rate when September is hot. 

Baby may come through a hot July without getting sick; at the same 
time he is not quite up to the standard. He has resisted the effect of the heat, 
but he shows the strain. In August he gets sick from some cause which would 
not have upset him earlier in the season. He dies in September. 

We have already noted that the top of the death curve lags after the top 
of the heat curve. The top of the sickness curve also lags somewhat. 

The heat is in the house. The room air of a thin walled house is the 
hottest air. Or when the baby has escaped the effects of room air made hot by 
the sun, he may fail from the effects of room air made insufferably hot and 
humid from a kitchen stove or laundry tub. 

Therefore, we may come back to the opening statement. It is the heat 
that kills babies. When it seems otherwise a closer analysis explains the ap- 
parent discrepancy. 

Sometimes the heat gets in its work on the milk. The remedy for this 
situation is ice. A newspaper campaign for ice for the poor is a health cam- 
paign. 

Sometimes the heat gets in its work on the baby directly. The remedy 
for this situation is to get the baby to a cool place. 

Some hospitals take care of babies in summer with air artificially cooled. 
Some sanitaria for the care of babies in summer are built over large bodies 
of water; others high up in the mountains. 

Each of these works on the principle that it is heat that kills the babies. 

BABIES IN HOT WEATHER 

The problem of keeping babies well in hot weather is, in part, a milk 
problem. Hot weather spoils the milk. Spoiled milk spoils the babies. Hot 
weather spoils the babies, even those who get unspoiled milk. 



810 



THE BABY 



But another part of the hot weather problem is the baby itself. In a 
rough sort of way the baby's food is burned up into energy of four kinds: 
first, that which is built up into tissue; second, that which is used up in ac- 
tion; third, that which is piled up as fat; fourth, that which is made into 
heat. I say roughly, because you cannot say of one food element, "This goes 
into tissue/' and of another, "This goes to fat," and have the elements stay 
where they were put. Within certain limits they swap around. A lamp 
may make light or heat or smoke; it may burn oil or it may burn the wick. 




Kansas State Bulletin. 

Fig. 288. — How to Place Baby in His Bath. 



The American Practitioner quotes Professor Abderhalden of Switzerland 
as saying : "The cells of our bodies never learn what the character of the food 
we eat really is." 

In the winter time a baby needs to make considerable heat and also needs 
bands and wraps to prevent its rapid radiation. In the summer time the 
restless, kicking, active, healthy baby always makes heat in excess, and the 
great problem is how he shall get rid of it. The air is nearly as hot as he is, 
and, therefore, cannot take up much of his heat. 

Not only is the baby made uncomfortable but often he is made sick by 
excess of heat. Some of the best doctors think most of the cholera infantum 
is heat stroke. What can be done about it? 

In the first place, the amount of clothing can be cut down as much as the 
law allows. A pickaninny clothed in a promise is pretty, near the proper 
thing when the temperature is 100° and the wind is holding from the south- 
west. I should say that all doctors are agreed that much of the summer sick- 
ness in babies is because they make heat faster than they can well get rid 



SUMMER COMPLAINT 



811 



of it. A band over the abdomen is all right on the cool days in summer, but 
it must be removed when the temperature in the shade goes over 80°. 

In the second place, the food can be cut down, particularly the fat ele- 
ments. Advise with the doctor about keeping the baby on buttermilk or 
skimmed milk while the weather is very warm. While it is important that 
the baby should not get much cream or butter during the extreme hot weather, 




Kansas State Bulletin. 

Fig. 289. — Screened Bed for Out-of-Doors Sleeping. 

it is also desirable to reduce slightly the quantity of food taken. This can 
usually be done if the baby is given plenty of clean water to drink. 

Let the mother whose baby is thin forget her wish for a fat baby until 
the cold weather comes. Let the mother who has a fat baby watch it care- 
fully — for hot weather threatens the fat baby worse than ever hawk threatened 
a chicken. And, in addition, the baby can be kept in the coolest part of the 
house, or on the roof, or out of doors, or in the park. 



SUMMER COMPLAINT 



Summer complaint in babies has some resemblance to contagious diseases. 
Many hold that it is caused by a germ. Where babies are crowded together, 
as in a baby hospital, the sickness rate from summer complaint is fearfully 
high. 

There was some reason for holding that summer complaint, like some 
other forms of contagion, is spread by flies. The New York Merchants' As- 
sociation had proved summer complaint was at its worst near the wharves. 



812 



THE BABY 



where badly infected flies abounded. Levy had shown that in Eichmond a 

fly campaign lessened the baby sickness rate. Nevertheless, exact evidence 
Was lacking. 

Last summer the bureau of public health of the New York Association 



COWDKMJ0DK5 

Is IbuR tar Happy In Hot Weather ? 

not — you're to blame. 

' This little tot 15 . 

COMFORTABLE AND HflFW 
WHEN THE 3UW1ER MV5 flRE HOT 

He b Dressed Right 

TO STAND THE BEIT. 




THl3 UNlttW LITTiE CODGER 
15 ALL FUS5ED UP AND (15 d 
RESULT HE 15 HOT 
UNI) UNCOMFORTABLE 

HE 15 DRE55ED WRONG 

roifs hot mvs. 

DoN'T DRESS y0UR BABY TO 
MARE f\ GOOD 5H0U Of 
Hkn-DRESSHMTO 
KEERJIlff COMFORTABLE 
s mv HrfPPV. 




KSIRSSm USt 

war— 



-.W.TH. Cmcaho. 



Chicago State Board of Health. 



Fig. 290. 



DIARRHEA— ITS TREATMENT 813 

for Improving the Condition of the Poor decided that it would try to get exact 
evidence. Dr. Armstrong picked out two neighborhoods in the Bronx where 
conditions were as nearly the same as it was possible to find. In each area 
were 311 families. In the protected area there were 1,725 individuals; in the 
other 1,744. The numbers of babies under one year were 100 and 98; under 
two years, 175 and 160; one to five years, 262 and 298. 

The* sickness in the two neighborhoods was closely watched. In the pro- 
tected neighborhood Dr. Armstrong's forces screened the houses and provided 
fly swatters, fly paper, and fly traps. They furnished covered garbage pails. 
They kept the premises clean and saw to it that stable manure did not serve 
as a breeding place. In the other area they did nothing except register all 
illness. 

They were able to reduce greatly the number of flies. They found that 
the flies caught in the cleaned houses average 14,000 bacteria ; those from the 
dirty houses, 1,100,000. 

Two babies died in the protected area, six outside it. The possible fly- 
borne illness oi the protected area amounted to 22 cases; of the unprotected 
area, 65. The total days of baby sickness in the flyless area was 273 ; in the 
fly area, 984. The cases of summer complaint in the flyless area were 20; 
in the fly area, 57. 

This experiment proves that flies are one of the factors in summer com- 
plaint. There are others. But by attending to this one we can reduce the 
amount of baby sickness materially. 

Incidentally the following facts were found: It costs nine-tenths of a 
cent per day per horse to treat stable manure with iron sulphate so as to make 
it fly-proof. The stableman would not do the work, even when the iron 
sulphate was furnished him. One per cent of the flies captured in this city 
area were biting stable flies. 

Screens did little good. When the weather was hot the people took them 
out. Cleaning was more effective than screening. Efforts against breeding 
places were most effective. 

The house to house daily visits extended from July 21 to September 13. 
When visiting was resumed on November 1 it was found that the customs 
and habits of the people had gone back to the old basis. 



DIARRHEA— ITS TREATMENT 

Diarrhea is more prevalent during the summer months. It reaches its 
maximum curve some time in August. This shows that it bears a relation 
to temperature and other atmospheric and telluric conditions. In the treat- 
ment of the disease it is necessary, therefore, to have in mind the season o:: 
the year and the agencies which hasten or retard recovery. 

Since food has much to do with the cause of diarrhea, in the treatment of* 
the disease great care should be observed in preparing the food. If the 
cause of the attack is located in the mother's milk, the baby is to be kept away 
from the breast and fed artificial food. 

The best of all artificial foods is cow's milk. Cow's milk easily undergoes 
fermentative changes in itself and is often contaminated by specific poison. 



814 THE BABY 

Before it is fed to the child it should be pasteurized. Where it is possible 
to obtain it, certified milk is preferable. 

As soon as it is discovered that the child has diarrhea, all food should be 
withdrawn. It should be put to bed in a room where absolute quiet can be 
maintained. A dose of castor oil should then be given, and, if there are signs 
of fever, it should be given a sponge bath with tepid water. If the baby 
does not show signs of improvement within twenty-four to thirty-six "hours, a 
physician should be called. 

Where the disease assumes a dysenteric nature, it may be several days 
before the child takes a turn for the better. In this case it would be fortunate 
if the treatment could be carried out under the supervision of a trained nurse. 
The main thing in this type of diarrhea is the nursing, and unless one has 
been trained in nursing, strict and accurate instruction from the attending 
physician should be given in regard to each detail connected with the treat- 
ment, all of which are to be rigidly carried out. 

The child should be kept in bed except, in the case of a breast-fed child, 
when it is taken up to be fed. The patient should not be handled, and walk- 
ing the room with the child in the arms is especially forbidden. 

The room should be kept cool, quiet, and provided with plenty of fresh 
air. The bedding should be changed frequently. Cleanliness is especially 
necessary. The napkins should be removed as soon as soiled and placed 
in a sterilizing solution, then washed and boiled. After the napkin is removed, 
the parts are to be carefully washed and thoroughly dried before redressing. 

When it is necessary to resort to medicine in the treatment of these cases, 
a careful physician must be called. 



COLIC IN BABIES 
i 

Of course, colic is only a symptom, but when a mother has had to worry 
with a colicky baby for a week or two she is not disposed to give much thought 
to finely drawn divisions between diseases and symptoms. She wants to 
know what to do. 

The first thing for her to do is to be certain that the apparent colic is 
the real thing. In a very young baby colicky pains are not due to gas in the 
bowels as often as they are to gravel in the kidneys. The young baby is 
apt to have plugs of uric acid crystals in the kidneys. These cause pain. 

Older babies are sometimes thought to have colic when they are suffering 
from congenital syphilis. When the cry results from syphilis, treatment for 
that disease must be given. Sometimes a hunger cry is mistaken for colic ; or 
the cry is due to anger — the child has been spoiled. 

In some cases of colic, clearly gas is the cause of the pain. If the gas is 
in the stomach, holding the baby upright or laying him on his stomach may 
cause the gas to come up. If the gas is in the intestine, trotting or changing 
position may give relief. An injection may cause the expulsion of gas. 

However, every mother of a colicky baby knows that the importance of 
gas as a cause of pain has been overrated. Sometimes the passage of gas stops 
the pain; more frequently it does not. A turpentine stupe to the abdomen 
or a hot bath will relieve the pain more often than measures to cause gas to 



DYSPEPSIA 



815 



pass. In some cases paregoric is necessary. Holt says a baby one month old 
may take one minim ; one three months old, two minims ; one one year old, five 
to ten minims. 

Mothers, though, are even more interested in preventing colic. The 
chance is that the colicky baby feeds too frequently. The 
babies who are fed once every four hours during the day 
and every six hours at night are not the colicky babies. 

The most frequent cause of colic is taking food into 
a stomach that has not had a resting spell. A baby's 
stomach cannot digest a meal, empty, and rest in two hours. 

If the baby is at the breast either he should be given 
a little water just before feeding or else his time at the 
breast should be limited to five minutes, or even three. 
If the baby is on the bottle, the indication is to decrease 
the richness of the food. 

It may be advisable to put the baby on skimmed milk, 
one and one-half ounces for each pound of the baby's 
weight. To do this a little malt extract and sufficient 
water is added. Gradually whole milk is substituted for 
skimmed milk. The element in the milk which is most 
at fault is fat. 

Dr. Grulee tells us that in colic calomel does no good 
and castor oil may do harm. 



DYSPEPSIA 

Fig. 291.— Feeding 

Babies are subject to a form of mild indigestion called TURE baby. 
dyspepsia by some physicians. It is characterized by 
vomiting, diarrhea, distention of the abdomen, gas, and a mild fever. There 
is a slight loss in weight. There is restlessness, nervousness, and peevish- 
ness. The baby is not very sick, but if the condition is neglected it may 
develop into a much graver condition. 

The cause of the condition is overfeeding. Babies that are fed whenever 
they cry are very apt to develop it. In older children injudicious feeding from 
the table is a frequent cause. Cakes, bacon, gravy, vegetables, coffee, and 
beer are often fed to young children, and in consequence dyspepsia develops. 

In nursing babies, whether at the breast or the bottle, the condition may 
come on because of an inability to digest sugar. Less frequently the trouble 
is an inability to digest fat. The excessive amount of sugar in sweetened, 
condensed milk, of milk sugar in evaporated milk, and malt sugar in many 
of the baby foods is a frequent cause. 

Bad milk is a very frequent cause. Grulee's book quotes Blum as having 
seen some cases that resulted from feeding milk from cows that were using 
green alfalfa hay. A Michigan physician once wrote me his reasons for think- 
ing the condition due to weeds eaten by cows in the pasture. 

In those cases where the cause is an inability to digest sugar a good 
deal of gas forms in the intestines. There is belching, the abdomen is dis- 
tended, colic is present, and the stocls are foamy. If malt sugar is to blame 




Qusste£aaJ2L 



■QrtWiH 



ju*rtt& 



Fig. 292. — A, Nipple with Proper Perforation; B, Nipple with Faulty Perforation, 
Permitting Milk to Run Too Freely, 

816 



EYE OE THE CHILD 817 

the stools are usually brownish. If milk or cane sugar is to blame the 
stools are grass green and contain mucus and curds. 

If the trouble is with fat digestion there is less gas and the abdomen 
is not much distended. The stools may be fatty, containing oil globules, 
fat curds. There may be a history of fat constipation — the constipation so 
frequently found in babies fed on milk too rich in fat. 

What is to be done about it ? Cut off the food supply. G-ive plain water 
or barley water sweetened with saccharin for a day, then begin feeding a 
mixture of skim milk and water — one ounce of skim milk to each pound of 
baby — as a day's ration. The amount of skim milk is increased until the 
baby is getting one and one-half ounces per pound of weight per day. Then 
whole milk is gradually substituted for skim milk. 

It is important to decide whether the fault lies with the sugars or the 
fats, since the food must contain one or the other when it cannot contain 
both. It would not do to increase the fat in a case where fat was the 
cause of the trouble and it would be equally harmful to increase the sugars 
when they were the food element that was disagreeing. 



EYE OF THE CHILD 

Kittens are born blind. When seven days old they get their sight. Such^ 
at least, is what I learned as a boy. One statement is an exaggeration. The 
other is less than the truth. Kittens when born are nearly, though not 
totally, blind. They have no caul over their eyes. Their eyes are merely 
unseeing. Sight does not suddenly come to them at seven days. It comes 
little by little. At the end of seven days they see poorly. 

Bad as that seems, the case is worse with babies. They are born blind, or 
practically so. Not that there is a caul for witchcraft to remove. The eye 
as a piece of mechanism is as complete as it will ever be. Eays of light 
enter it. Images are formed on its mirror. But no impulse travels from 
the eye to the brain. 

At the age of 3 months the brain and the eye have hooked up enough so 
that the baby will watch a bright light. Not until the normal child is 7 
years of age is the eye normally good. After that the sight may train on. 
Apropos of this Dr. Shaw tells us that to Professor Lowell, whose sharp 
vision permitted him to discover important details about the canals on Mars, 
the ordinary man was telescopically blind. 

There are some eyes which are perfect in appearance, and in which 
careful examination shows no defect, which are incapable of good sight — at 
least without special care. For some of these nothing can be done; for some 
much can be done. If they could be picked out at the beginning of school life 
and then taught with the development of sight in mind, they could become 
efficient. 

At the same meeting at which Dr. Shaw discussed this group of children 
with poor sight Dr. Parke Lewis discussed the reasons for nearsightedness in 
school children. The f arsighted eye is one that is too shallow ; the nearsighted 
eye, too deep. 

"The shape of the eye, as has been shown by careful measurements of the 



818 



THE BABY 



cranial bones, 
inherited from 



s~\ 



/ 



id 



\U 



u 



\ 




is determined by the shape of the skull, and this in turn is 
our ancestors." 

Most babies are farsighted — their eyes are shallow. 
If they try to look at near objects their eyes cross. It is 
rare, however, for a baby's eyes to show the effects of 
strain. They do not use them enough. By the time school 
age is reached the bones of the face and head have deter- 
mined the shape of the orbit. The eye is often found to 
be too deep — nearsighted. 

Whatever may be its variation from the normal — be 
it nearsightedness, farsightedness, or astigmatism — the 
strain of routine school work causes a "tugging at the 
sensitive portion of the eyeball." Certain fibers begin to 
stretch. Hence, as Dufour has said, "The number of 
shortsighted pupils increases from class to class. The 
degree of shortsightedness likewise increases." 

The remedy for this proposed by Dr. Lewis is that 
the sight of all children be examined at the beginning of 
school life, and that those whose eyeballs show that they 
are destined to shortsightedness be taught without books 
or with little book work. 



WEANING THE BABY 



Sooner or later the nursing baby must be weaned. 
It must learn to build its bones and muscles out of the 
materials provided by nature. Sucking is very often cut 
short, and, not infrequently, unduly prolonged for the 
pleasure of the mother, This is wrong and injurious. 
The good of the child should be the only consideration, 
providing the mother is healthy. 

When should a baby be weaned? Most nursing 
mothers are careful not to wean their babies during the 
hot summer months, which is a very good practice. Other 
considerations which are of equal and perhaps greater 
importance are little known and hardly ever taken into 
account by the great majority of nursing mothers. 

A healthy child should ordinarily be weaned between 
the ninth and tenth months. About the sixth or seventh 
month the front teeth appear — an indication that the 
system of the child is getting ready to take care of other 
food than the mother's milk. 

In weakly, scrofulous children, the appearance of the 

front teeth may be delayed for several months. There 

also are hereditary instances of late teething. When the 

baby shows its teeth it is a sign that it is preparing to take its seat around 

nature's table. 

Another important guide is the weight of the baby. If the baby goes on 



Fig. 293.— Lactom- 
eter for Test 
inq Milk. 



WEANING THE BABY 



819 



increasing in weight, breast feeding can be continued till nine or ten months ; 
if the weight becomes stationary, or, what is worse, begins to fail, the baby 
should be weaned, irrespective of its age. 

The point is that it is not a matter of age in terms of months — it is 
rather a question of physiological advancement. Some children are as far 
advanced at six months as others are at eight. The state of growth and 




Pi 111 ft! 

ilis 





Fig. 294. — Simple Milk-Testing Appabatus. 



ability to take care of other food are better guides than the mere age of the 
child. 

Ordinarily breast nursing should not be prolonged after the tenth month. 
If the mother suffers from any serious illness, 
acute or chronic, it is best to wean the child 
earlier. Pregnancy also necessitates earlier 
weaning. 

As to the season, the best time to wean 
a child, everything else being equal, is in early 
spring or fall. Keeping the child out in the 
open air is very soothing to its irritated ner- 
vous system at the time of weaning. 

A child should be weaned gradually. 
Sudden weaning, much practiced in former 
years, does much harm to mother and child. 

When the first teeth appear, along in the 
sixth or seventh months, a healthy child should 
be given some other food besides the mother's 
milk at stated intervals. Four ounces of milk, 
with the addition of two ounces of barley 
water, may be given. In about a week these 




Fig. 295. — Chapin Dipper for Re- 
moving Top Milk. 



820 THE BABY 

feedings may regularly alternate with the nursings. After a while a little 
chicken or beef broth may be added. 

If the child is in this manner gradually accustomed to take other food, 
it will sometimes voluntarily give up the breast. At any rate, the breast 
will not be missed much when it is entirely withheld. The cases where the 
child will refuse to take other food than its mother's milk are rare and require 
expert management. Thus managed, there ought to be no evil results to the 
child from weaning. 

A frequent source of trouble and disease at this period is an oversolici- 
tous mother, who thinks that the baby always is hungry and will give it too 
much food. The more food the baby gets the more irritable it becomes, and 
it cries, not of hunger but because of overfilling, pain, and discomfort. This 
cry frequently is misinterpreted, and more food is given, and a vicious circle 
is established. 

The diet after weaning should consist of milk and barley or oatmeal 
gruel, chicken or beef broth, some stewed fruit, orange juice, zwieback, and, 
a little later, some soft-boiled eggs. 

Last but not least, give the baby plenty of water to drink. 



WEIGHT DISTURBANCE IN BABIES 

The babies who come in the class suffering from so-called' weight disturb- 
ance are artificially fed. Earely does the condition develop in the breast-fed. 
Dr. Grulee says that this is a disease of babies of the well-to-do"and that it is 
much more frequent in winter than in summer. 

The reason for this is that it is in a certain sense a midway condition. 
The babies are not right, but then they are not very ill. The same condition 
developing in the baby of a poor person or developing in a baby in hot weather 
would go on to a more serious form of trouble. 

The two outstanding symptoms are constipation and fretfulness. Com- 
monly, the mother tells of how her fat baby seemed to be thriving except 
that he was constipated. A while back she thought he was doing extra well, 
as his weight increased rapidly. Suddenly the increase in weight stopped. 
Now for several weeks he has not gained, not even an ounce. 

Oh, yes, she will say, he was fretful. Somehow she could not find out 
what he was fretting about. Maybe it was gas, as a fair amount passed. 
Latterly she has noticed that his urine smelled like ammonia. 

Yes, there was some tendency to eruption. The urine was strong and 
had chafed around the buttocks. Somehow dusting powders would not keep 
the creases from getting sore. She could not see why he was not growing 
and thriving, as his stomach was not upset, his food was agreeing, and he was 
fat. 

The trouble with this baby is that he is not digesting the fat in his milk. 
In the intestines the undigested fat is being changed to fatty acids. These are 
absorbing alkalies from the system. The peculiar looking stools are mostly 
fatty soaps caused by undigested fat. The system, robbed of its alkali to 
make these soaps, is overacid. That causes the ammonia in the urine. The 
scientists call this overacidity — acidosis. 



FEEDING BABIES 



821 



What must be done is to give the baby less cream. Commonly they 
start the baby on the proper amount of skimmed milk properly diluted. In a 
few days a little whole milk, an ounce or two a day, is substituted for some 
of the skimmed milk. The addition of whole milk to the diet must be done 
very slowly. A little ought to be added and the result watched for a day or 
two before it is tried again. If the stools show fatty or chalky masses the 
whole milk must again be withdrawn. 

But energy without fat is not possible unless something replaces it. The 
first carbohydrate to be tried as a substitute for fat is malt extract, say half 
an ounce a day. This can be increased for a few days, and then everything 
going well malt food can be substituted. Barley water can be given in place 
of plain water. 

Older babies can have cereals or cereal gruels. The child must be kept in 
the open air as much as the weather will permit. Good air is almost as neces- 
sary as good food. Care should be taken to keep the skin clean. 



FEEDING BABIES 



There are those who hold that the methods of preparing milk for the ar- 
tificially fed baby have been too complicated. On the one hand they have 
been too complicated for the 
best interest of the baby. On 
the other hand, they have 
seemed so difficult that many 
mothers have given their 
babies condensed milk and 
baby foods. They had no 
hope of being able to make 
the more complex mixtures. 

A simpler method is be,- 
ing advocated by some of the 
best medical men in the coun- 
try — a method so simple that 
no one need hesitate to under- 
take it. This method is not 
intended for mothers who 
can nurse their babies. If a 
mother can nurse her baby 
she had better do so. It is 
better for baby. It is less 
trouble for the mother. 

A good system and one 
that is widely used consists 
of a series of nine strengths. 
No. 1 in the list consists of two ounces of 7 per cent milk, one ounce of milk 
sugar, one ounce of limewater, and seventeen ounces of boiled water. No. 9 
consists of ten ounces of 7 per cent milk, three-quarters of an ounce of milk 
sugar, one ounce of limewater, and nine ounces of boiled water. 




Chicago Health Dept. 

Fig. 296. — Breast Pump in Use. 



822 



THE BABY 



Between these two extremes there are seven mixtures as the series pro- 
gresses from one to nine. The quantity of milk increases one ounce a step and 
the quantity of water drops correspondingly. 

Seven per cent milk is milk containing 7 per cent fat. It can be 
bought as 7 per cent milk or it can be roughly guessed at by taking 
the top pint of a quart of ordinary milk or the upper twenty-two ounces of 
Jersey milk. 

Weighing, measuring for these mixtures, and changing them as the baby 
gains in age, appears formidable. Possibly it is not so complicated, but at 
least it appears so. To get away from this is one of the reasons for the simpler 
system proposed. However, it is not the only reason. Its advocates claim 
that the simpler mixtures are more easily digested and nourish better. 

The Simpler System. — The basis 
of the system is that in children 
under a year of age one and a half 
ounces of good, clean, fresh cow's 
milk will furnish all of the food nec- 
essary for growth, heat, and energy 
for a pound of baby for twenty-four 
hours. Then the first step is to weigh 
the baby. The baby's weight in 
pounds multiplied by one and a half 
gives the number of ounces of milk 
needed by the baby in twenty-four 
hours. 

As the result of very careful de- 
terminations by scientific men, one of 
whom is Rubner, the man who is re- 
sponsible for the feeding standards in 
use in the German empire during this 
war period, it has been found that a 
baby needs about forty-five calories in 
a day for each pound of its weight. 
One and a half ounces of good milk 
with the cream on it is a little short 
of the required number of calories. 
Instead of using more milk the calo- 
ries are gained by adding some sugar. 
The reason that more milk is not used 
is because one and a half ounces con- 
tains enough protein, the food needed 
for growth, and more than that 
amount of milk would furnish more protein than the child needs. 

Making Energy. — The necessary energy in younger babies may be fur- 
nished in the shape of ordinary cane sugar, milk sugar, or malt sugar. Grulee 
says the best of these is malt sugar, though various forms of starchy foods can 
be given slowly to displace it at any time after the third month. 

In babies over three months old the day's food can start with one-half 
ounce of malt food and this, within two weeks, can be increased to one ounce. 




Chicago Health Dept. 
Fig. 297. — Diagram Showing Construction 
of Breast Pump. 



FEEDING BABIES 



823 



We have, then, for a baby weighing ten pounds fifteen ounces of whole milk 
to which has been added one ounce of malt food. 

The next question is how much water should be added to it. To determine 
this it is necessary to know how many ounces a baby should eat in a day. 
How many times shall baby be fed and how much at a time? The capacity 
of the stomach at different ages according to 
Holt is as follows: 

At birth, 1J to 2 ounces. 

At three months, 4-| ounces. 

At six months, 6 ounces. 

At one year, 9 ounces 

The next question to settle is the number 
of times a baby should be fed. The authori- 
ties are all in favor of long intervals between 
feedings. Of course, the policy of feeding a 
baby every time it cries or in order to put it 
to sleep is not followed now by anybody who 
is well informed. 

The only people whom I have heard ad- 
vocate it in recent years are a few women who 
thought they knew because of practical experi- 
ence. When asked what the practical experi- 
ence was they said they had had large families, 
some of them ten children. When asked how 
many of their children had died teething they 
answered, four, five, six, some of them nine 
out of ten. 

Intervals of Feeding. — The stomach must have plenty of time to digest 
one feeding, empty itself, and rest before a new feeding is given. A baby's 
stomach cannot finish the digestion of milk in two hours. Therefore when 
a baby nurses within two hours of another nursing the fresh milk and the 




Fig. 298. — Arnold Sterilizer. 




Kansas State Bulletin. 



Fig. 299. — Out-of-Door Pen. 



partly digested milk are mixed, but what is of more consequence, the stomach 
is kept continuously at work. Everything in nature rests at intervals or 
breaks down. 



824 



THE BABY 



The interval agreed on by those who know best is four hours. If a newly 
born baby is begun on this basis it is simple enough. It becomes his habit. 
When one has started in on another habit the problem is somewhat more 
difficult. The feeding hours are six o'clock, ten, two, six, and midnight. This 
means a four-hour interval during the day and a six-hour interval at night. 
After the baby is six months old the night feeding can be shifted to ten 
o'clock, which makes an eight-hour interval at night. 

The long interval between feedings gives the* stomach plenty of time to 
complete digestion of the milk and to get a good rest before the next working 
time. 

The long interval plan is not new. It has been tried out for years in 




Kansas State Bulletin. 



Fig. 300.— The Right Way. 



this country. Most of us have heard of the success of Australian and New 
Zealand mothers with their babies. Only one out of every twenty-four of their 
babies die. They use the four-hour plan. 

With five as the number of feedings and the amount of each feeding for 
each age known, it is very easy to calculate the amount of food required for 
the twenty-four hours. In practice Dr. Grulee holds it advisable to give a 
little more food at each period than is indicated by the size of the stomach 
in the 'table by Dr. Holt. He gives to a baby three months old five ounces ; 
six months old, seven ounces; nine months old, nine ounces. Children be- 
tween these ages take a quantity between these measures. 

Amount of Food. — Using these figures as a basis, it is easy to figure 
the amount of food required. For instance, a baby six months old will 
take five times seven, or thirty-five ounces of food in the twenty-four hours. 
If the baby weighs fourteen pounds his daily food supply would consist of 
twenty-one ounces of milk and one ounce of malt food. In order to bring this 



FEEDING BABIES 



825 



up to the quantity required, thirty-five ounces, it will be necessary to add 
fourteen ounces of water. 

A baby nine months old, weighing fourteen pounds, would take forty-five 
ounces of food, consisting of one ounce of malt food, twenty-one ounces of 
milk, and twenty-four ounces of water. 

In the first place, this plan is simpler and easier from the standpoint 
of the mother. In the second — and this does not appear on the surface — it 
does away with the very elaborate calculations as to percentages of fat, pro- 
tein, sugar in cow's milk and human milk, upon which the older formulas 
were based. The foundation of the newer plan is simpler, as well as its super- 
structure. 

Not even age and weight are inflexible guides as to how much a baby can 




Kansas State Bulletin. 



Fig. 301.— The Wrong Way. 



or should eat. If a baby fed on this plan does not gain in weight, has no bowel 
trouble, and goes at his fists as if he was hungry, this mixture should contain 
a little more milk and a little less water. If he gets too fat, or has colic, or 
spits up his food, or gets an eczema, he should have a little less milk and a little 
more water in his mixture. 

Older Infants. — After the baby passes nine months of age the problem 
of feeding becomes much simpler to the careful mother. To the careless one 
the hazards are greater than when the babies were younger. 

What is meant is this : An older baby has very much better digestion 
than a younger one, but the advantage is often more than offset by permitting 
the child to eat without regard to the digestibility of the foods eaten. 

After the ninth month a thick starch gruel, consisting of one-half ounce 
of barley flour, oatmeal, or flour ball to a pint of water may be added to the 
diluted milk. After the tenth month a strained vegetable soup may be added. 

A vegetable soup recommended by Grulee consists of a handful of spinach, 



826 



THE BABY 



a large beet, and two carrots in a quart of water, boiled two hours, strained 
and diluted to a quart. About this time meat juice may be added. Orange 
juice may be begun in babies as young as 3 months of age. 

The proportion of milk to the weight of the baby should be allowed 
gradually to decrease. The rule is to give one and a half ounces for each 
pound of weight. In the latter part of the time the child is at the bottle it 
is a good idea to decrease this proportion. For instance, when the child is 9 
months old, to make it one and a third ounces in place of one and a half. 

Later one and a quarter ounces is enough. 
It is never advisable to give a young child 
more than a quart of milk a day. 

Second Summer. — The opinion is 
general that the second summer is the time 
of greatest hazard to the baby. It is a 
period of great hazard, but it need not be 
so. In the case of about half the babies, 
those born in the spring and summer, the 
first summer is not a teething period. The 
second summer is a teething period for all 
babies. 

The food during the first summer is 
entirely in the hands of the parents. That 
of the second summer is sometimes contrib- 
uted to by outsiders ; the child himself may 
slip something unawares; the parents are 
disposed to be less careful the second sum- 
mer than they were the first. 

During the second year milk should 
continue to be the chief element of diet. 
The first additions are usually fruit juices, 
crackers, and cereals. At the fifteenth 
month spinach, beets, carrots, and potatoes 
may be given. Meat juice, thinner gravies, 
and butter are given to advantage. At 
about eighteen months chicken, meat, and 
fish, finely chopped and well cooked, may 
be added. The habit of giving the child 
a bone to suck as a method of starting the 
use of meat is a good one. 

Under Three Months. — Feeding a 
baby under three months of age will not. 
concern many readers of this volume. In 
the first place the great majority of mothers breast feed their babies for three 
months. The milk generally holds out that long even in the mothers who 
have a poor milk supply. In the second place the feeding of a baby under 
three months of age is a matter of such skill and varies so much in the indi- 
vidual case that most people are anxious to leave* it to skilled baby feeders. 

There is some difference of opinion as to whether a baby should have 
any food in the first twenty-four hours of its life. I think the majority are 




Kansas State Bulletin. 

Fig. 302. — Cuts Showing Deciduous 
Teeth: 1, central incisors. Crown 
calcified before birth, erupted 5-8 
months after birth; 2, lateral incisors. 
Crown calcified before birth, erupted 
7-10 months after birth; 3, cuspid 
(eye tooth). Crown calcified by 3 
months after birth, tooth erupted 
14-20 months after birth; 4, first 
molar. Crown calcified by 6 months 
after birth; tooth erupted 12-16 
months after birth; 5, second molar. 
Crown calcified by 6 months after 
birth, tooth erupted 20-32 months 
after birth. 



FEEDING BABIES 827 

of the opinion that it should not. Plain water, unsweetened, is better than 
sugar water. 

During the remainder of the first week Dr. Grulee offers the baby three 
ounces of a mixture half milk and half water. To a seven-days-old baby 
weighing eight pounds he gives eighteen ounces of milk and water, half and 
half, in six feedings. A fourteen-day-old baby weighing eight pounds gets the. 
same mixture with the addition of one-quarter ounce of malt food. A two- 
months-old baby weighing ten pounds gets milk, twelve ounces; water, ten 
and one-half ounces; malt food, three-quarters of an ounce, in five feedings 
of four and one-half ounces each. 



FEEDING SICK BABIES 

If it were possible to obtain an accurate record of baby sickness it would 
be found that many babies get sick in June and the early part of July, though 
the baby death rate does not begin to show much rise until after the middle 
of the latter month. 

The asylums, sanitaria, hospitals, and baby tents find that the children 
who are severely sick in midsummer give a history of mild sickness in the 
early summer. It is the old, old story of the "stitch in time saving nine/' 

Loose bowels, green stools, mucus, and blood cannot be neglected with 
any degree of safety after June 15 in this climate and June 1 in warmer 
climates. The child may seem to be happy, not upset by the little indigestion, 
and it may seem useless to worry about so trifling a matter. But, unless 
these trifles are attended to, things will get worse as the weather gets hotter 
and, presently, the baby is in a condition where no food seems to agree with 
it and no doctor seems to help it. The mother must carry on her long, weary 
fight to keep the poor, skinny baby alive until the nights get cool in October. 

The first thing to do when the baby gets sick is to stop feeding it. Prob- 
ably the milk is bad anyhow. But, whether it be good or bad, it will disagree 
with a sick baby. In place of milk the baby should take clean water from a 
clean bottle or a clean cup. If the trouble keeps up there are milk substitutes 
which can be given until it is safe to give milk again. The physician or nurse 
will demonstrate how these are made. 

The next step, after stopping the food, is to empty the child's intestines 
of all fermenting, decomposing food. The parent is justified in going as 
far in this line as the use of oil by the mouth and of simple enemas by in- 
jection. If relief does not come when these have acted the mother is not 
justified in going further. She should get help from a physician or nurse. 
Caring for a sick baby is so largely "doing and showing/' as contrasted with 
"telling," that a nurse is needed more than would usually be the case. 

As the child goes back on milk let it be watered milk or good butter- 
milk. If the first feeding agrees, let the next be slightly less watered, and the 
next still less, until within a few days the diet is one proper for the age and 
season of the year. Occasionally a mother continues to give watery milk 
after the acute trouble has subsided and the baby in a few weeks shows signs 
of starvation. 

Remember — a baby with indigestion can be starved by overfeeding. The 
indigestion passed, it may be starved by underfeeding. 



828 



THE BABY 



SELECTION OF BABY FOOI5 

Many thousand women cannot get ice with which to keep the hahfs 
supply of cow's milk. They have no mother's milk. They cannot do the 
best thing; they cannot do the next best thing; they must choose further 
down the line. 

WHAT KILLS THE BABIES 

this 'diagram shows the chief causes of death among 

Children Under Two Years of Ase and the Ratio 

of Each Cause to the Total Deaths 1n This Age Division. 

•In eoch 100 deaths among children under 2 years of age 37 are caused 
fey diseases of the digestive system ; 23 by the iropure-air diseases t 19 by 
defects and accidents at birth; 9 by acute contagious diseases* 3 by diseases 
of the nervous sqstcm; 2 by, tuberculosis i 2 by, violence » I by venereal diseases t etc. 



70 Percent of Such Deaths Cati 


^AVOIDED - 


With Proper Care 




Pebcent op 


Tota 

5 j 


u r D£/ 

. 2 


iTHS I 
5 ■ 


MDER 



?Ybs. 

5 4 





j Chief causes of death a- 
1 mono children under 1 
1 years of age an& the propor- 
tion each contributes to W 
total at this age period. 


DIARRHEAL DISEASES 
and Other Diseases 
of Disestivc System 


1 














Diarrheal Disease* sa.6% 
Convulsions t(,% 
Gastritis ••*% 
Other Dis. of Digestive Sys. 1.47. 


















impure-Air Diseases 












i 








Pneumonia 16.47. 
Bronchitis b£l 
Influenza -0.47. 










3^22 












Congenital Defects 
and Accidents 










I9L2 










Premature Birth 127. 
Congenital Debility 407. 










| Injuries el Birth IA% 
1 Other Defects ot Birth 5.97. 


Acute Contagious 
diseases 






7 












| Diphtheria 2.77. 
| Scarlet Fever 117. 












Measles 1,1 7! 


Diseases of NERVOUS 

SYSTEM 


■3. 


> 
















Meningitis (simple) 2.47; 
Other Dis. Nervous Sys. «-77. 


TUBERCULOSIS 


■ Z-2 


















Tubercu losi » - Lungs 0.7 7. 

. Meninges. 1.07. 

Abdominal , o.l-r 

All Other a3 7. 


VIOLENCE 


■•7- 


















Accidents- 1.27. 
Suffocation 0.2T. 
Burns and Scalds 0.57, 
Falls ai% 

Homicide a5% 


VENEREAL DISEASES 


„ 


















Syphilis 107. 
Gonorrhea 0.17, 


DISEASES op URINARY 
SYSTEM 


|0.6 


















Nephritis 0S7. 
Other Dis. Unnory Sys. 0.1% 


Rickets 


|06 


















Rickets ®«7. 


Diseases of heart 

and BLOOD VESSELS 


|05 


















Heart Diseases 03% 
Other Circulatory DiS. 0.2^ 


ERYSIPELAS 


|0.4 


















Erysipelas 0*1 


all Other Diseases 


HM 


















Tetanus and Trismus «S% 
Pyemia and Septicemia ft»% 
AH other causes 19% 



Department op Health, 

Chicago. 
Popular Education Series 
No.5 

Fig. 303. 



FEEDING BABIES 829 

To help this large number of mothers much investigation has been going 
on in recent years. Conclusions are far from being final, but they are point- 
ing in certain directions. 

A baby food must contain milk in some form. The investigations point 
definitely that way. A recent study of four foods, made by research workers 
at the University of Illinois, showed this quite well. They fed mice on 
Horlick's malted milk and Nestle's food, which contain dried milk, and with 
two other foods which contain no milk. 

They observed the mice, as to whether they kept up their weight, grew 
properly, and bore young capable in turn of bearing healthy young. Or, to 
put it another way, they would divide a batch of young mice into two groups. 
One group was fed on ordinary mixed food, the other on food under test. The 
members of the two groups were weighed, measured, and closely observed at 
regular intervals. The number of young and the conditions of the young 
were noted. 

As the second generation approached maturity the test young were divided 
into two groups. One was fed on the test food, the other on ordinary food. 
The number and condition of the third generation were counted and ob- 
served. 

In this way the research workers determined whether the test food pro- 
duced fat, supported growth, made possible the breeding of sound progeny, 
with sufficient vitality to grow up and themselves produce sound progeny. 

The milk foods stood the test. The foods in the manufacture of which 
no milk is used did not. 

The teaching of this experiment is that where a mother is selecting a food 
for her nursing baby she should read the label carefully and select one made 
wholly or partly from milk. This refers to the use of milk in the manufacture 
of the food. If the food must be mixed with milk at the time of use it has 
no advantage over the use of milk. 

A baby food which is a dry powder will keep better than one that is 
liquid or nearly so. After a can of evaporated milk is opened it spoils rapidly. 
It is not safe, therefore, to use evaporated milk unless it can be kept as cool 
as tap water will keep it. It must be kept clean. After a can of condensed 
milk is opened it spoils slowly. It must be kept cool and clean. A dry, 
powdered food is much easier to keep. 

MERIT OF BABY FOODS 

• 

Most babies get mother's milk until they are eight months old. Many 
babies are not so fortunate, however. There is a very large group, composed 
in part of babies under eight months and in part of the older babies, which 
must depend on cow's milk and other baby foods. 

In this group there are two smaller groups that do not thrive on cow's 
milk. These are: (1) babies who can get nothing but ordinary city raw milk 
and (2) babies in whose homes there are no facilities for keeping the milk 
cold. It matters not whether the milk be certified, pasteurized or raw, it will 
not keep unless it be cold. 

Some of these families can be provided with ice. Where ice is not avail- 
able, then what? Evaporated milk, condensed milk, or some baby food. 



& 

01 






O -P! . 

n^ C: 9 ^ 

*> O X. 

fc c^ a. 



•Sll^o" 



tC.S ^ vn > 




I 



^ a. 



*CS ^ CJ ^-S *> 

OCl^Cl OQ. c^ 2^ ^ o 

S o § S3 



k. "V-jt 



"a3J.VM 







r\tU 

85 

VDlU 
<*« 

^£ 
o-iu 

KcQ 



830 



FEEDING BABIES 



831 



Whenever we study statistics relating to baby welfare we find a dispro- 
portionate sickness rate among the babies fed on these foods. Bnt we must 
remember that these comparisons are between the babies on mother's milk, 
iced milk, and uniced condensed milk. A fairer study would be between 

WHY, OH NHY PASTEURIZE 
IF YOU DON'T SWAT THE FLIES! 



COME. OK IN, 
FELLOWS, ITS 
STERI 1_»21EE>. 




CHICAGO HERALD 



S£^ 



Fig. 305. 

babies fed on uniced raw milk and babies fed on uniced condensed milk and 
uniced baby foods. But no baby doctor would dare feed a baby on raw cow's 
milk kept uniced. It would be too risky. 

It all comes back to this : In those homes where the choice lies between 
warm milk and baby foods, the lesser evil is the condensed or evaporated 



832 THE BABY 

milk and the baby foods. Or to put it differently, if a mother cannot get ice 
to keep the milk during the hot days she had better give her baby some form 
of canned food. 

As between the two kinds of milk, evaporated or condensed, some will 
prefer the one, some the other. Condensed milk is evaporated at a low tem- 
perature. Not all bacteria are killed. The milk is then preserved by adding 
to it 40 per cent of its volume of cane sugar. The few feeble bacteria present 
are restrained by the sugar. Evaporated milk is evaporated at a higher tem- 
perature in a vacuum pan. No sugar or other preservative is added. It must 
be sterile, else it is not marketable. 

Soft Spot on Head. — I. N. 0. writes: "How and whence comes the 
small soft spot on the uppermost part of babies' heads? How long does it 
take before it is completely hardened? What is its purpose, and is there 
any danger in injuring or breaking it?" 

Reply. — 1. The bones of a child's head begin as ordinary membranes. 
These membranes begin to be converted into bone at centers. The centers 
are located near the middle of the patches of membrane. The conversion 
of membrane into bone proceeds from the middle toward the edge. By the 
time the child is eighteen months of age the bony plates growing from the 
different centers have met, been knitted together, and form a solid bony 
brain box. At the time of birth this change of membrane has not been 
completed. There are soft areas. The location of the largest of these is 
known to every parent. The next in size is at the back of the head near 
where the neck joins it. 

2. Usually eighteen months. The range is from fourteen to twenty- 
four months. 

3. The purpose is twofold — to make being born easier and to allow for 
rapid growth of the head after birth. To perforate the fontanelle is dan- 
gerous, of course. However, it is not easily perforated. The membrane is 
nearly as tough as young bone. 

Shape of Baby's Head. — L. T. H. writes: "Our baby's head seems to 
be getting fiat on the back. Will you please tell us whether it will grow 
round again, when she sits up? She is six months old and weighs ten 
pounds, double her weight at birth. She is perfectly well, but does not hold 
herself up like some larger babies of the same age. Her food is cow's milk 
and barley water." 

Reply. — The head has a remarkable capacity for righting after being 
pressed out of shape. Nevertheless, it is easy to shift the baby's position 
frequently. • 

She should not sit up for another month. Do not stimulate her to sit 
up before she is ready. As she started small she may be a little slow in 
sitting up. 

Mouse Story Untrue. — A. J. writes: "My wife saw a mouse twice 
on the first day she felt life within her, and the second time she saw it she 
put her hand to her mouth to prevent an outcry. Do you think that the 
child is likely to be marked?" 

Reply. — No. Two hundred years ago it was proved that no such effect 
was possible. Have her forget her worries. 



FEEDING BABIES 833 

Measurements for Baby. — Mrs. M. K. writes: "I wish data in regard 
to perfect baby 2 1 /k years old." 

Reply. — The following are measurements for an average baby of 32 
months : 

Weight, 29 pounds; height, 35 inches; circumference of head, 19V2 
inches; circumference of chest, 20 1 /£ inches; circumference of abdomen, 
19V2 inches. 

Watch out for a baby contest in your neighborhood. If you learn of 
one where the babies are to be marked on a score card, such as that devised 
by Dr. Clark of Waterloo, enter your baby. You will learn much, and 
your baby may get a prize. 

Broken Tooth. — Mrs. B. writes: "A baby 18 months old had an acci- 
dent and broke one of her upper teeth. Should the root be pulled out or 
will the second teeth push it out?" 

Reply. — Leave it there. It is needed to hold the dental arch in place. 
When the time comes the tooth below will dislodge the root unless it has 
been absorbed in the meantime. The X-ray will show the conditions there 
if it seems advisable to use it. 

Nursing the Baby. — Mrs. C. G. writes: "1. I have not sufficient milk for 
my baby (two months old). My health is excellent, and I eat plenty of 
wholesome food, drink two quarts of milk a day, and plenty of water. 
My mental condition is good, and I get sufficient rest and exercise. 2. Can 
you give an opinion on Reed & Carnrick's Soluble Food? I use a little 
of it every day for the baby. Is cow's milk better?" 

Reply. — The German experiments show that nearly every mother can 
be made to give enough milk for her baby. Experiments both with cows 
and women show that no particular article of food is a milk producer. 
Observation shows that, among people in fair circumstances, overeating, 
by producing indigestion, makes against rather than for a full milk supply. 
The German experiences show that the best results follow attention to 
details, such as plenty of sleep, freedom from anxiety (for instance, lest 
they will not give milk enough), regular and proper emptying of the 
breasts. Are you not worrying that you may not be able to nurse your 
baby? 

2. Modified cow's milk is better. Have you Holt's, or Kilmer's, or 
Slemons' books on baby feeding? 

Let the Baby Sleep. — Young Mother writes: "Should a baby about 
three months old be permitted to sleep six or seven hours at night without 
nursing? Does a combined alcohol and sweet oil rubbing after each night's 
bath do any good to the child? What rubbing do you recommend, if any?" 

Reply. — 1. Let the baby sleep as long as he will. If he will go seven 
hours at night between feedings at three months old, by all means allow 
him to do so. 

2. Do not use alcohol and sweet oil. Bathe with water and soap. If 
there is a tendency to chafe, use a dusting powder, otherwise not. 

Good Place for Babies. — E. L. R. writes: "Will you please let me know 
what effect, if any, the climate, water, and general conditions of southern 
California would have on a family, including a year-and-a-half-old baby, 
moving out there from Chicago?" 



834 



THE BABY 





B 




Fig. 306. — Tape Worm. A, Magnified 
Head; B, Segments; C, Egg. 



Reply. — It would be a good place for you. Babies thrive in southern 
California. The baby death rate in that section is low. 

Child Is Cross-Eyed. — Mrs. B. writes: "About two months ago my 
two-year-old baby fell down and injured her right optic nerve. Will she 
outgrow it? I am dreadfully worried about her. I have been bathing her 

eyes frequently, and put a piece of 
black sticking plaster at the side of 
the eye, hoping {he color would help 
attract the eye toward its proper 
position again." 

Reply. — The optic nerve runs 
from the brain to the back of the 
eyeball. It is so deeply placed that 
falls do not hurt it. You need not 
feel ashamed of your mistake, since 
the myriad-minded Kipling made 
the same mistake in his novel, "The 
Light That Failed." 

I judge your baby is cross-eyed. 
If so, it is because the muscle which turns the eye toward the nose is too 
strong for the one which turns it toward the cheek. Bathing will not help. 
Sticking plaster will not help. Have the child play in the open air and 
the trouble may get right by itself. If not, glasses may correct it. If 
not, a simple operation will. 

Cause of Worms. — Mrs. H. A. writes: 
"What is the cause of worms in children? What 
is the best way to get rid of them? What do 
you think of Pape's diapepsin for indigestion? 
Is it harmful when used regularly?" 

Reply. — 1. Worms hatch from worm eggs. 
The eggs are swallowed. One child with worms 
is liable to infect a group. 

2. For round worms nothing is more effec- 
tive than santonin powders (two to five grains). 
Ordinary worm medicine is effective. Other 
kinds of worms require other treatment. 

3. Let it alone. 

May Do Baby Harm. — Mrs. P. M. is giving 
her one-month-old baby three-quarters of a grain 
of saccharin a day. Is it wise? Is the passing 
of undigested food by a baby reason for alarm? 

Reply. — 1. The government experts have re- 
ported adversely to saccharin. There is a good 
deal of literature published in the last few years 
on the harm done by milk sugar in baby feeding. 

I can see no reason why you should give your baby saccharin, and I can 
see where it might do harm. 

2. Undigested food is not of great consequence if the baby is gaining in 
weight and is comfortable. Nevertheless, in raising a bottle-fed baby it is> 
wise to take counsel with your physician periodically- 




Fig. 307.— Round Worm 
Greatly Magnified. 
a, worm; b, head; c, 
eggs. 



FEEDING BABIES 



835 



Left-Handed Baby. — R. H. D. writes: "Our baby boy, five months old, 
uses his left hand a great deal in picking up his toys. Is there any way 
to prevent him from becoming left-handedf" 

Eeply. — It depends on the way the brain cells are hooked up. Inherit- 
ance is a factor in it. You can train a child to use his right hand by 
keeping a mitt on the left. This 
must be persisted in to be suc- 
cessful. When persisted in it 
generally results in ambidexter- 
ity, which is highly desirable. 

Let Baby Sleep Out of Doors. 

— C. C. K. writes: "My baby 
was born in May and has been 
out of doors every day during 
the summer and fall, except when 
it has rained. Is it advisable to 
let him have his daily nap out 
of doors during the winterf" 

Eeply. — It is. Babies six 
months old are good heat makers 
and should have lots of exposure 
to cold. The ability to catch 
cold from exposure to cold, from 
cold feet, wet feet, et cetera, is 
acquired as the result of cod- 
dling. It is frequently found in adults. 
It, of itself, is an abnormality. 




u 



Fig. 308.- 
male; 



-Pinworms: a, head; b, female; c, 
1, eggs; e, pinworms, natural size. 

It is seldom found in babies. 



Not Robbed of Vitality. — X. Y. Z. writes: "Kindly inform me if it 
is in any way harmful for an infant or young child to sleep with a healthy 
and clean grandmother?" 

Eeply. — Sometimes grown people roll on infants. Many deaths are 
caused in this way. Babies are liable to catch colds from adult bedfellows, 
even though the adults are not sick themselves. These are about the only 
objections. Weigh them in your case as against the advantages in a 
domestic way. The idea that the baby is robbed of magnetism, or elec- 
tricity, or vitality has no foundation in fact. 



Avoid Use of Drugs. — Mrs. B. R. writes: "My baby, one year old, is 
troubled with constipation. We have used maltine with cascara sagrada 
for him. He does not seem to be improving. For breakfast I generally 
give him a cereal and for other meals he has cream on bread and some- 
times a white sauce on bread. What do you advise me to do about 
himr 

Eeply. — Do not give the baby cascara sagrada or any other drug habit- 
ually. A one-year-old baby should be able to take enough water, fruit 
juice, and oatmeal gruel to relieve constipation. Dilute the milk more. 
Give more oatmeal gruel ; give more water, more orange juice, prune juice, 
or scraped apple. If something must be used, use enemas and soap 
sticks. 



836 THE BABY 

Baby with the Colic. — Young Mother writes: "Kindly tell me what to 
do for my baby for colic. He is now three weeks old, and has colic some 
time of every day and night" 

Reply. — Your milk is probably too rich in solids. Give the baby some 
water just before it nurses. You should eat less food and exercise more. 
If the condition does not improve, you had better have your doctor help 
you to work it out. 

Dandruff on Baby's Head.— J. M. writes: "What can I do for scaly 
dandruff on three-months-old baby's head? Have used olive oil and white 
vaselin with no avail/' 

Reply. — To keep the baby's scalp oiled and cleaned helps, but it does 
not go to the root of the trouble. A baby with head eczema needs a change 
in its diet. Generally the food is too rich. The only treatment which 
avails is to change the feeding and overcome constipation, and even that 
sometimes gives results slowly. 

Baby's Second Summer. — H. J. M. writes: "I notice reference in your 
column to a baby's second summer being a hazardous period. Is it any 
more so than any other summer, and, if so, why? Would you recommend 
any special food?" 

Reply. — It is especially difficult to hold a child to a simple diet during 
the second summer. During the second summer a child should have fiye 
meals between seven in the morning and seven in the evening. The diet 
lists should be made up from milk, dry toast, crackers, cereal, rice, eggs, 
a little meat, orange juice and other fruit juices, butter, soups, and a 
few vegetables, such as spinach, asparagus, new peas and potatoes. 

Feeding the Baby. — Mother writes: "1. Should I feed my eight- 
months-old baby anything aside from breast milk? 2. Are Graham crack- 
ers good? 3. (a) Will it hurt this baby to cry itself to sleep at night? (b) 
As this seems the only method, how long should I let the baby cry? J/.. How 
can I break the baby from nursing three or four times a night? 5. Is 
water out of the faucet all right for the baby to drink? 6. How many 
teeth should a baby eight months old have? 7. Does it hurt this baby to 
stand on its feet, as it insists upon doing?" 

Reply. — 1. If the baby is thriving do not feed anything beside breast 
milk. If the baby is not growing or is hungry a good part of the time, 
dilute cow's milk and add it to the feedings. Many mothers give milk 
enough when baby is eight months old; some do not. 

2. They will be good when the baby is a little older. 

3. (a) No. (b) Until it goes to sleep. 

4. Give some water, but no food, at the old times. If the baby has been 
nursing every two hours during the night run for awhile on a four-hour 
interval. At the end of two months it can be made to go without food for 
six to eight hours at night. Evidently you began to train your baby wrong. 
To teach proper sleeping and eating methods will be more troublesome now 
than it would have been at the beginning, but it will be less trouble now 
than if you put it off longer. 

5. Yes. 

6. One to four. 



FEEDING BABIES 837 

7. If the baby is healthy and strong it will not, provided it tries to 
stand as it wants, not as the parent wants. 

Baby Improperly Fed. — Mrs. T. C. writes that her baby is a year old, 
weighs thirty pounds and has six teeth. Lately the baby has been vomiting 
a good deal. She gets oatmeal and milk in equal quantities (amounts not 
stated). The baby pulls at the mothers breasts, but there is not much 
milk — at least the mother thinks not. She is jive months pregnant. She 
asks : 

1. Is the baby's indigestion due to teething f 

2. Is the food right? 

3. Does allowing the baby to nurse hurt the unborn babe? 

Reply. — 1. Indigestion is not due to teething. Indigestion is due to 
faulty feeding. 

2. You are overfeeding — especially starch. Your baby is too large for 
good health. She will be certain to get in serious trouble when hot weather 
comes unless you decrease the amount of starchy food. 

3. If you keep well nourished and strong it will do the new baby no 
harm. If you are not, it will. Remember you are feeding yourself, your 
unborn babe, and your one-year old. If you are equal to it, as shown by 
your own condition, keep it up. If you are thin or run down, tire easily, 
cut off the only one you can — the one-year old. 

"When the Milk Fails. — Mrs. H. E. 0. writes that she has a boy faur 
months old. Her milk has failed. She gave boiled milk, and the baby 
became constipated. The baby is nervous. 

Reply. — When mother's milk fails, the best food is fresh cow's milk. 
This should be either certified or pasteurized. It should be diluted accord- 
ing to the age of the child. 

It is not a bad idea to use malted milk, condensed milk, and baby 
foods during the hot weather. Particularly is this true if you are not 
certain that your cow's milk is clean, cold, and fresh. But such foods are 
not well enough balanced for feeding continued over a long time. 

The constipation should be corrected by orange juice, two or three table- 
spoonfuls a day. Water should be given. 

Do Not Boil It. — Mrs. S. B. writes: "Should one boil certified milk 
for a baby five to six months old? At what age can a baby sit up in a high 
chair?" 

Reply. — 1. If you are certain the certifying is not a fake, do not 
heat the milk at all. If you are not certain, pasteurize it, but do not 
boil it. 

2. Seven months. 

More Fruit for Baby.— F. G. T. writes: "My baby, 11 months old, is 
troubled with constipation. I feed him soft boiled egg, Graham crackers, 
oatmeal, bread, orange and prune juice, and milk. He drinks one quart of 
milk a day. Can you advise as to any change in his diet to overcome this? 
Otherwise he has always been healthy, and is growing splendidly." 

Reply. — Make no radical changes. Give him water several times a day. 
Try a baked apple. Give more fruit, beef juice, meat and bread. You 
may have to give him less milk to get him to eat more of the bulkier 
foods. 



838 THE BABY 

Mother's Milk.— R. T. E. writes: "I am a mother of a baby three and 
one-half months old. My supply of milk is scant. I would like to know 
what the simple things are to make milk." 

Keply. — First, freedom from worry and anxiety, above all, fear that 
the milk will dry up. Second, regular sleep and plenty of rest. Third, 
plenty of plain, wholesome, nutritious food. No one kind of food is ma- 
terially better than any other. Fourth, regular nursing at intervals of less 
than six hours. 

Feed Baby Now. — Anxious writes: "I have a baby girl sixteen months 
old. I fully intended weaning her at the year, but friends advised not to 
do so until she had her stomach teeth. Thinking she would have them 
before the warm weather came, I kept on nursing her. As she hasn't got 
them yet, I am at a loss to know whether I should wean her or nurse her 
through the summer. She has the four upper and lower, also her three 
double teeth, and the fourth is just about through. She has had no trouble 
with her teething, and she has been well ever since she came." 

Keply. — She will be twenty-two months old by cold weather. You will 
hardly have milk that long. You had therefore better start feeding her now. 

Feeds Baby Too Much. — H. C. writes: "My baby weighed eight pounds 
at birth. He weighs thirteen pounds at four months. Per gleanings from 
your 'How to Keep Well' articles, I am supplementing the breast by three 
ounces of Horlick's malted milk, a teaspoonful at a time. The baby has 
eczema on face and scalp in three places that do not yield to Cuticura. 
Could he be fed beef broth to supplement?" 

Keply. — You are feeding too much. The gain in weight and the 
eczema both prove it. The baby is too young to be taking so much carbo- 
hydrates. Why supplement with anything? If necessary to use anything 
give one cow's milk feeding properly diluted. 

Weaning the Baby. — Mrs. H. writes : "My baby boy is eight and one- 
half months old and I nurse him. Now I find myself pregnant again. 
1. Is it necessary for me to wean baby? 2. If so, what shall I feed him?" 

Reply. — 1. Decide this question by whether the baby is thriving or not 
and whether you keep in good condition. You probably will have to wean 
him before cool weather anyhow, and you might as well start now. 

2. Diluted pasteurized milk. 

Nothing to Do with the Moon. — Mrs. F. K. writes: "I wish it might 
be possible if you see fit to have an article on 'Weaning a baby by the sign 
of the moon,' as I know from my experience there is everything in it. I 
weaned my baby the seventh of September and never had one bit of 
trouble. A friend weaned hers the week after, and the poor little thing 
cried for a day and night." 

Keply. — There is nothing in it. The moon is not mixing up with 
babies and babies are not mixing up with the moon. The mother who is 
weaning her baby should watch the baby closely and let the moon go hang, 
for a baby whose food and habits are being radically changed needs close 
attention. 

Conclusions drawn from one or two experiences are usually misleading. 

Why one of these babies did well and the- other poorly I do not know. 



FEEDING BABIES 839 

Maybe one naturally had a better digestion than the other. Maybe one 
got cleaner, fresher cow's milk than the other. Maybe one was more in- 
telligently handled than the other. 

The apparent relation to the moon was coincidence rather than cause 
and effect. It is not the first time, by long odds, that coincidence has 
been confused with cause. We should always be careful not to draw con- 
clusions from too few observations. It makes trouble for us. 

January Good Weaning Time. — Mrs. C. R. F. writes : "I wish to wean 
my 9y2-months-old boy, who is in the best of health, and would thank you 
to advise me what food would be best for him and whether he should be 
fed at regular intervals or whenever he is hungry." 

Reply. — January is a good weaning time, though 9% months is a little 
early. Use 13 ounces of milk, % ounce milk sugar, 1 ounce lime water, 
6 ounces gruel. Give orange or prune juice every day. Feed at regular 
intervals of four hours. Do not feed from 10 o'clock p. M. to 6 o'clock a. m. 
If he does not thrive, get medical counsel. 

Bowlegs in Babies. — Mrs. E. G. H. writes: "Would you kindly inform 
me if there is a cure for bowleg gedness in a child of two years? What 
causes it? Will it correct itself if left alone, or would you advise braces?" 

Reply. — Bowlegs result from putting weight on legs the bones of which 
are not yet firm enough. The weight and the pull of the muscles cause the 
legs to bow out, bowlegs, or bend in, knock knees. Why are the bones too 
soft? Because of rickets. A mother who notices that her baby sweats 
around the head, does not hold his head up well, does not sit up straight 
as children do at his age, should suspect rickets. If his head is overlarge, 
or his legs are not developing well, or his teeth are much delayed, she 
should strongly suspect this condition. 

Rickets should always be discovered and cured before the legs begin to 
bow. If the legs have bowed, can anything be done ? Yes. The food must 
be richer. Cream and butter should be added. Meat and vegetables must 
be given. It is well to feed the milk raw. Cod liver oil can be given 
whenever enough milk and butter cannot be taken. Life in the open air is 
essential. The child should be kept off his feet as much as possible until 
the rickets has been remedied. 

A certain amount of bowing of the legs tends to remedy itself when 
the rickety condition is remedied. The bones of children are not com- 
pletely ossified and the tendency of the muscles is to pull a slightly bowed 
bone to its normal shape. If the deformity is bad, nothing but operation 
will cure. I do not think braces will help. 

Baby Carriages. — H. 8. B. writes: "In a discussion regarding 
baby carriages for children under two years of age, an agreed opinion could 
not be reached in regard to the so-called baskets. It was the opinion of 
several that the construction was such as to cause permanent injury for 
the reason that it did not have the proper springs to prevent jarring. 1. In 
view of your valuable advice in regard to babies, I will appreciate it if you 
will give me your opinion on this point. 2. Also, what is the proper quan- 
tity of certified milk for one feeding where a siob-months-old child is fed 
every four hours?" 

Reply. — 1. Will not cause permanent injury. 

2. An average baby six months old should be fed in twenty-four hours 
thirty-three to forty-two ounces of prepared milk containing eleven ounces 
of whole milk. This should be divided among the feedings. 



840 THE BABY 

Cause of Sty. — H. M. writes: "Will you please reply to the following 
questions ? 

"Our bahy, eight months old, seems in perfect health and weighs seven- 
teen and a half pounds, but she has already had three sties, or gatherings, 
on her eyelids and is getting a fourth. Can you tell me the cause of them 
and how I can prevent their coming? What is the best thing to do after 
they have started to gather?" 

Reply. — Keep the eyelids very clean by washing them in a saturated 
solution of boracic acid. A sty is due to bacteria infecting the lid after 
traveling from the surface down the lash. Therefore, sometimes a sty can 
be absorbed by pulling out the lash or lashes whose roots are infected. 
Other than that, the child's nutrition is probably out of balance. Probably 
she is being overfed. When bacteria travel down hairs, there is usually 
some such constitutional reason. 

No Remedy Known. — W . L. D. writes: "My boy, aged three, grits his 
teeth at night dreadfully ; in fact he wakes me up every night, sometimes 
several times. He eats only what a child of his age should, and for supper 
he gets only milk or some cereal. How am I to stop the habit? I am 
afraid he will hurt his teeth, for he grinds them together with an awful 
force and can be heard in any of the adjoining rooms." 

Reply. — If I could help you I would. Many letters asking for help 
along this line come to this department. 

I have not read or heard of anything promising. 

Break Lad of Habit. — Worried Mother writes: "Is thumb sucking a 
bad habit? My boy is nearly five years old, and has sucked his thumb since 
babyhood. It seems impossible to break him of the habit. Does it enlarge 
the adenoids? When not sucking the thumb his mouth is open most of the 
time, which gives him almost a dumb expression." 

Reply. — Your letter answers itself. Your child keeps his mouth open 
most of the time and has almost a dumb expression. Break him of the 
habit, or break a leg, else he will break your heart. 



CHAPTER XLV 

Children 

WHY IS YOUR CHILD "IT"? 

Of the backward children Dr. L. B. Ayres of the Russell Sage Founda- 
tion says: "We know them in school as the children who are always a little 
behind physically, a little behind intellectually, and a little behind in the 
power to do. Such a child is the one who is always f it' in the competitive 
games of childhood.-" 

He further says that when a child fails to keep up in work, study or play 
he is being educated to consider himself not the equal of his fellows; finally 
he becomes thoroughly trained in failure and is destined to a life of failure. 
Even if Thomas Jefferson's fine phrases in the Declaration of Independence 
that "all men are created equal" were true a few years on the playground 
and in the schoolroom would make them unequal. 

When a child is the "it" of a group there's a reason. It may be that 
the cause cannot be remedied. If it can be remedied it should be. What 
of the parent who permits his child to train for failure because of some cause 
that can be remedied? What of the school board which permits it? or the 
school teacher? 

One of the causes is poor vision. One group of investigators has exam- 
ined the eyes of backward children. Another group has investigated the 
school standing of children with eye defects. The conclusions of the two 
groups are in a general way the same. The conclusion of each group sustains 
the conclusion of the other. A very large proportion of the backward chil- 
dren have poor vision. A very large proportion of the children with poor 
vision are backward. 

Tens of thousands of children have been investigated. The investiga- 
tions have been made in Europe and in many parts of the United States. 
Some of the investigators were eye specialists, some school teachers in ordinary 
everyday schools, and some were associated with reform schools. There is 
no possibility that by any accident the cases were not typical. We can be 
certain that the proportions found are about the proportions existing in the 
schools of our town. 

Dr. Shaw said before the last International Congress on School Hygiene 
[1913] that in his experience 66 per cent of the backward children who were 
not subnormal mentally had ocular defects. Some were nearsighted, some far- 
sighted, some astigmatic and some had cross eyes. When the eyes were prop- 
erly cared for the children ceased to train for failure. They ceased to be 
the "its." 

He made a special plea that something be done for the cross-eyed children. 

841 



842 CHILDKEN 

Most people believe that children outgrow cross eyes. They do not. Behind 
the cross eyes is trouble with the vision. Generally cross-eyed children are 
farsighted. In their straining to see in spite of their infirmity the eyes are 
pulled out of line, sometimes one, sometimes both. 

Generally the eye which is most farsighted is pulled in. As that eye 
looks in one direction it forms one picture. The eye looking forward forms 
another. The cross-eyed person endeavors to see two pictures at once. But 
however capable the two eyes may be of seeing two pictures at the same time 
the brain can register only one. 

In the early days of cross eyes there is a struggle between these two 
pictures for supremacy in the brain register. Confusion results — vision con- 
fusion and then brain confusion. A way out must be found. The way is 
blindness in the crossed eye. A cross-eyed man sees with the eye that is 
looking at the object his mind is on. What the other eye sees the man does 
not see. The result is that the crossed eye passes from usefulness through 
incapacity into degeneration. 

Dr. Shaw thinks cross eyes should be discovered when they first begin 
to cross. To do this properly every child should have an examination of the 
eyes before starting the first grade followed by occasional examinations 
throughout school life. 

When there are no school physicians the teacher can catch many cases 
of squint in the very early stage by following a simple test. The pupil looks 
intently at a sentence on the blackboard twenty feet away. The teacher covers 
first one and then the other of the student's eyes. When the hand is sud- 
denly removed from in front of a badly defective eye it will be noticed that 
the eye is slightly crossed and that it will quickly jump back into line. Such 
children should go to the eye specialist for a more careful examination. 

Aside from the use of this method the teacher is in a very good position 
to judge of the sight of the student. Dr. Baker even went so far as to say 
"the teachers are in a better position to diagnose eye strain than the inspector 
or nurse, not from the fact that the child cannot read the test card but from 
the symptoms shown in the classroom during the usual period of school 
hours." 

As one can infer from the above statement by Dr. Baker there are simple 
test cards available everywhere by the use of which a teacher can form a 
fair idea of the vision. In addition to using these an observant teacher can 
strongly suspect eye strain from such signs as frequent sties, redness of the 
lids, excess of tears, intolerance of light, squinting, habitual blinking, 
wrinkling of the brows, "crow's feet" at the outer side of the eyes, holding the 
head sideways, bending over the work or frequent shifting of position. 

Dr. Shaw told of a boy whom one teacher reported spending the long 
school hours practically unemplo}'ed, twisting and turning about on his seat and 
making strange grimaces. The trouble with the boy was that he had opacities 
on his cornea. "Sitting through the school session without any intelligent 
idea of what was going on about him, the child was simply amusing himself 
getting glimpses of the light which streamed into the room from the various 
windows." 

Dr. Fulkerson studied the proportion of children having poor vision 
among a lot of backward children. He found that 53 per cent of them were 



WHY IS YOUB CHILD "IT"? 843 

deficient because their sight was bad. By remedying the defects the children 
were able to train away from failure. He quoted others as having found 
from 42 to 45 per cent of such children with eye defects. 

Wessels says 25 per cent of school children have defective sight. The 
percentage of children with defective sight among the backward is more than 
double that among all children. He says that it costs $35 a year to teach 
each pupil. It costs $280 to carry each pupil to the eighth grade. If by 
reason of poor vision the child is backward it costs the community $280 to 
carry him to the fourth. 

On the basis of 7,814 children examined in a Philadelphia series Wessels 
figures a composite loss of $414,685. The extra expense to which Philadelphia 
is put to educate backward children of poor vision he places at $87,000 
a year. 

The reports from those who are in charge of reformatories and prisons 
show that the proportion of those with poor sight is even larger. Dr. Case 
found that of 400 boys in the Elmira reformatory 223 needed glasses in 
order to do near work without suffering. In the New Jersey reformatory 
83 per cent of the boys need to wear glasses. Dr. William Eichards said : 

"Some time ago I became impressed with the idea that the criminals I 
knew also were the most incompetent people I knew, and thought there might 
be some relation between these two facts. I therefore made a physical exami- 
nation of a good many criminals and found that they were all of them suffer- 
ing from some form of physical defect." 

William Evers, formerly guard on "murderers' row" in the Tombs, is 
quoted by Dr. Eichards as follows : 

"I have been dealing with criminals for twenty-nine years; perhaps I 
have seen more murderers than any man in the United States, possibly in 
the world, and I have never seen a criminal who did not have some physical 
defect which in my opinion was the cause of his being where he was." 

Stimulated by his experience with criminals in the prisons in New York 
state and convinced that he was working at the wrong end of the line, Dr. 
Eichards and his associates for several years have been successfully handling 
groups of incorrigibles in the New York school by attending to their physical 
defects and especially their visual defects. 

The children cared for fell into three groups. 

1. The ungraded, or those too backward for regular classes. This group 
formed half the total. 

2. Backward children who had to take more than one term to a grade. 

3. Delinquent children, truants, and those who kicked and bit and 
screamed every now and then and with whom nothing could be done in a 
disciplinary way. 

A great many people not especially interested in child welfare will be 
interested in one general position taken by Dr. Eichards — that there are a few 
great causes of disease which can be grouped under two general heads, "faults 
of habit" and "faults of structure." These make a favorable soil for the 
exciting causes of disease to act upon. 

Dr. Wessels investigated the proportion of backward children among 
those with poor vision. In his Philadelphia city hall clinic he examined 
9,167 school children. He found faulty vision in 7,319. The examinations 



844 CHILDBEN 

were carefully made after the eyes had been prepared by the use of drops. 
Of the 7,319 children with poor vision he found upon investigation that 5,211, 
or 72 per cent, were backward. The proportion of backward children in- 
creased as the age of the children increased. Only 29 per cent of the 8 year 
old children were backward. Of the 14 year old children with poor sight 
95 per cent were backward. 

Professor Dufour laid down the following rules: 

1. In all schools the number of shortsighted pupils increases from class 
to class. 

2. The average degree of shortsightedness increases from class to class. 

3. The number of shortsighted pupils increases with the increase in the 
school demands. 

In other words, school work is a strain on the eyes. The longer it lasts 
the more eyes give way under it, and the greater the degree of giving 
way and the harder the work, the greater the number of eyes which give 
way. 

Dr. Cohn found that in the Breslau schools 6.7 per cent of the children 
in the elementary schools were nearsighted; in the academy grade, 19.7 per 
cent; in the university, 59.5 per cent. 

Dr. Eislay found in the Philadelphia schools that 4.27 per cent of the 
lower grade children were nearsighted. The percentage for the academy 
grades was 19.33. Drs. Posey and McKenzie reported that 19.75 per cent 
of the students in the University of Pennsylvania were nearsighted. 

Dr. Parke Lewis advocated changing the educational method where it 
was evident that the eye was going down under the strain. Some of these 
cases can be adequately cared for by properly fitted glasses. Some can be 
relieved by changing the light or the position of the desk or some other detail. 
However, there remain cases in which the eye strain is too great in spite of 
what is done. For these Dr. Lewis suggests that there be less reading and 
more instruction by other means. 

Eousseau wrote : "The child who reads does not think ; he does nothing 
but read; he gets no instruction; he learns words." With a good part of 
this Dr. Lewis agrees. When a child reads he first gets the words from the 
printed page. He then forms a mental image of the thoughts contained in 
the words. 

Dr. Lewis says this is a roundabout process. The mind may stop midway 
of the process, whereupon the printed words mean nothing. To show a 
child an orange, to permit him to handle it as he is told about oranges, is 
a better pedagogic method. By teaching the science through the art we teach 
better and we spare the eyes. 

Eeturning to the starting point, the "it" child is being trained to 
timidity, self-effacement, lack of courage and an acceptance of inequality. 
A very large proportion of the backward children can be made normally 
capable. A very large part of the trouble is due to poor sight. The figures 
show that children with poor eyes are backward and also that backward 
children have poor eyes. 

Many of the sight defects can he corrected by the use of glasses or by 
changing the lighting. By modification of the methods of instruction it is 
'possible to spare the eyes. 



EVIDENCE OF NORMALITY 845 



EVIDENCE OF NORMALITY 

A child of three years of age should be able to : 

1. Touch his nose, eyes, mouth, and pictures of these when directed. 

2. Eepeat easy sentences of six syllables with no error. 

3. Enumerate familiar objects in pictures. 

4. Give family name. 

Four years: 

1. Know own sex. 

2. Recognize key, knife, penny. 

3. Eepeat three numerals in order when heard once. 

4. Eearrange a rectangular card cut differing by half an inch. 

Five years : 

1. Discriminate weights of 45 grains and 180 grains. 

2. Draw after copy a square that can be recognized as such. 

3. Count four pennies. 

4. Rearrange a rectangular card cut diagonally into two triangles. 

Six years : 

1. Know whether it is forenoon or afternoon. 

2. Define in terms of use the words fork, table, chair, horse, mamma. 

3. Perform three commissions given simultaneously. 

4. Distinguish pretty from distinctly ugly or deformed faces in pictures, 

Seven years: 

1. Describe pictures shown him. 

2. Note omission of eyes, nose, mouth, or arms from four pictures. 

3. Draw diamond shape from copy so that it can be recognized. 

4. Pick out red, green, blue, yellow. 

Eight years : 

1. State difference between paper and cloth, butterfly and fly, wood and 

glass in two minutes. Two satisfactorily. 

2. Count from twenty-one to one in twenty seconds without more than 

one error. 

3. Name days of week in order in ten seconds. 

4. Count value of six stamps, three ones and three twos, in less than 

fifteen seconds. 

Nine years: 

1. Give correct change from 20 cents (two dimes) paid for an article 

costing 4 cents. 

2. Name the day, month, day of month, year, allowing error of three 

days either way on day of month. 

3. Name the months in order, allowing one omission or inversion in 

fifteen seconds. 



846 CHILDREN 

4. Arrange in order of weight boxes of same size weighing 90, 180, 225, 
and 270 grains in three minutes. Two out of three trials. 

Ten years: 

1. Name a penny, nickel, dime, quarter, half dollar, two, five, and ten 

dollar bills in forty seconds. 

2. Copy design after ten seconds' exposure. 

3. Tell what one should do in various emergencies and answer difficult 

questions. 

4. Use three given words in two sentences. 

Eleven years: 

1. Detect nonsense in three out of five statements in about two minutes. 

2. Name three words that rhyme with obey in one minute. 

3. Use three given words in one sentence. 

4. Rearrange shuffled words of eight word sentences, two out of three with 

one minute for each. 

Fifteen years: 

1. Imagine clock hands interchanged for hour 6:20 and for hour 2:56, 

telling the time. 

2. Write correctly the opposite of seventeen out of twenty-seven words. 



TRAINING THE CHILD 

One of the first, if not the first, score cards devised to value scientifically 
the physical charms of the contestants in baby shows was worked out by the 
Drs. Clark of Waterloo, la. Judging the entries in a baby show by this 
method has just about displaced the old hair pulling, jealousy exciting method, 
or lack of method, formerly employed. 

Now the Drs. Clark are out with a plan for the orderly training of 
babies. In their opinion lying, stealing, prostitution, cruelty and destructive- 
negs develop upon idleness, disorderliness, and selfishness which in turn result 
from bad training during the first sixty months of life. They propose that 
the character qualifications and mentality of every child over eighteen months 
of age be tested not less often than once every three months. 

For the purpose of valuing these qualities in children and teachers they 
have devised two score cards. One is for children between eighteen and forty- 
eight months of age. The other is for children over four years and for adults. 

The score card for young children contains four points : 

1. Expression of the face and eyes, nervous stability, control of the 
emotions. 

2. Helpfulness to family. 

3. Readiness to care for self. 

4. Self-control as to eating. 

The score card for older children and for adults covers the four points 
covered in the first card and six new points besides. A well trained, normal 
child should score 85 on the score card. 



FIVE CHILDKEN DEAD 847 

Accompanying the score cards are schedules of games arranged according 
to ages. At nine months the child should "pat-a-cake" and find his own teeth 
and tongue; at eighteen months he should help clear off the table and paste 
paper to form squares and crosses; at twenty-four months he should string 
beads, select the colors of beads with accuracy and voluntarily pick up broken 
beads and put them into waste baskets; at thirty-six months he should brush 
his teeth, build houses with blocks, cut out and paste pictures and draw crude 
pictures of houses. 

The teaching of a child should be through play. In the training of a 
child no use should be made of commanding, imploring, threatening or 
buying as a means of securing obedience. They are even more pernicious 
than when used with adults. 

"Don't" should not be used until all other methods of accomplishing 
a purpose have been exhausted. Generally a child bent on mischief can be 
diverted by engaging his attention with some helpful or at least harmless 
act of greater interest to him. The Drs. Clark define mischief as a small 
crime. 

In the main a child can be taught anything desired by encouraging him 
to imitate his parents, his teachers and his companions. Orderliness, cleanli- 
ness and industry can be taught by providing toy brooms, dust brushes and 
cloths and permitting the child to imitate the work of putting the . house 
in order. 

FIVE CHILDREN DEAD 

At least once every day I receive some letter intended for the health 
commissioner of Chicago. I have just read one such. It is a birth report. 
A midwife reports the birth of a girl baby with the name E. S., let us say. 
From the certificate as it lies before me I gather the following information : 

The father, Henry S., is a workingman, forty-four years of age. As his 
employment is one that is unionized it is fair to assume that he belongs to 
a union. This means that he gets wages that are at least fair. He is not 
trying to maintain his family on the wages paid to unskilled laborers. They 
live in a part of town where the residences are two story frame cottages set 
on ordinary city lots. 

His wife, Mary S., is thirty-nine years of age. This is the twelfth child 
born to Mr. and Mrs. S. Of these seven are living and five are dead. The 
certificate does not give the ages of these children but they are necessarily 
young. Probably the oldest is less than twenty years of age and perhaps two 
or three are under five. It is a safe guess that of the twelve less than half 
will reach fourteen years of age. 

It is not fair to a hard working woman that she should bear twelve 
children and lose half of them at ages when they are still dependent on her. 
Thirty-nine years old, twelve children ! Ever since she put on long dresses 
she has been caring for babies. Most of the time she has been bearing 
one and caring for another and more often two. Outside of her children 
precious little time has Mary had for any pleasure except pleasure in her 
children. To the mother who loses more than half of her babies in baby- 
hood pleasure in her children is mixed with pain. 



848 CHILDEEN 

Is it necessary that half of the babies of the Marys should die? There 
are places where the Marys raise eleven out of their family of twelve babies. 
Eight here in town with Mary, not five miles away from her, there are Marys 
who have raised some nine and some even ten of their twelve children. Then 
why not Mary? 

She has been very busy. Probably she has never heard of the way those 
more fortunate mothers have preserved the health of their children. Nobody 
went to her with that information and she did not have time to go out in 
search of it. The only people to tell her how were neighbors who had lost 
their six or ten babies. 

Maybe her babies had to live on dirty milk. Mary got the best she 
could but the best was not good enough to save her babies. Maybe her house 
was small, and she had to wash and cook in the room Avhere the baby slept. 

Whatever the cause, is it fair to have Mary bear twelve children and 
lose half of them in babyhood? 



WHAT THE MOTHER OF A CRIPPLED CHILD OUGHT TO KNOW 

It is estimated that there are over 200,000 crippled children in the 
United States. To the mother of a crippled child this statement means that 
there are hospitals and schools for the proper care of such children. Of 
these 80,000 are crippled as the result of tuberculosis. 

Tuberculosis in bones and joints results in the main from eating food 
containing tubercle bacilli. The food which spreads more tuberculosis than 
all other foods combined is milk from tubercular cows. 

The mother of a crippled child should know how she may protect the 
other children in the family as well as the one that has been and perhaps is 
still being infected. 

She should know that the pain in tubercular disease of bones and joints 
is usually felt in some portion of the body remote from the diseased area. 
For instance, a persisting pain in the pit of the stomach in a child who holds 
his back stiff and who cries when jolted is apt to mean tuberculosis of the 
spine. A child with a persisting pain in the knee is apt to be suffering from 
hip joint disease. 

The mother of a child crippled from tuberculosis of the bones and joints 
should know that a great deal can be accomplished by treatment. The disease 
can be arrested. By discovering the disease early a great deal of the deformity 
can be prevented. 

In a certain sense the responsibility for early diagnosis is up to the doc- 
tor. But how is the doctor to diagnose it early unless the parents first get 
suspicious and have the symptoms investigated? To a limited extent the 
deformities which follow the acute stages of the disease can be repaired. In 
some cases it is possible to insert new bone in place of the lost bones. Stiff- 
ened joints can be made movable again. Surgery offers much to some of the 
cases in this group. It is important that the mother know that crippled 
children frequently suffer from neglect — neglect of which the parents do 
not know. 

The disease is in a bone or a joint. The muscles are sound, but they 



WHAT MOTHEE OF A CRIPPLED CHILD OUGHT TO KNOW 849 

are liable to shrink from disuse. It is important that the muscles be kept 
in good health during the acute stages of the disease. This can be done by 
rubbing and manipulating, by passive exercise, massage, and electricity. 

When the acute symptoms have subsided, the bones or joints have healed 
and the child can get around, the mother should stimulate the child to play. 
Play keeps the muscles healthy and the joints movable. 

It renders another service which is just as valuable. It keeps the child 
in touch with other children, develops his mind, and prevents him from 
becoming sensitive and morbid. 

Sugar Good for Children. — A. B. C. writes: "How about sugar for chil- 
dren 1 ? Is its moderate use (accent on moderate, please) advisable? My 
boys, ages 9 and 10, like it on their oatmeal of a morning. Some pronounce 
that 'combination harmful. They say it conduces to colds, etc." 

Reply. — Sugar is an excellent food for children. It is burned into 
energy and children use that commodity by the wholesale. There is much 
danger of their overdoing it. When they are first allowed candy and sweets 
without stint they overdo, but after a short while they become satiated. 
A good part of the overdesire for sweets is due to an undersupply. Desire 
shrinks a little when we know we can get what we want. There are some 
exceptions. I should say let the children have plenty of sugar on their 
oatmeal. 

Candy Good for Children. — W. 0. writes: "1. When a person has a 

'sweet tooth' that is, takes lots of sugar in both drink and food, has that a 
tendency to produce bad effects (blood turning into sugar, etc.) later in 
life? 2. Children as a rule are great for sugar and sweets. Is it good or 
lad for them?" 

Reply. — 1. Yes. Eating of sugar and starches carried beyond the burn- 
ing power of the system causes one form of what is called diabetes. How- 
ever, it is the mildest form and easiest kept under control. It affects grown 
people. 

2. Children should have all the sugar and sweets they want. It is a good 
idea to keep clean, wholesome and especially home made, candy where the 
children can take it whenever they want it. Candy is a good heat maker 
and a fine energy producer. 

Bad for Child. — Mrs. B. writes: "Kindly inform me what the effect of 
continued crying is on a young child? We have been letting our baby girl 
cry herself to sleep since birth, and, while no evil consequences have been 
observed, we have wondered if such a practice would not have a harmful 
effect on the child's nervous system in time." 

Reply. — Ordinarily a week is long enough to establish the habit of 
going to sleep without rocking. If your child cries herself to sleep after 
months of effort properly to train her I suspect the reason is that you are 
not firm in your control of her, that you start out to control her but weaken. 
To cry herself to sleep is bad for the child but for her to grow up uncon- 
trolled is worse. 

Kernels in the Neck. — L. P. B. writes: "In reply to 'Subscriber you 
say the kernels that form in a child's neck are easily cured. 1. Please tell 
me how they are cured. 2. How can one tell whether they have any con- 
nection with tuberculosis or not?" 



850 CHILDEEN" 

Keply. — 1. Give the child plenty of nutritious food. Let him play out 
of doors all the time. Have his tonsils and teeth put in good condition. 
If absorption is occurring through the nose have that put in shape. Most 
cases of enlarged glands that have not suppurated will get well under such 
treatment. Tuberculin will help. 

2. A tuberculin test. 

Aid for Weak Ankles. — 0. S. says he has a boy, 3 years of age, with 
weak ankles, inclined inward. A physician informed him this would cause 
fiatfootedness unless corrected. The doctor did not know what to do, and 
G. S. asks a remedy. 

Keply. — If the condition is bad have an orthopedic surgeon work out 
the proper plan for relief. If it is only a matter of giving the ankle 
a different tilt an intelligent shoemaker will succeed. If the condition is 
less marked let him go barefooted in the summer time. Encourage him to 
exercise his leg and foot muscles. 

Bath Not Harmful. — H. B. A. writes: "Is a daily ~bath ever too much 
for a normally robust, sturdy little girl aged 5?" 

Keply. — No ; the custom is to discontinue the daily bath about the third 
or fourth year, but that is to save trouble. 

Have Children Exercise. — Mrs. J. 0. K. writes: "I have adopted two 
children, a girl of k and a boy of 2, both of them being thin after a spell 
of measles and the mumps. I wish to know what to feed to them, as I want 
them to get robust. What should we eat to overcome constipation? What 
should a person who is anemic eat to become stout?" 

Keply. — 1. Plenty of vegetables, fruit, bread, milk and some meat. 
Have them exercise in the open air above everything. 

2. Fruit, vegetables and bran. 

3. Milk, bread, meat, vegetables and fruits. There are no special blood 
foods, or flesh foods or strength foods. Any food which is good, nutritious 
and wholesome is a blood food. 

Keep Room Cooler. — C. L. Z. writes: "What is the cause of a boy of 
5 years having night sweats? He seems apparently well." 

Keply. — It is of no consequence. Keep his room cooler and he will not 
sweat. 

Do Not Use a Brace. — T. J. S. writes: "What is the best way to get a 
6-year-old girl who is round-shouldered to hold her shoulders back as she 
should? She is a light eater. Her hair is dry and comes out a good deal 
when combed. We have been using crude petroleum oil on her head, which 
has helped. We put the oil on in the morning and wash the head in the 
evening. Is there anything else that could be done to benefit the hair? She 
seems perfectly well; runs and plays all day, and sleeps soundly about ten 
hours each night. For the shoulders do you recommend exercising or a 
brace? If the former, what exercises, and if the latter, what make or 
kind?" 

Reply. — Do not use a brace. Her shoulders are round because of one 
or both of two defects. Her chest is too narow, the curves in her spine are 
not as they should be, or both. In any event, the posture of her shoulders 
is an effect and you must go after the cause. 



CHILDREN 851 

Boy Fitful Sleeper. — R. M. H. writes: "My boy, aged P-fa, is a rest- 
less and fitful sleeper, waking frequently, and crying out. His health is 
excellent and his evening meal not unduly heavy. He has been fretful at 
night since birth. He sleeps alone. What is the trouble*?" 

Reply. — Ten years ago you would have given this boy worm medicine. 
When no worms came you would have said the medicine was no good. You 
have covered almost every point except two. Is the boy a mouth breather, 
waking when his mouth gets dry? What is his inheritance as regards 
sleeping ? If the trouble is due to mouth breathing the remedy is removal 
of adenoids or tonsils. If it is inheritance you must do the best you can 
to make his sleeping environment quiet. 

Night Terror. — J. II. C. writes: "Kindly let us know what you would 
advise in the case of our girl, J/, years of age, who recently has awakened 
at night with marked symptoms of hysteria. For some minutes she would 
toss on the bed, sticking at the air as well as beating her head. She seemed 
incapable of speech, although she talks excellently when fully awake. Her 
inability to recognize her mother at such stages is one of the distressing 
features of the case. She is naturally of a highly sensitive disposition and, 
accordingly, her training has been along the lines of persuasion and sug- 
gestion. Her food at all times has been carefully chosen and it is within 
the last six months that she has been given meat at all. She never drinks 
tea or coffee or partakes of any condiments whatever. Both mentally and 
physically her development has been normal." 

Reply. — The trouble with your child is night terror and not hysteria. 
Do everything to promote her physical health. If she has adenoids, en- 
larged tonsils or bad eyes have them attended to. Be careful as to her 
diet at supper. 

Underlying night terror is a supersensitive nervous system. Send to the 
National Committee for Mental Hygiene, 50 Union Square, New York, for 
its pamphlets on training children. 

Nervous While Asleep. — V. C. writes that her boy is twelve years old. 
When he is asleep the muscles of arms and legs twitch and jerk — a sort of 
tremor every few minutes. She asks what would cause this condition as 
he is apparently in good health and large for his age. 

Reply. — He is dreaming and mentally tense. He should have less 
nervous excitement, particularly toward bedtime. He should have plenty 
of exercise; he should eat but little meat; he should be taught to relax 
mentally. There is no radical difference between nervous tension when 
asleep and when awake. 

Little Lad Dreams. — M. G. writes: "My little son, 1± years old, when 
asleep twitches and jerks his legs, arms, and quite frequently even his face 
twitches, sometimes to the extent of awakening him. This has continued 
since he was 2 years old. He is apparently in good health and is happy 
and bright. He also at times complains of cramps in the calves of his 
legs." 

Reply. — He is dreaming and his muscle twitching is associated with 
his dreams. To dream during sleep is as natural as to think while awake. 
Nevertheless, dreaming which is associated with twitchings and cramps is 
not so restful as sleep should be. 

The probability is that the child's digestion is below par. Give him 



852 CHILDREN 

a very little simple evening meal — not much bread, rice or sugar, or food 
Of that character. Examine his stools repeatedly for worms, especially for 
pinworms. Do not allow him to play after supper, or to stay up late, or to 
get excited in any way. See that his bed is comfortable and his room well 
ventilated. 

Your physician may find that he has adenoids. 

Treatment for Children's Colds. — L. E. F. writes: "What do you con- 
sider the best home treatment for ordinary colds in children? I am inex- 
perienced, need the knowledge, and confess a fear to lasting results from 
colds." 

Reply. — A purge, light diet, quiet in bed until the aching stage has 
passed. To keep them from having colds — keep them away from people 
with colds and out of warm, stuffy rooms. Read "Cause and Cure of 
Colds" by Sadler. 

Mouth Breathing. — Parent writes: "My daughter, 9 years old, grinds 
her teeth when asleep, breathes through her mouth, and tosses around in 
bed all night. Sometimes she sleeps on her arms and knees, but still 
grinds her teeth. None of the other children can sleep with her. What 
would you advise?" 

Reply. — Have the school physician or your family physician examine 
her for adenoids and enlarged tonsils. Probably she is thrashing around 
because instinctively she wants to breathe through her nose but is forced to 
breathe through her mouth. 

Diseases of Children. — F. L. B. writes: "The real reason why most 
parents are not so averse as they might be expected to be to their children 
having measles, scarlatina, and mumps is that these diseases, which are 
rarely fatal to children when properly treated, are far more severe in their 
effects upon adults. Parents, knowing there is small chance of their chil- 
dren escaping these diseases all their lives, prefer that they should have 
them when they are small, when chances of fatal effects are so much less. 
As to scarlet fever (the real article) and diphtheria, I have never known 
any parents so foolish as to desire their children to have these deadly dis- 
eases. They are dangerous in the extreme to all — young and adults alike." 

Reply. — The mistake under which you labor is so widely believed in 
that it should be corrected. In neither smallpox, scarlet fever, diphtheria, 
measles nor mumps is the disease more severe in grown people than in 
children. You cite three: scarlatina, measles and mumps. Scarlatina is 
nothing but scarlet fever and what is presently said of scarlet fever ap- 
plies to it. 

Mortality Statistics Bulletin 109, United States Census Bureau, ana- 
lyzes 800,000 deaths in the registration area of the United States in 1910. 
There were 6,598 deaths from measles distributed as follows: Under 1 
year of age, 1,540 ; 1 to 2, 2,027 ; 2 to 3, 1,002. Total under 5, 5,338, leaving 
1,260 for all the years of later life. Of this number 852 deaths occurred in 
children of what is termed the school age, 406 were divided among the 
people between twenty and eighty-five. These statistics cover 54,000,000 
people. For purposes of illustration, of all people forty-five years of age 
among this 54,000,000 only 7 died of measles. 

Scarlet fever figures differ only in that the death rate is lower among 
babies and higher among school children. Age forty-five shows even bet- 



CHILDREN 853 

ter with 2.6. Contagious diseases do not run a milder course in children 
than in adults. Clinical experience confirms the figures of the census 
bureau. 

Condition Not Dangerous. — Mrs. M. G. writes: "A boy of 8 is pro- 
nounced by a doctor abroad to have a heart which has nothing wrong with 
it, but is not strong aciioned. 1. Is this condition at all dangerous? 2, 
Should any special precautions be taken with regard to games, running, 
etc., at school? 3. Is there jany treatment which will strengthen a weak- 
actioned heart? Jj.. Would it be inadvisable to take a child or person with 
a not strong -actioned heart to live or stay for any length of time at a high 
altitude? The place I have in mind in asking is 6,000 feet above sea level." 

Reply. — 1. No. 

2 and 3. A weak heart muscle in a boy of eight merely means that all 
his muscles are weak. What is good for his leg muscles is good for his 
heart muscle. See that he plays in the open air up to the limit of his ca- 
pacity. If you can arrange it so that in school or on the playground he 
can have some group play under a playmaster so much the better. 

4. No. 

Children's Diseases. — W. P. writes: "Please write an article telling 
people how unnecessary it is for children to have measles, scarlet fever, 
and diphtheria. I know a few people who believe it a good thing for chil- 
dren to have the diseases in order to 'rid their systems of impurities,' etc., 
and because 'all children have it, you know.' 1. Doesn't the board of health 
quarantine against measles? 2. Isn't a man who permits his children to 
suffer with measles without a physician s attention letting them take 'a 
chance' even if they are 'given purgatives and hot water baths'? 3. Does a 
child's physical organization suffer any consequences from an attack of 
measles?" 

Reply. — Having a contagious disease gets nothing out of the system. 
The system of a person that has had a contagious disease is in no better 
condition and sometimes is in a much worse condition for having had the 
disease. In this day of enlightenment almost no children have smallpox ; 
but a small minority have diphtheria, less than half have scarlet fever and 
not much over half have measles. Therefore, a mother who exposes her 
children to infections throws away a good chance of escaping them. 

1. Yes. 

2. Yes. 

3. Usually the child is not violently ill. Recovery is usually complete. 
However, many children die. More nursing babies die of measles than of 
scarlet fever. Many children get pneumonia as a complication, some get 
Bright's disease, some suffer such changes that for years thereafter they 
are frail and delicate. 

Feeding the Little Ones. — P. A. E. writes: "I am the mother of two- 
children under 7, whom I try to care for in the best possible way open to 
me, but in the last few months I have been led to wonder if I am finicky 
and fussy on points where I had thought I was only reasonably sensible. 
1. Is dinner at 6:30 p. m. as good as at noon? I have always prepared din- 
ner for the children at noon, even though I have to prepare another din- 
ner for their father and myself at night. 2. Are fried potatoes, doughnuts, 
and pie suitable food to be served frequently (almost daily) to children? 



854 CHILDREN 

3. Is it worth the effort of a mother who also has the work of the house to 
do to provide especial foods for children, such as baked or creamed potatoes 
instead of fried, and custards, rice puddings, etc., for desserts? 4. Is it 
justifiable economy to cut down the butter that goes into the cream sauce, 
the egg that goes into the muffins, etc., for young, growing children? I 
am assuming actual poverty does not make it necessary. I hunt for places 
to add to the butter and egg allowances/' 

Keply. — 1. No. 

2. Children can digest these articles much better than adults. Fed 
occasionally or somewhat oftener they are good enough. 

3. No. 

4. Do not economize on the children's food. You can well do so on that 
of the adults. In hot weather feed the children as little fat as possible. 
Give them bread, meat, sweets, fruits and candies. 

Change Boy's Diet. — Mrs. B. H. J. writes: "My son is 6 years old, 
about the right size, strong, rather thin, and active. Every month or two 
he has trouble, called by the doctors a bilious attack. There are high fever, 
a coated tongue, and bad breath. He has been doped with calomel time 
and again \one and one-quarter grains\, which brings away great quan- 
tities of dark green mucus. Then he gets well. He has puffs under the 
eyes a great deal, but examination of the urine shoivs a nearly normal con- 
dition. He has always been troubled with constipation, which is hard to 
regulate by diet, as he cares for few vegetables or cereals. Bran bread 
seems to irritate the bowels and bring on attacks. Please advise me what 
to do to prevent these attacks." 

Reply. — The dark green passages after calomel, usually held to be proof 
of the good done, is no proof at all. In the first place much of the green 
color is due to a mercury salt. In the second place the place for green 
bile is the liver, liver ducts, gall-bladder and upper intestines. In those 
locations it does good work. Whenever it passes beyond the zone things 
are not right. Therefore, green bile in the stools is a sign that the medicine 
is doing something that should not be done. 

Do not dope the boy with calomel. If he needs to be depleted from 
time to time do it with something that will not produce so unnatural a 
result as green stools. 

However, the proper plan is to change his diet. Train him to eat vege- 
tables and fruit in quantity and to drink plenty of water. That may be 
somewhat troublesome but it is less troublesome than a bilious attack 
and a course of calomel once a month. 

Growing Pains of Children. — Mrs. T. B. H. writes: "Physiology says 
children sometimes have what are called growing pains in their arms and 
legs. Our little girl complains of some in her legs some mornings. Shall 
I consult a physician?" 

Reply. — Yes. Growing pains are rheumatic and gouty. Infection 
through the throat must be thought of when the trouble is present in a 
child. 

Child in Need of Treatment. — F. C. writes: "I have a boy 4 years old 
who is in the habit of sniffling. Two or three months ago, as a result of 
this habit, a channel to his ear became affected, and his ear drum was 
operated on by one of our best specialists. It seems impossible for us to 



CHILDREN" 855 

teach him to blow his nose, and we are fearful this habit will give him 
chronic catarrh. Have you any suggestions to offer as to the cure of this 
habit?" 

Reply. — Your child should be examined and treated. There is some- 
thing behind a "habit of sniffling" which "blowing the nose" cannot remedy. 

Promiscuous Feeding. — E. T. A. writes: "Can you say something to 
help make promiscuous feeding of other people's children as bad form as 
promiscuous kissing? My children have been offered every kind of dainties 
at any time of the day, and I believe I am the judge of what and when 
they may eat. Do say something concerning a mother s responsibility as 
the sole guardian of young stomachs, please." 

Reply. — Promiscuous feeding is even more important than promiscuous 
kissing. Making food into tissue is the child's daily task. Promiscuous 
feeding of children by promiscuous people is like the promiscuous use by 
promiscuous people of a monkey wrench on an engine. 

Bananas Good for Child. — Mrs. G. E. N. writes: "Bo you consider 
the daily use of bananas either as a breakfast fruit or dinner dessert desir- 
able, they being the cheapest and most easily obtained fruit? Do you con- 
sider a dish of sliced bananas with sugar and cream, eaten with several 
slices of bread and butter, a dish of cereal, and a glass of milk a proper 
summer breakfast for a healthy child of 9 years?" 

Reply. — Yes, one or two of them. Bananas should be chewed. When 
bolted the stomach juices cannot get in well. 

Take Child to Specialist. — J. L. W. writes: "What is the common sense 
way to treat earache in children? My little girl, 6 years old, is a sufferer 
from earache; not chronic, but there appears a tendency to trouble at times 
when she has played outdoors in the wind, or got her feet wet." 

Reply. — To relieve the pain a hot water bag should be placed against 
the ear. A general hot bath will be of service. If absolutely needed pare- 
goric may be given. So much for that part. 

Earache is due to infection which travels from the throat to the ear. 
To treat earache properly the throat must be treated. She should be taken 
to a throat specialist. Most of the deafness of middle life is due to just 
the condition described by you. 

Have Child Examined. — M. G. C. writes : "A healthy child of 5 is fre- 
quently chafed and irritated. Is the cause urine, or could there be a dis- 
charge from the vagina that causes the itching and smarting? What course 
should be pursued?" 

Reply. — The cause might be thread worms. It might be a gonococcal 
infection. Have an examination to discover what is the cause. 

Food for Young Child. — M. A. R. writes: "Will you kindly advise the 
best combination of foods to be given to a healthy, normal, female child of 
three and a half years to four years of age?" 

Reply. — At the age of four years a child may share the general table 
diet providing it is plain and varied. Fried and highly seasoned foods 
should not be given. 



856 CHILDREN 

As to quantity a healthy child should be permitted to satisfy her appe- 
tite if she eats slowly and masticates thoroughly. Breakfast should consist 
of milk, a cereal and cream and bread and butter. An egg, fresh fish 
or chicken may be added. For dinner give soup, meat, bread and butter 
and some light vegetables. Junket, or pudding, milk, toasted bread and 
butter and stewed fruit will do for the evening meal. Fresh fruits may be 
given before or after meals. 

Tea, coffee and alcoholic beverages are not for the use of children. 
Make meat prominent in the diet. • 

Celluloid Toys. — L. 8. writes: "Are celluloid toys dangerous for habies 
as to explosion on catching fire? Are they dangerous only when exposed 
to open fire, or will striking cause them to explode?" 

Reply. — They are dangerous. An open fire or a high degree of heat 
can ignite them. I have never heard of a spark from a blow exploding a 
celluloid toy. 

Sleep for the Child. — Mrs. F. C. H. writes: "My son, 2 years and 5 
months old, has always been accustomed to long afternoon naps. As he 
grows older he is less inclined to go to sleep, sometimes requiring stories 
and urging for more than an hour. When he wakens it is too dark for him 
to go out again, and he then cannot be made to go to sleep before 8:30 
p. m. We have always had him out every possible moment, and it seems 
too bad these beautiful fall days for him to spend so much time in the 
house. Would it be detrimental to him to discontinue or omit the afternoon 
nap and put him to bed at 6 o'clock? He is normal in every way except he 
has to be urged to eat practically every mouthful." 

Reply. — I would hesitate to advise you to discontinue the boy's naps 
but you can shorten the time to advantage. Wake him at the end of two 
hours and maybe one. It he rests quietly for some time before dropping 
off to sleep count that out of his sleeping time on the basis of sixty min- 
utes of rest in bed while quiet but awake equaling about thirty minutes of 
sleep. If he is a fitful eater encourage him to play actively since play gives 
him muscular exercise.. 

Baby Likes to Eat Mud. — Mrs. J. F. writes from Green Bay, Wisconsin: 
"My son, 2 years 8 months old, seems perfectly normal except for strange 
appetites. He will eat mud, mortar, or coal unless watched, and seems to be 
hungry for such things. When put to bed he rolls from side to side, singing 
himself to sleep. He wakes up in same manner. His diet is carefully 
watched. He seems sturdy, and is fat, but at times he is quite pale. Kindly 
advise me as to method, other than punishing, of curing these morbid 
habits." 

Reply. — The child should be studied, not punished. The probability is 
that he has a mild case of scurvy or rickets. If this is the trouble the 
remedy is to feed him plenty of fresh meat, fruits and vegetables. He may 
have a nervous trouble. It may be that the need is for companionship 
with children mentally more normal; if so, kindergarten will cure him. 
The family physician and the mother should carefully study the child to 
find the reason and correct it. 

Starch Craving Unnatural. — M. C. K. writes: "I have often heard of 
people craving starch. My small daughter eats laundry starch whenever 



CHILDREN 857 

she can get it, and I watch her continually, fearing that it is injurious. 
Does this habit grow? Is it harmful? What causes it?" 

Reply. — She cannot digest raw starch. It ferments in her intestines. 
Both children and adnlts are liable to starch indigestion. 

I suggest that yon see your physician. The craving is unnatural. 
Such cravings may indicate chlorosis, or intestinal catarrh. 

Feeding Year-Old Child. — D. F. writes: "May I trouble you to let me 
know what you consider a proper diet for a baby 1 year old, just weaned 
and perfectly healthy? She has a good appetite and does not find milk 
sufficient." 

Reply. — 1. Feed regularly. 

2. Milk with one-fourth its quantity of barley or oatmeal water should 
form the basis of the diet. Six to eight ounces of this mixture may be given 
at a feeding. 

3. A little stale bread, potato and butter, zwieback, beef soup, white of 
an egg, prune or orange juice may be given alternately. 

4. Rich foods should not be given at this period; solid food not until 
the child is able to chew it. 

5. Watch the child closely for evidence of indigestion. Be guided by 
your physician in changing the food and feeding habits as soon as trouble 
shows. 

Feeding the Baby Potatoes. — G. F. M. writes: "Kindly inform me 
whether mashed potatoes with butter or meat gravies in moderate quan- 
tities given to babies more than a year old cause constipation or are in any 
way harmful to them." 

Reply. — If given in moderation potatoes with gravy and butter will be 
all right. It will not cause constipation. Begin with a small portion and 
gradually increase the allowance. However, the quantity given can be 
easily overdone. 

Nodding Spasm. — C. E. W. writes: "My baby girl, Ik months old, has 
been since birth a healthy, normal child. She is heavy for her age, weigh- 
ing So pounds; she talks and walks and eats heartily of milk, eggs, cereal, 
fruits, and soups. At the age of a year she began to develop a shaking of 
the head. Her head moves constantly, and the shaking from side to side is 
in appearance like an aggravated case of palsy. Except for this condition 
the child seems to be in perfect health. What could cause it? What 
treatment would you advise? Is it curable?" 

Reply. — Your child has what is usually known as nodding spasm or 
Henoch's spasm of the head. Have you noticed that the eyeballs are moved 
almost constantly (nystagmus) I The condition develops sometimes in 
teething children. Rickets is the cause in many cases. 

It generally responds to a regulated diet, life in the open air and the 
use of some preparation of phosphorus. The outlook for cure is good. You 
should have your physician see her. 

Cleft Palate. — M. M. L. writes: ''Is there any cure or remedy for a 
'split' palate, antedating the birth of the child, who has now reached the 
age of 16, without any lessening of the impediment in speech caused ' 
thereby? Is there any artificial appliance made which would prove of 
benefit in a case of this kind?" 



858 CHILDREN 

Reply. — In the development of a child the growing in of a membrane 
to divide the nose from the mouth takes place rather late. The membrane 
(both the hard and soft palate) grows as a plate coming down from each 
side, finally growing together in the middle. This is the way it hap- 
pens in the mouth. The lips follow a somewhat different plan. It some- 
times happens that halves do not completely unite — then we have cleft or 
split palate. It should be operated on. The earlier the better because the 
child must learn to use the muscles differently in talking. 

Stature. — A. R. writes: "I have a son 12 years old who is no taller 
than boys 9 years old, and I am afraid he always will be small. My hus- 
band is 5 feet 10 inches tall and I am 5 feet 6 inches. Both are strong 
and healthy. The two other children (girls) are of proper height. He is 
the second child. Some time ago I read that a British physician prescribed 
thyroid extract for a boy 18 years old and the boy gained seven inches in 
six months. Can you give me information about it?" 

Reply. — In determining stature three factors must be considered — in- 
heritance (of great importance), ductless glands and nutrition. In decid- 
ing whether inheritance is the cause it is necessary to consider the family 
tree as far back as the four grandparents at least. One short grandparent 
is most likely the explanation of the shorter stature of your son. It has 
been demonstrated that plenty of exercise leading to good muscular develop- 
ment and an abundance of food helps. As to whether the use of ductless 
glands taken by the mouth will help or not I hesitate to express an opinion. 
The matter is being investigated in many different quarters and informa- 
tion sufficient for guidance should be forthcoming before long. Do not 
give your boy thyroid except under medical guidance. The drug is too 
powerful to be otherwise taken. 

Harelip Can Be Cured. — Mrs. A. C. writes: "A child was born here 
with a bad case of harelip and cleft palate. What is the cause of that? 
„ Had the baby lain in such a condition before birth as to prevent proper 
development? Some old people say it is a birthmark, caused by the mother 
being frightened. Is that so? If it is properly attended to from the start, 
can it be cured? This child was immediately taken to a specialist, who 
put a few stitches in the palate. That seemed to help enough so a little 
food could be taken through his mouth. Two weeks after a wire was placed 
so as to draw the two parts together. This has been done about three times. 
The last time the jaw bone ivas split on the opposite side. It has helped 
some, but during the last couple of months nothing has been done, and that 
deep gash in his jaw looks anything but promising. Please state your 
opinion of such a case. He is 7 months old." 

Reply. — The mother being frightened and the position of the child 
have nothing to do with the case. As the child is being formed the upper 
lip develops from four centers. If the four separate pieces fail to grow 
together just right a harelip results. The reason for harelip is so easily 
understood by studying the development of the mouth that it is hard to see 
how all the foolish ideas got started as that about birthmarks, mother 
being frightened, position of child, and the like. 

Harelip can be cured. As your physician does not seem to be doing 
well get him to direct you to a specialist in operations on harelip. 

Will you not also write to the Eugenics Laboratory, Cold Spring Harbor, 
N. Y., if you know of other cases of harelip in this family ? 



CHAPTER XLVI 



First Aid 



Not to know what to do in minor emergencies is somewhat of a disgrace 
now. First aid is being taught by scores of agencies and nearly everybody 
is being reached. The American Eed Cross is teaching it by a number of 
approved methods. The national and state governments are covering some 
part of the field. 

First aid is a larse part of the program of the Boy Scouts and the 
Camp Fire Girls. The Y. M. C. A. 
teaches it to its members. The large 
employers keep first aid posters con- 
spicuously displayed and some provide 





Fig. 309. — Method by Which One 
Man Can Carry a Wounded 
Man. 



Fig. 310. — Another Method by 
Which One Man Can Carry a 
Wounded Man. 



systematic care in first aid. The boys who have been trained in the army, 
navy and militia know what to do and what not to do. 

Books on first aid, clear and simple in text and well illustrated, are sold 
for a few cents. Among these none is better than the series written for the 
Eed Cross by Major Charles Lynch of the United States army. From the 
Manual of Instructions most of the following is taken. 

859 



860 



FIKST AID 



The materials for first aid are given as bandages, compresses, splints, 
tourniquets, stimulants and emetics. The surgical instrument houses sell first 
aid packages containing material often needed. Simple pocket first aid pack- 
ages constitute one form; another form is a portable case and a third, more 
fully equipped, is intended for use in an emergency hospital. 

No person should be near a patient but those actually needed for help. 
The injured person needs air. Furthermore, he should be spared the mental 
shock of seeing a mob of strange people crowding around him. 

The best position for the patient is lying fiat. If the face is flushed 
it is safe to raise the head enough to put a pillow under it. If the face is 

pale the head must not be 
raised from the floor. If 
the patient is vomiting the 
body should be turned on 
the side and the head 
turned so that the vomit 
runs out of the mouth. 
Beyond this no lifting of 
the head is justified. To 
raise the head straight up 
is greatly to increase the 
danger that the vomit will 
go by gravity into the wind- 
pipe. 

No water or stimulant 
should be given. Unless 
consciousness has fully re- 
turned the liquid is apt to 
go into the windpipe. On 
account of the tendency to 
nausea from shock the 
liquid, whatever it may be, 
is liable to cause vomiting. 
Whisky does more harm than good and brandy has no advantage over 
whisky. 

A distinguished woman physician was once hauled from hospital to 
hospital when suffering from the shock of an apoplectic attack because some- 
one had given her whisky when she became faint and the hospital attend- 
ants, smelling whisky, thought she was drunk. 

A prominent woman was carried to a police station and neglected for 
several hours though suffering from concussion as a result of a fall because 
some busybody tried to pour some whisky down her throat as she lay half 
conscious. 

As a general rule, after a few minutes of unconsciousness the rested 
heart again becomes equal to its task and no stimulant is needed. Generally 
speaking, any consciousness that returns after a stimulant would have re- 
turned without the stimulant and those cases in which consciousness does 
not return spontaneously are harmed by stimulants. 

If a person who has been unconscious would like a bracer give him 




Fig. 311. — A Short Stretcher Made with Two Rifles. 



FIKST AID 



861 



half a teaspoonful of aromatic spirits of ammonia in a fourth of a glass 
of water. 

A person recovering from a hurt generally wants water. This is be- 
cause shock has paralyzed the salivary glands and not because he needs water. 
If he insists give him a few sips, but see that he sips it ; or give him a piece 
of ice to hold in his mouth or gum to chew. 

Loosen the collar and all tight clothing. If there is profound shock — 




Fig. 312. — Method by Which Two Men Can Carry a Wounded Man. 



Cover the body well with blankets. 

Put hot bricks to the extremities. 

Rub the limbs briskly. 

Place flannels wrung out of hot water or towels over the abdomen. 

Put ammonia or smelling salts to the nose. 

Give hot coffee or aromatic spirits of ammonia. 

Introduce two fingers into the rectum and stretch the sphincter muscle. 

After severe injuries it may be advisable to move the patient. Do not 
do so until search has been made for fractures. 

If there is a fracture of the arm above the elbow or leg above the knee 
or if both bones of the lower leg are broken the patient must not be moved 
until the broken limb is splinted. 



862 



FIEST AID 



For this any sort of a board or rod or broom handle will do. To this 
the injured limb must be securely tied in several places. 




Fig. 313. — Compress the Carotid Artery for Severe Hemorrhage about 

the Head and Neck. 

The patient generally knows when a bone is broken. Works on first aid 
give signs by which one may know when there is a fracture. Such are 
deformity, crepitus, and the like. The person hurt will generally tell you 




Fig. 314. — Digital Compression of Subclavian Artery. 



offhand of the fracture and where it is, and probably the inexperienced helper 
had better accept the diagnosis and proceed accordingly. 

if there is a compound fracture, that is, if the broken bone sticks through 




Fig. 315. — Diagram Showing Position of Important Arteries. The arteries shown in 
heavy cross-bars are superficial and ean'be compressed at points in area shown. Arteries 
shown in dots are deep. 



864 



FIRST AID 



the skin or if there is a wound extending down to the break the wound 
must be covered by the compress found in the first aid packet and then the 
limb must be splinted to something solid and firm. 

In treating the wound the fingers must not touch the bone or the wound. 
It is highly desirable that the wound should not become infected and to 
inspect it or handle it is to invite infection. 

When the fracture is of the backbone or of the neck the warning against 
reckless handling of the patient must be emphasized. It may be better to 
leave him where he is until the doctor comes. 

If he is to be moved it must not be done until the back and neck are 





Fig. 316. — Digital Compression of 
the Femoral Artery. 



Fig. 317. — Tourniquet 
to Control Hem- 
morrhage in the 
Forearm or Hand. 



rigidly splinted; otherwise the broken bone may tear the spinal cord and do 
irreparable harm. 

Whenever wounds break the skin the part must be protected to prevent 
germs from getting in. The few that are driven in by the agent producing 
the wound stand a good chance to be destroyed if no more are carried in. 

It is well to encourage wounds to bleed and ooze up to a certain point. 
Bleeding and oozing constitute the best sort of washing. It is much better 
to put nothing on a wound than to put on any unclean thing. In fact, it is 
better to put nothing on than to put on anything about which you are not 
certain. 

At the present time there is a decided movement toward the open treat- 
ment of wounds. When one has a first aid packet he should open up the 
wrapping and apply the compress and do it without washing the wound. 
Leave that for the doctor. 

In case the hemorrhage from the wound is excessive, the treatment of 
the hemorrhage takes precedence over treatment of the wound. If the hemor- 



NOSE BLEED 



865 



rhage comes in spurts it is from an artery. If it is a steady flow it is probably 
from a vein especially if it is dark. 

If the blood is spurting deep pressure should be made on the skin be- 
tween the bleeding point and the heart. If the blood is from a vein the 
pressure should be on the other side of the wound. 

Pressure in the wound is often 
ineffective because the cut vessels may 
contract until it is out of the wound. 
It is so liable to infect that it is rarely 
justified. 

Often in arterial hemorrhage 
some near-by artery between the cut 
and the heart can be seen throbbing 
and pressure upon it will speedily 
show whether it or its branch is the 
vessel injured. 

If the bleeding wound is in a 
limb the tourniquet can be applied. 
For this no special anatomical knowl- 
edge is required. Students taking first 
aid courses are always taught some 
score or more points at which impor- 
tant blood vessels can be reached, 
for example, just in front of the ear, 
where the lower jaw can be felt work- 
ing in its socket; over the throbbing 
artery in the temple; in the neck at 
the front border of the heavy muscle 

running from the breastbone to a point just behind the ear; deep in the 
hollow behind the collar bone; at the inner border of the big muscle of the 
front of the arm — the biceps; at the middle of the groin. 




Fig. 318. — Compressing the Femoral Artery 
with Tourniquet and Pad for Severe 
Hemorrhage in Leg. 



INTERNAL HEMORRHAGE 

In internal hemorrhage have the patient lie flat. Apply cold over the 
organ where the bleeding is located. Put hot bricks to the feet. Do not give 
stimulants. 

NOSE BLEED 



If mild, do nothing. When severe grasp the two nostrils with the finger 
and thumb. Press the soft wings against the septum. Have the patient 
lean forward. The purpose is to allow the nose to fill with blood and to give 
this blood time to clot. Apply a cold cloth wrung out of ice water to the 
back of the neck or place a piece of ice under the upper lip between that and 
the gum. Press on the lip. 

Cold water or ice on the back of the neck or over the bridge of the nose. 
A towel wrung out of cold water and placed around the neck with one end 



866 



FIRST AID 



over the bridge of the nose. Pinch the nostrils together. If bleeding per- 
sists, plug with a piece of cotton. Tie a thread around a piece of cotton as 
large as the end of the thumb ; soak in strong tea or lemon juice ; push gently 
up into the nostril. After the bleeding has stopped for about a half hour pull 
the cotton out gently by the thread. 



DISLOCATIONS 



A man giving first aid should never try to replace a dislocated joint 
except in two locations — ringers and jaws. To try will generally mean to 

fail and the hauling and pulling may harm 
important structures. It has happened that 
large blood vessels have been torn and impor- 
tant nerves have been paralyzed. In case of 
dislocation the injured limb should be snugly 
wrapped and made as comfortable as possible 
while help is being secured. 

DISLOCATION OF THE LOWER JAW 

Tear a handkerchief in two. Wrap one 
piece around each thumb. Place the thumbs 
in the mouth pressing against the crowns of 
the teeth on each side. With the fingers seize 
the lower jaw on each side. Press down and 
backward. As the head of the bone slips into 
its socket the molars will clamp the thumbs 
unless they are quickly slid toward the tongue. 




Fig. 319. — Compressing Bra- 
chial Artery for Severe 
Hemorrhage in the Elbow, 
Forearm and Hand. 



DISLOCATION OF A FINGER 



By grasping the finger with one hand above 
the dislocated joint and with the other below 
it and making gentle traction the joint will slide into place. A little gentle 
flexion and extension will be of service. 



RESCUE OF PERSONS AT FIRES 

Lynch, after advising that persons going into a burning building tie a 
wet handkerchief around the nose and mouth, says : "Kemember that the air 
within six inches of the floor is free from smoke; so when unable to breathe 
crawl along the floor with the head low, dragging anyone you have rescued 
behind you. Crawl backward in the same way down a staircase or any 
slope." 

TREATMENT OF A BURN 



Exclude air by a thin paste made with water and cooking soda, starch 
or flour. Smear on a cloth and cover the injured surface. If these are not 



ELECTEIC SHOCK 



867 



at hand use vaselin, lard, cream or any grease. In using grease use the 
cleanest possible. Do not use old grease or dirty grease. Do not use car- 
bolized grease. If time will permit heat the grease and then cool it before 




Fig. 320. — Artificial Respiration, Inspiration, Pressure Off. 

using it. To boil is not necessary. A place where burns are frequent should 
always carry a picric acid compress or picric acid bandages. When these are 
available they should be used instead of the soda paste. 




Fig. 321. — Artificial Respiration, Expiration, Pressure On. 

Burns with acid should be treated with lime wash made of lime scraped 
from the wall and thrown into water, soapsuds or milk of magnesia. 

Alkali burns should be washed in vinegar, lemon juice or hard cider. 



ELECTRIC SHOCK 



The safest means of rescue when it is possible is to short circuit the 
current before it reaches the persons shocked. This can be done by dropping 
a metal bar or rod or a wet stick or rope on the side between the power 
and the person. If the live wire is on the ground and the person is on 
it it will be safe to roll him off with the hands. If the live wire is on the 
prostrate person it will be safe to fleck it off with a dry stick if the hands 
are dry. Of course it is much safer to handle the wire with a glass rod or 



868 



FIRST AID 



with hands covered with rubber gloves. If neither of these is at hand covering 
the hands with a mackintosh is fairly safe. 

The patient is to be covered with warm wraps. Artificial respiration 




Fig. 322. — Blanket Stretcher. 



is to be done if breathing has stopped. In some cases respiration having 
started up will stop again. In that event artificial respiration must be 
resumed. 




Fig. 323. — A Pillow Used as a Temporary Splint in Fracture of the Leg. 



The household emergency box should contain the following, according 
to Lynch: • 

Alcohol. 

Aromatic spirits of ammonia. 
Castor oil. 
Epsom salts. 
Powdered mustard. 
Lime water. 
Bicarbonate of soda. 
Sirup of ginger. 




Fig. 324. — Gun Used as a Temporary Splint in Fracture of the Femur. 



SOME MINOR AILMENTS 



869 



Sirup of ipecac. 

Witch hazel. 

One-tenth grain calomel tablets. 

Carbolized vaselin. 

Five grain bismuth tablets. 

One dram oil of cloves. 

Soda mint tablets. 

Talcum powder. 

One package antiseptic gauze. 

One-half pound absorbent cotton. 

Six gauze roller bandages. 

Two Bed Cross First Aid outfits. 

One roll oiled silk. 

One small bottle collodion. 

One box tooth wax. 

One box tooth plasters. 

One pair scissors. 

One sharp knife. 

Pins. 



SOME MINOR AILMENTS 

COLIO AND CRAMPS 




Fig. 325. — Sling Made From 
Coat. 



Appendicitis starts with colic. Fever comes 
after. 

Gall stones cause a colic, but the pain is 
liable to be so severe that it is referred to as 
"stabbing." The shock with gall stones is 
usually severe. 

Kidney stones cause a colic. The pain shoots into the genital organs. 

Then there is the ordinary abdominal colic known as cramp or colic. 
It is caused by spasm of the muscles of the intestinal wall. When much 
shock is present look for a cause. If fever follows the colic look for a cause. 




Fig. 326. — First Aid in Fracture of Leg. Strapping legs together. 

Treatment — Put a hot water bottle over the seat of pain. Take essence 
of peppermint or sirup of ginger in warm water or take soda mint tablets. 
Take a purge. Produce vomiting where indicated. 



8*0 



FIRST AID 



TRANSIENT DIARRHEAS 

Give a laxative — sirup of rhubarb, castor oil or A. S. & B. pills. A 
dose of salts or purgative water acts more quickly. To ease the cramping 
give sirup of ginger, a teaspoonful in water after each passage; or paregoric 
in teaspoonful doses, repeated when needed at four hour intervals ; or Squibbs' 




Fig. 327. — First Aid Treatment of Fracture of Both Bones of Leg. 

cholera mixture. Cholera mixtures and paregoric contain opium and there- 
fore should be taken cautiously. Stop all food except boiled milk. If the 
diarrhea persists see a physician. 

Diarrhea in babies is a more serious matter and it is taking chances 





Fig. 328. — Fracture of 
Nose. 



Fig. 329. — Fracture of Finger. 
Wooden Splint Applied to 
Palm Surface. 



to doctor it at home. When a baby gets diarrhea give a dose of castor oil 
and watch the food closely. When the oil acts and the diarrhea does not stop, 
see a physician. 

NAUSEA AND VOMITING 



Nausea may be due to some food which has disagreed. In that event 
home treatment is all that is needed. It will save trouble to empty the 
stomach. Two glasses of lukewarm salt or mustard water may be given. 
It may be necessary to put the finger in the throat or to tickle the throat 
with a feather. After this use a little cold water and a soda mint tablet. 



SOME MINOK AILMENTS 871 

Many forms of severe infection [scarlet fever] begin with vomiting. In 
certain diseases poisons in the blood are excreted by the stomach and nausea 
results. Therefore the field for home treatment of vomiting is somewhat 
limited. 

HICCOUGH 

Between the chest and the abdomen is a great muscle called the dia- 




Fig. 330. — Break of Bone in Back of Hand. Corresponding to Right Middle Fin- 
ger. Corrected by Bending Hand Over a Bandage Held in the Palm with Adhe- 
sive Plaster Reaching from Back of Hand to Front Part of Wrist. 

phragm. Hiccough is due to spasmodic contraction of this muscle. Transient 
hiccough can be relieved by holding the breath just as long as possible, or 
by intently trying to bring the two index fingers close together without touch- 
ing them, or by throwing a glass of cold water on the face, or by any one 
of a half dozen tricks. 

If these do not bring relief vomiting should be induced. If the hic- 
cough is disturbing enough to warrant nervous chills apply warm applica- 




Fig. 331. — Fracture of Wrist. Colles Fracture. 

tions and give a cup of hot tea. If there is much shock give twenty drops of 
aromatic spirits of ammonia. 

Stop up both ears with the fingers of each hand and drink water slowly 
from a cup held by someone else. Produce sneezing. Pull tongue out and 
put a piece of sugar or soda on it. Hold out for a few minutes. 

NEURALGIA 

Apply hot applications or rub with a menthol pencil or with some good, 
warm, aromatic liniment. 



872 



FIEST AID 



EMERGENCIES 

The following suggestions are for the mothers who may or may not have 
a first aid kit handy. Children especially are prone to fall down and skin 
their knees. Bumps are of everyday occurrence. Children are constantly 
getting into mischief resulting in emergencies for which few mothers are 
prepared. 

BLACK EYE 

Bathe the eye immediately with hot water and rub it very gently. 

FOREIGN BODIES IN NOSE 

Children are much inclined to push corn, beans and other small objects up 
into their noses. The first thing to do is to tickle the nostril with a thread 
or feather until the child sneezes. Do not push anything into the nose as 




Fig. 332. — Dislocation of Both Bones of the Forearm Backward, Showing Position 
of the Ends of the Dislocated Bones, Deformity of Elbow, and Position of 
Forearm. 

it may push the objects up farther. Have the child blow the nose. If these 
simple procedures fail call a doctor. 



See page 865. 



NOSE BLEED 



CHOKING 



Slap on the back between the shoulders. Eaise the child's arms as high 
as possible above the head. If the object is small let it go through the body. 
Have the child eat bread or potatoes. Do not give castor oil or other 
laxative. 



HICCOUGH 



See page 871. 



EMERGENCIES 
BITES OF INSECTS 



873 



For the relief of bee stings, mosquito, fly, spider, bug and other insect 
bites applications of damp baking soda or ammonia water will afford relief. 

RUSTY NAIL WOUND 

Wash the foot and wound with warm water and soap. Thoroughly cleanse 
the wound with peroxid, then with alcohol, and paint with several coats of 
tincture of iodin. 




Fig. 333. — Artificial Respiration, Sylvester Method. Expiration. 



See page 866. 



BURNS 



BRUISES 



When the skin is not broken apply cloths wrung out of hot water; then 
apply witch-hazel. If the skin is broken cleanse the wound with castile soap 
and warm water; then use boracic acid solution and apply zinc oxid. 




Fig. 334. — Artificial Respiration, Sylvester Method. Inspiration. 



CUTS 



Cuts should be washed and cleansed with peroxid, a piece of gauze dipped 
in boracic acid solution should be applied and then the cut bandaged. If the 
cut is deep make a pad of many thicknesses of the gauze and bandage tightly. 
If the cut is large and requires stitches call a doctor. 



874 



FIRST AID 



ARTIFICIAL RESPIRATION 

This procedure is simple. A certain sort of artificial respiration con- 
sists in expelling the air by pressure on the chest sixteen times a minute. 
As soon as the pressure is relieved air will flow into the lungs. On this 




Fig. 335. — One Method of Resuscitation After Drowning. Can be Employed bt One 
Man. Drains the Lungs; Lifting, Especially with Arms Under Body, Expels Air 
from the Lungs; Normal Expansion Draws in Air. To be Repeated Fourteen Times 
to the Minute. 



AETIFICIAL EESPIKATION 875 

simple procedure the different artificial methods of respiration are built. 
No one of them is difficult to carry out. A Boy Scout or a Camp Fire Girl 
can carry them out just as well as can a physician. 

Sylvester Method. — Clean all water and dirt out of the nose and mouth. 
Roll the person on his back. Elevate the shoulders about two inches by put- 
ting his coat under them. Have someone pull the tongue out slightly and 
hold its tip just outside the lips. Place a watch where the operator can see 
it. Unless checked by the watch the respiratory movements will be gone 
through with too rapidly. 

Kneel just above the person's head facing towards him. Catch both his 
arms just below the elbows. Draw the arms outward and upward until they 




CM- 

Fig. 336. — Artificial Respiration. Hall Method. 

are pointing toward your abdomen. Hold in this position two seconds. This 
moving pulls the chest upward. As it moves upward the ribs move outward. 
Thus a partial vacuum is created in the bronchial tubes and air rushes in 
to fill it. 

Carry the arms back to the side and front of the chest following the 
track through which they were lifted. Complete this movement by firm 
pressure on the lower part of the chest exerted through the person's elbows. 
This second movement compresses the chest, drives out the air and places 
the structures of the chest in such condition that the spring back when the 
pressure is relieved will pull air deep into the chest. 

This is a respiratory cycle. It should not be gone through oftener than 
sixteen times a minute. If artificial respiration is worth doing at all in a 
given case it is worth keeping up for two hours. 

Laborde has suggested an addition which can be carried out by some care- 
ful person while artificial respiration is going on. More care is required for 
the Laborde procedure than for artificial respiration. 

The suggestion is that every time the hands are carried above the head 
the person holding the tongue shall draw on that member. The tongue is 
allowed to go back into the mouth as the arms are carried to the chest. 
Traction on the tongue must not be too strenuous. 

While artificial respiration is going on the body must be wrapped in 



876 



FIEST AID 



blankets and hot bricks put to the feet. If the person has been in the water 
the wet clothing must be removed, the body dried and warmly wrapped. 
Sometimes a nervous shock will start the breathing apparatus; such would 
be ammonia to the nose, anal stretching and rectal injections of warm 
coffee. 

FIRST SUNSTROKE TREATMENT 




Fig. 337. — Triangular Bandage. A, base; B, apex; 
C, D, basal ends. 



The elevated roads of Chicago furnish each of their employees with a 

vest pocket manual of first aid in emergency accident cases from which I 

extract the following instructions for cases of sunstroke and heat prostration : 

"Carry patient quickly to shaded spot out of the direct rays of the sun 

and get all the fresh air pos- 
sible for him. Place patient 
upon his back and remove all 
clothing from neck, chest, and 
waist. Put ice to the head and 
temples and pieces of ice over 
the body and arms. With a 
large piece of ice gently rub 
up and down along the spine. 
Do not be rough in rubbing 
the patient. 

"If a hose and water are 
close at hand, turn a stream of water over the entire body and keep it running 
over him continuously. Do not give any liquids by mouth. Place a hand- 
kerchief or piece of gauze, saturated in spirits of ammonia, near the patient's 
nose. If an oxygen tank is handy, place the oxygen tank on one side of the 
patient's nose and turn on a fine spray of oxygen. 

"Keep up a brisk massage of the legs ^ 

and arms to stimulate the circulation. ^** x x 

These cases are hospital cases; so follow _ y \^ 

the above rules until a physician or am- 
bulance arrives." 

The reason for the insistence that 
sunstroke cases are hospital cases is that 
there are different affections due to heat. 
Heat cramps, heat prostration and some 
cases of heatstroke yield readily to the 
simple treatment indicated. Sunstroke of 
the more violent kind, especially of the 
asphyxial type, is a severe condition call- 
ing for a high degree of medical skill. 

In addition to the immediate effects of heatstroke and sunstroke there 
are later effects. Osier tells of a man who subsequent to a sunstroke could 
never stand a temperature of over 75°. He lived in a cellar for a summer or 
two and then moved to Alaska. Some are made so sensitive to heat that in 
summer they get severe headaches, they have ugly tempers and they may 
become delirious or insane. 




z\ 



Fig. 338. — Triangular Bandage 
Folded Once and Twice. 



FIEST AID REQUIREMENTS 



877 



In every case of violent sunstroke there remains behind some men- 
ingitis. In some cases there follows a violent form of progressive chronic 
meningitis. 

FIRST AID REQUIREMENTS 

The article telling of the first aid packet required by ordinance in 
Arlington, Massachusetts, stimulated a correspondent to inform us that the 




Fig. 339. — Method of Rolling a Bandage. 



Massachusetts law, chapter 557, acts of 1914, require every factory to keep & 
first aid package at hand. Acting under this law the state Board of Labor 
requires the following articles in first aid packages: 




Fig. 340. — Triangle Bandage for Head. The base A is placed downward over the brow, 
and the apex B at the nape of the neck. The basal ends C and D are carried backward 
over the ears and crossed over the apex below the external occipital protuberance, the 
"bump" on the back of the head. This prevents the bandage from slipping upward. The 
basal ends are then returned to the front and tied, the apex being turned upward and 
pinned to the body of the bandage. 

One two ounce bottle of aromatic spirits of ammonia (to be renewed 
every three months). 

One two ounce bottle of 4 per cent boric acid solution. 
One two ounce bottle of alcoholic iodin. 



Fig. 341.— Four-tailed Bandage for Fracture of Lower Jaw. 




Fig. 342. — Four-tailed Bandage for Chin. Place the center of the bandage (see Fig. 341) 
against the chin with the wide tails below, when the latter are turned upward and tied on 
top of the head. The upper or narrow tails are carried backward and tied at the nape of 
the neck. 




Fig. 343. — Double-Headed, Knotted Bandage. The double-headed knotted bandage is 
made of a strip of muslin about eight yards long and two inches wide, and rolled into two 
heads or cylinders. The knotted bandage is generally used to arrest hemorrhage] from the 
scalp by making pressure upon the temporal artery, which is situated just in front of the ear 
and extending upward into the scalp. The pulsation of this vessel can easily be felt. Before 
applying the bandage, a firm compress should be placed over the artery at a level with the 
upper border of the ear. A piece of cork, for example, about half an inch thick and the diameter 
of a silver half-dollar, should be enveloped in a piece of soft muslin and applied over the 
artery. The operator then, holding a roller in each hand, places the outside of the bandage 
against the compress and carries one roller around the head just above the eyes in front, and 
the other below the occipital protuberance or "bump" on the back of the head, and to the 
opposite temple; at this point the hands of the operator change rollers and return them to 
the compress, over which they form a knot by twisting and changing their direction, one roller 
being carried over the top of the head and the other beneath the chin, and then meeting at the 
opposite side. At this point the rollers are again changed and returned to the compress, over 
which a second knot or twist is made in the same manner; two or three knots over the com- 
press are usually sufficient to arrest the hemorrhage. 

878 



FIRST AID REQUIREMENTS 



879 



Two three ounce tubes of 3 per cent bicarbonate of soda in petrolatum. 

One three inch by ten yards roll of gauze bandage. 

One two inch by ten yards roll of gauze bandage. 

Two one inch by ten yards rolls of gauze bandage. 

One medicine glass. 

Three drinking cups (paper), to be used once only. 

One teaspoon. 

One eye dropper. 

One pair 4^2 inch scissors. 

One dozen assorted safety pins. 

One one ounce jar of green soap, to cleanse hands. 

One basin, enameled, or nonrustable metal. 

One-half pint of grain alcohol. 





Fig. 344. — Figure of Eight of the Hand. 
dicates route taken by bandage roll. 



Arrow in- 



Fig. 345. — Cravat Bandage 
for Hand. 



Six paraffin envelopes, each containing 6 x 36 inches of sterilized 
gauze, dressings for wounds, burns, etc. 

One yard of 24 inch canton flannel, to make triangular slings. 

One one inch by five yards spool of adhesive plaster. 

One rubber tourniquet, 24 x y 2 inch, or of webbing about 24 x 1 
to control hemorrhage. 

Two splints, 30 x 4 x 3-16 inch, whitewood, and one wire gauze splint, 
about 30 x 4 inches, for fractures. 

The National Founders' Association, 20 
counseling with other manufacturers, has 
standard package : 

One tourniquet. 

One pair of nickel plated scissors. 

One pair of nickel plated tweezers. 

One triangular sling. 

One wire gauze splint. 

Twelve assorted safety pins. 



inch, 



South La Salle Street, Chicago, 
adopted the following for its 



880 FIEST AID 

One two ounce bottle of castor oil. 

Two three ounce tubes of burn ointment. 

One two ounce bottle of 3 per cent alcoholic iodin. 

One two ounce bottle of white wine vinegar. 

One two ounce bottle of 4 per cent aqueous boric acid. 

One two ounce bottle of aromatic spirits of ammonia. 

One two ounce bottle of Jamaica ginger (or substitute), 

One piece of flannel, 24 x 36 inches. 




Fig. 346. — Adhesive Plaster for Sprain of the Thumb. 

One roll of absorbent cotton (1.5 ounce). 

One roll three inch by ten yards of gauze bandage. 

One roll two inch by ten yards of gauze bandage. 

One spool one inch by five yards of adhesive plaster. 

Six packages 6 x 36 inches of sterile gauze. 

One teaspoon. 

One metal cup. 

Two medicine droppers. 

Three paper drinking cups. 

First aid record cards. 



FIRST AID OUTFITS 

Arlington, Massachusetts, now requires that every shop or factory where 
machinery is used for manufacturing purposes be equipped with a first aid 
outfit. In that city the Board of Health has the power to fix requirements of 
this character and their rules shall have the same standing as do ordinances 
by city councils. 

The rule is as follows: Every person, firm, or corporation operating a 
factory or shop in which machinery is used for any manufacturing purpose, 
or for any other purpose except for elevators, or for heating, or hoisting ap- 
paratus, shall at all times keep and maintain free of expense to the employees 
a full set of the following articles, the same to be kept in a suitable dust- 
proof case : 

Adhesive plaster, 1 inch roll and 2 inch roll. 

Bandages, 2 dozen assorted, sizes 1 to 4 inches. 

Absorbent cotton, 1 pound. 



FIEST AID OUTFITS 



881 



Gauze, 1 package of ten yards. 

Elastic tourniquet, 24 inches. 

Safety pins, 2 dozen. 

Splint material, 4 white wood strips, 30 x 4 x 3-15. 




Fig. 347. — Bandaging Wrist and Hand. Numbers indicate route of bandage. 

Scissors, straight, 3 inch blade. 

Basin, enamel. 

Tablets, corrosive sublimate and citric acid, 100. 

Carron oil, 1 quart. 

Aromatic spirits of ammonia, 4 ounces. 

There are many first aid outfits now on the market. This would be a good 




Fig. 34.8. — Spiral Reverse Bandage. 



one. The New York health department would modify it by omitting the 
carron oil and specifying that the gauze and cotton should be in small 



Carron oil is a poor dressing for burns. It is dirty, it is apt to spread 
infection; it should be omitted. 




Fig. 349. — Bandaging Elbow. 




Fig. 350. — Triangular Bandage Applied to Shoulder, Hand and Elbow. Shoulder: 
The triangle should be applied to the shoulder by placing the base A downward across 
the middle of the arm, the apex B being turned upward against the neck. The basal 
ends C and D are carried to the inner side of the arm, crossed and returned to the outside 
and fastened. The apex B is tied or pinned to a cravat or sling placed round the neck. 
Hand: In injury to the posterior part, or dorsum, the hand may be bandaged by placing 
the base of the triangle A upward at the back part of the wrist, the hand lying on the bandage; 
the apex B is turned over the fingers upon the palm and carried to the wrist ; the basal ends 
C and D are then carried to the front and crossed, and returned to the back of the wrist 
and tied, or crossed again, and tied in front. In injury to the palmar surface of the hand, 
the base should be first applied to the front of the wrist. Chest: The triangular band- 
age is applied by placing the base A downward across the lower border of the chest, with 
the apex B over the shoulder of the affected side, the basal ends C and D being carried 
around the sides of the back, and tied together in such a manner that one end of the 
knot is longer than the other. The long end is then tied to the apex, which has been carried 
over the shoulder. 

882 



POISONS AND ANTIDOTES 



8S3 



The object in specifying that the gauze and cotton be divided among 
small packages is that the entire amount may not be soiled when first used. 

In addition to the first aid cabinet a factor)' equipment could very well 
include a few simple remedies. Massachusetts requires this. Moreover, there 
are laws requiring that certain industries in which the workers are exposed to 
certain poisons shall carry the antidotes for those poisons in convenient 
accessible cases. 

A medicine chest should in- 
clude at least the following: 

Medicine glass — two ounces. 

Droppers — two. 

Aromatic spirits of ammonia — 
four ounces. 

Salts — one pound. 

Cathartic pills — one hundred. 

Vaselin — one dozen boxes. 

Laudanum — two ounces. 

Diarrhea, mixture — four ounces. 

Oil of cloves — one ounce (for 
toothache). 

Sirup of ipecac — two ounces. 

Limewater — one quart. 

Mustard — one pound. 

Bicarbonate of soda — half 
pound. 




POISONS AND ANTIDOTES 



Fig. 351. — Triangular Bandage Used for 
Arm Sling. The base is placed vertically 
along the outer border of the right side of 
the chest, with the basal end thrown over 
the right shoulder, and the apex is placed 
behind the left elbow, the left arm being 
bent at a right angle and held in front of 
the bandage. The other basal end is now 
carried around the forearm and over the 
left shoulder, and tied to the first basal end 
at the back of the neck. The apex is then 
carried around the elbow and pinned to the 
bandage in front. 



In a case of poisoning the need 
is for quick action. A physician 
should be summoned at once; but 
to wait for his coming before get- 
ting into action might be a fatal mistake. 

The first procedure whenever the poison has been taken into the stomach 
is to produce vomiting. Frequently a lot of time is lost in hunting up emetics. 
Vomiting should be stimulated by tickling the throat. If a feather or straw 
is handy use that; if not, use the finger. 

In the meanwhile someone should be preparing some lukewarm salt water 
or mustard water. No time should be wasted on accurate dosage, as the water 
is to come up again anyhow. 

When the physician comes he will give apomorphia hypodermically, and 
in most cases he will use the stomach pump. In some cases a stomach pump 
will be available before the doctor comes. The most satisfactory stomach 
pump is the simple kind consisting of a tube and a funnel. 

To operate a stomach pump the end of the tube is introduced into the 
mouth, pushed to the fauces, and the patient is told to swallow. As he swal- 
lows the tube is pushed gently. The patient swallows the tube just as he 
swallows food. Pushing on the tube may help or it may interfere. The 



884 



FIBST AID 




Fig. 352. — Triangular Bandages Used for Arm Slings. The bandage is to be applied in a 
manner similar to Fig. 351, with this exception — instead of the second basal end being 
carried over the left shoulder, it is carried under the left arm, then upward across the back, 
and tied to the first basal end over the right shoulder. If the right shoulder or clavicular 
region be injured as well as the left arm, the latter can be placed in a sling, leaving the affected 
shoulder (the right) uncovered by laying the first basal end over the left shoulder, the base 
being carried from above obliquely downward and to the right, the apex of the bandage and 
the arm being in the same position as in the slings just enumerated. The second basal end 
is now carried under the left arm and upward over the back, and tied to the first basal end at 
the left shoulder. 



essential part of the proceeding is the swallowing, not the pushing. The 
head must be bent forward slightly else the tube cannot be swallowed. 




Fig. 353. — Triangular 
Bandage for Collar- 
bone Fracture. 




Fig. 354. — Dressing for 
Fracture. 



Collar-bonb 



The tube having been swallowed, the salt water is poured into the funnel. 
After a fair quantity has been run in the funnel should be rapidly lowered 



POISONS AND ANTIDOTES 



885 



and the stomach contents siphoned out. This should be repeated several 
times. 



il %/ 




Fig. 355. — Triangular Bandage of Breast. 



Acetanilid, Antipyrin, Antifebrin (Headache Medicines). — Antago- 
nists: heat externally; coffee; aromatic spirits of ammonia — teaspoonful in 
half a glass of water. 




Fig. 356. — Figure-of-Eight Spica Bandaoe of Shoulder. Numbers indicate 

route of bandage. 



886 



FIEST AID 



Acetic Acid. — Antidotes: whitewash from the wall; soap; chalk; lime- 
water; magnesia. 




Fig. 357. — Temporary Dress- 
ing for Fracture of Clav- 
icle 




Fig. 358. — Strapping with Adhesive Plaster for 
Broken Rib. 



Arsenic. — Antidote: hydrated oxid of iron with magnesia. 

Alkalies (Such as Lye, Washing Powders, Etc.). — Antidotes: vine- 




Fig. 359. — Cravat Bandage 
for Knee. 




Fig. 360. — Spiral Reverse Bandage of Thigh Showing In- 
troduction of the First Reverse. 



gar; lemon juice; albumin; milk; gelatin; oils. (Potter says never use the 
stomach pump.) 

Alkaloids (General). — (Morphin, atropin, strychnin, quinin are illus- 



POISOXS AXD ANTIDOTES 



88? 



trations of alkaloids.) Antidotes: tannin, half a teaspoonful in water; 
potassium permanganate, fire grains in water, freshly mixed: borax in milk, 
twenty-five grains to the ounce; charcoal — empty the stomach immediately. 
Wash it out after the antidote has been given. 




Fig. 361. — Spiral Reverse Bandage of Thigh Completed. 

Ammonia (Smelling Salts, Hartshorn). — Antidotes: vinegar; lemon 
juice; orange juice. 

Bichlorid of Mercury. — Antidotes: white of egg, one white for each 
four grains of poison. Stomach should be emptied at once as the albuminate 




Fig. 362. — Bandaging Hip and Abdomen. Numbers indicate route of bandage. 



of mercury is soluble in the alkaline content of the stomach. An excess of 
albumin puts the mercury back into solution. Iodid of potassium should 
be given carefully for several days after the poison as it assists the kidneys 
in getting rid of the mercury. 



888 FIRST AID 

When other means are not available or practical in cases of poisoning 
drug or nourishment is given by rectal injection. In these cases the solution 
should be warmed and at least one-third more given than when taken by 
the mouth. The ordinary household syringe should be used and care should 




Fig. 363. — Triangle Bandage on Hip. The triangular bandage at this portion of the 
body is applied in very much the same way as at the shoulder. The center of the base A 
is placed downward across the middle of the thigh, the apex B being carried upward above 
the crest or upper border of the pelvis or haunch-bone, the basal ends (C and D) 
are carried around the thigh, and fastened at the outside. The apex \B is attached above 
to a cravat around the waist. 

be taken that the air in the syringe is expelled before the pipe is introduced. 

In the absence of a stomach pump the rubber tube of an ordinary foun- 
tain syringe can be used by cutting off the rubber or metal end. The bag 
takes the place of the funnel of the regulation stomach pump. 

When corrosives have been taken a stomach pump should not be used as 
the membrane is usually swollen. 

Cannabis Indica — Hashish.— Antidote: lemon juice from time to time. 
There is no record of death from hashish poisoning. 

Carbolic Acid. — Antidotes: wash out the stomach with equal parts 
of alcohol and water. Leave about half a pint of the mixture in the stomach 
for a few minutes, then wash out with warm water. If the case is first seen 
some time after the poison has been taken give an ounce of Epsom salts 
or half an ounce of Glauber's salts. Vinegar; soapsuds. 

Chloral Hydrate. — Antidote: two teaspoonfuls of the official solution of 
hydroxid of potash to be taken well diluted every hour for several hours. 

Chloroform (Internally). — Antidotes: sodium carbonate, half a tea- 
spoonful in plenty of water; pint of coffee by rectal injection; hot water 
bottle to the extremities. 

Coal Oil (Kerosene, Gasoline).— Antidote: wash out the stomach with 
warm milk. If a stomach pump is not at hand give a quart of milk and 
then produce vomiting. 



POISONS AND ANTIDOTES 



889 



Cocain. — Antidotes: if the drug has been swallowed give a fresh solu- 
tion of permanganate of potash. If it has been taken hypodermically give 
morphin or chloral. Stimulate. 

Cyanid of Potassium. — Antidotes: where factories use cyanid of potash 
they should keep the following stock solutions on hand : solution of ferrous 
sulphate, 3 per cent, one ounce; solution of potassium hydroxid, 5 per cent, 
one ounce. Keep these solutions in separate bottles. To use, mix, add 
two or three grains of calcined magnesia and a pint of water. Give the 
mixture, wait ten minutes and then wash out the stomach. Other antidotes: 
cobaltous nitrate ; hyposulphite of soda ; bleaching powder in weak solution 
in water. 

Formaldehyd. — Antidote: ammonia. In case the gas is objectionable 
sprinkle ammonia around. When the gas has been inhaled heat some water 




Fig. 364. — Good Method of 
Strapping a Sprained An- 
kle with Adhesive Plas- 



Fig. 365. — Bandaging Leg. Spiral Reverse. 



of ammonia diluted with two parts of water and inhale the steam cautiously. 
If the formalin has been taken internally give aromatic spirits of ammonia, a 
teaspoonful in a glass of water. 

Gas, Illuminating. — Antidotes: inhalations of a spray of chlorin water; 
oxygen by inhalation; artificial respiration should be kept up several hours 
if necessary. 

Headache Medicines (See Acetanilid). 

Hypochlorite (Bleaching Powder). — Antidote: hyposulphite of soda, 
fifteen grains in water every hour for several doses. 

Iodin. — Antidote: starch, teaspoonful washed down with water. 

Lead Salts. — Antidote: Epsom salts, teaspoonful in water. Eepeat in 
an hour. Produce vomiting. 



890 



FIEST AID 



Lead Colic. — To a pint of boiling milk add ninety grains of alum. Give 
a wineglassful every hour or two. 
Matches (See Phosphorus). 
Mineral Acids (Muriatic, Nitric, Sulphuric, and Some Others). — 

Antidotes: whitewash; wall plaster; chalk; soapsuds; magnesia; cooking soda. 
(Potter advises against the use of the stomach pump because of the liability 
of puncturing the stomach.) 

Morphin (See Opium). 

Mushrooms, Poisonous. — Antidote: give atropin sulphate. Do not 
give more than one dose of 1/100 of a grain before the physician takes charge. 





Fig. 367. — Tkiangle Bandage on Foot. 
The foot should be placed on the triangle 
with the base A backward, and laid behind 
the ankle, the apex being carried upward 
over the dorsum or top of the foot. The 
basal ends C and D are brought forward, 
crossed, then carried around the foot, and 
tied on top. 



Fig. 366. — Figure-of-Eight 
Bandage of the Ankle 
and Foot. Numbers in- 
dicate route taken by band- 




Fig. 368.— Reef Knot. 



Opium (Morphin).— Antidotes: a third of a spoonful of tannin dissolved 
in water, or wash out the stomach with a 1 per cent solution of potassium 
permanganate. Leave some in the stomach. Borax (5 per cent) in milk. 
Coffee by the rectum. 

Oxalic Acid (Salts of Lemon, Ink Eradicator). — Antidotes: wall plas- 
ter; whitewash; limewater; chalk; ink; magnesia. (Potter, from whose 
therapeutics most of this information is drawn, says: "Avoid cooking soda, 
since it forms compounds as toxic as the acid itself. Never use the stomach 
pump.") 



POISONS AND ANTIDOTES 801 

Prussic Acid. — Antidotes: cobalt nitrite; hyposulphate of soda; give 
inhalation of ammonia. 

Phosphorus (Matches; Some Rat Pastes). — Antidotes: wash out the 
stomach with a 1 per cent solution of permanganate of potash. Leave some 
in the stomach. Limewater; charcoal; hydrated magnesia. 

A poison case should contain the following substances properly labeled: 

Borax; bicarbonate of soda; limewater; charcoal; common salt; calcined 
magnesia; permanganate of potash; hyposulphite of soda; starch; sulphate of 
magnesia; tannin; solution of ferric sulphate, 600 grains in 4 ounces of 
water ; magnesia, 150 grains in a pint and a half of water ; nitrate ; hypodermic 
syringe and pellets of apomorphin muriate ; strychnin and morphin sulphates ; 
stomach pump. 

Martindale's antidote bag: dialyzed iron; sirup of chloral; chloroform; 
spirits of chloroform; magnesia; spirits of ammonia aromatic; oil of turpen- 




Fig. 369. — Grannie Knots. 

tine ; acetic acid ; tincture of digitalis ; tannic acid ; amyl nitrite ; zinc sulphate ; 
Ipecac ; bromid of potash ; permanganate of potash ; solution of ferric sulphite, 
40 cc. in 125 cc. of water; magnesia in solution, 10 grains in 750 cc. water in 
a bottle 1,000 cc. capacity; mix and make official antidote for arsenic. Hypo- 
dermic syringe and morphin, atropin, apomorphin, pilocarpin and strychnin. 

Poison Oak Treatment. — B. H. M. writes : "What is the test remedy for 
poison oak? Why does it break out again every year about the same timef 

Reply. — One attack of poison oak'dermatitis makes the skin more sensi- 
tive to the poison. The poison does not stay in the system between attacks. 
There is a contact with the vine before every attack. Bathe the poisoned 
parts with hot water, and dry carefully. Spread ichthyol ointment [10 per 
cent] on sterilized gauze and bandage loosely or strap with adhesive plas- 
ter. Dressing should be changed twice daily. If the face is poisoned make 
a mask of gauze, cutting holes for the eyes, nose and mouth. 

Alcohol and Snake Bite. — Mrs. W. F. V. writes : "Is an alcoholic stimu- 
lant the best remedy for snake biteV 

Reply. — It is not. If a stimulant is needed aromatic spirits of am- 
monia is a better one. 

Snake bite is rarely fatal. But few snakes are poisonous. Of the 
poisonous snakes few are capable of killing a grown person. 

Alcohol has got the credit for curing a great many people who would 



892 FIRST AID 

have become well without it and indeed have become well in spite of it. 
When a man has been bitten and is scared stiff alcohol gives him some 
Dutch courage. For this purpose morphin and hyoscin would be better. 

Treatment of Wounds. — S. B. C. writes: "We are being told on every 
side that we must not wash a wound with soap and water or antiseptic 
solutions lest the tissues be injured. You say iodin should be in the emer- 
gency hit, but you do not say how it should be used" 

Reply. — If a wound is greasy and dirty (shop wound) wash it out with 
gasoline. If the wound is through ordinarily clean skin wash around the 
wound with soap and water and follow with alcohol. 

The iodin may be poured into the wound, or it may be applied to the 
wound with an applicator made with a toothpick and a bit of absorbent 
cotton. If the iodin runs over the sound skin that excess should be washed 
off with alcohol. Then cover the wound with a small amount of gauze. 
Hold the gauze in place by a light bandage. Do not seal out the air with 
collodion. 

Where wounds are stinking, suppurating with decomposing secretions, 
such as are the neglected wounds of the European war, the best treat- 
ment is to clean with peroxid of hydrogen and to apply very light open 
gauze dressings. Such wounds need oxygen and air. 

Toxemia. — F. L. B. writes: "1. What would produce toxemia in a child? 
2. What would cause toxemic poisoning? 3. With proper care would the 
prognosis be favorable? 4- Should a relapse or second attack of poisoning 
be feared, if so from what cause?" 

Reply. — Toxemia merely means that there is a poisonous substance in 
the blood. What would cause it, whether a given case would get well and 
whether it will recur depend on what the nature of the poison is and some 
other factors. For instance, a child eats spoiled food. Some of the harm- 
ful substance is absorbed, some goes to the brain and causes fever, some to 
the skin and causes a rash. If the child vomits and purges before much 
poison has been absorbed it should get well. The toxemia will not return 
unless the child again eats spoiled food. 



CHAPTER XLVII 

Occupational Diseases 

When human slavery was abolished employers became careless of work- 
ers. Any sort of a hole would do for a servant's room ; employees were worked 
until they fell; accidents were inevitable; lead poisoning was unfortunate 
but unavoidable and consumption was a visitation of Providence. Now we 
recognize industry as social. It is no longer the business of the employer 
alone. 

First, the government came around sticking its nose into interstate com- 
merce. There was a great outcry from the railroads but the measures stuck. 
Then came regulation of public and semi-public utilities. Then came the 
government sticking its nose into private business looking for combinations 
m restraint of trade, for unfair competition, for dishonesty of many sorts 
including cheating by substituting fakes or impurities for food and by lying 
labels. Finally, the socializing process is extending to movements for the 
prevention of accidents, trade poisoning and occupational disease. 

This preventive movement is being fairly well received by legislative 
bodies, employers and employees. Each complains a little but as I see it 
there is no great amount of justification for it. Probably the reason is 
that the educational work has been well done. John Calder said: 

"Legal obligation to safeguard thoroughly has only succeeded where per- 
suasion and enlightenment have accompanied it/' 

The American Eed Cross from time to time issues pamphlets telling how 
to prevent injurious industrial conditions. It distributes wall cards telling 
what to do in case of accident or poisoning. There are several organizations 
doing similar work. In consequence many places of business now contain 
first aid cabinets distributed at convenient points around the factory. Some 
have first aid corps that have a certain amount of training in the accidents 
liable to occur in the various factories. 

Some have emergency hospitals. I know of a few large plants with a 
large amount of floor space under cover where there are complete motorcycle 
ambulance systems. But the majority of the plants have not developed any- 
thing of this character. They are not large enough to warrant the necessary 
organization. These should at least have cards of instruction prominently 
displayed and first aid cabinets containing antidotes for poisons and surgical 
dressings. 

The Illinois Commission on Occupational Diseases found in Illinois 
seventy industrial processes which are productive of lead poisoning. Sixty- 
three out of 89 brass foundries were acknowledged centers of trade sickness. 
Of 187 men examined 161/. were found to be suffering from brass poisoning. 
Out of 1,760 men examined only 17 were over fifty years of age and only 180 
were over forty. 



894 OCCUPATIONAL DISEASES 

The commission examined 240 men employed in steel mills and subjected 
to carbon monoxid gas. Practically all of them were in bad physical condi- 
tion but the commission found it difficult to say whether the cause was carbon 
monoxid in the works or factors outside. Among other things they noticed 
a loss in muscular power and a sluggish mentality. The relation of carbon 
monoxid poisoning to these changes should be investigated. 

Few people understand how many industries make use of poisonous 
metals and therefore subject their workers to poisoning. Some of those using 
lead are: painting, enameling, glass making, file making, kitchen tinware, 
pottery, india rubber, plumbing, milk bottle covers, electric cables, storage 
batteries, dry sandpapering of lead paint and those processes which make 
use of phosphorus. 

I would suggest reading of Dr. Alice Hamilton's address as printed 
in Human Engineering for 1911 if for no other reason than it shows how 
little employers know about the conditions of their men. I have reference 
not so much to the philanthropic side as to the premature senility, loss of 
muscular strength and mental tone, incapacity from illness in their workers 
■ — expenses which the employer unconsciously carries in part. 

Acid Burns 

A manufacturer wrote me a short time ago about hydrofluoric acid burns 
in his factory. His letter has prompted this article. Hydrofluoric acid is used 
for cutting glass. The fumes irritate the breathing apparatus and the eyes. 
When the solutions of acid get on the hands they make deep burns which 
heal slowly. A milder effect is a chronic inflammation of the skin — a 
dermatitis. 

For the removal of the fumes hoods should be placed over all vats and 
ventilating fans should draw the fumes into these hoods under strong draft. 
The eyes should be protected by celluloid goggles, the hands by rubber gloves. 
These are the recommendations of the Illinois Commission on Industrial 
Diseases. If the worker gets a dermatitis from rubber gloves, as some do, 
he can keep his hands covered with grease and then wear a pair of well 
greased cotton gloves. 

A factory using hydrofluoric acid should have easily available facilities 
for hand washing. When acid splashes on the skin it should be washed off 
with plain water and then silicon or sand should be applied. This should be 
washed off later and the burn treated like any other burn. 

With other forms of mineral acid poisoning, wherever in the process 
fumes are given off (including those processes where liquids are so heated 
as to cause steam to rise) the fumes should be collected by hoods from which 
the air is drawn by fans. If this does not suffice the men should be provided 
with respirators. Goggles should be used to protect the eyes. When acid gets 
on the skin it should be quickly washed off with water. Alkali, such as baking 
soda, should be at hand and some of this should be dusted on as soon as the 
excess of acid is washed off. The burns should then be treated as are other 
burns. 

In trades where alkali is used the fumes must be carried away. When 
alkali has got on the skin it should be washed off with plain water and then 



PHOSPHORUS POISONING 895 

with a weak acid. Watery solution of mineral acids should be kept at hand 
but in their absence vinegar can be used. 

Workers with chromic acid and bichromate not infrequently suffer from 
poisoning of the skin with these substances. Sometimes the acid is strong 
and deep burns resulting in chronic ulcers develop. To prevent this facili- 
ties for washing with soap and water should be provided. 

More frequently the effect is a chronic eczema. To prevent this the hands 
should be Washed with an aluminum sulphate solution (8 per cent), one 
ounce in one pint of water. They should then be greased with a fresh cold 
cream or with fresh lard. While at work rubber gloves should be worn. 



PHOSPHORUS POISONING 

One of the most interesting papers read at the International Congress 
on Hygiene was one by Sir Thomas Oliver on industrial diseases. In the 
course of his lecture he complimented the United States upon the passage 
of the bill to prevent the use of poisonous forms of phosphorus in the 
manufacture of matches. 

According to Sir Thomas, when students of occupational diseases dis- 
covered the horrible effects of phosphorus upon the matchmakers they recom- 
mended sanitary shop regulations thinking in this way to prevent phosphorus 
poisoning. Many governments embodied such regulations in their laws and 
many factories installed such provisions as a part of their shop practice. 
Nevertheless phosphorus poisoning was about as frequent and as horrible 
as before the regulations were enforced. 

Sir Thomas showed many lantern slides illustrating horrible deformity 
amongst match workers. One poor fellow lost half of his upper jaw and then, 
instead of taking up farming, he went back into the factory, was again poi- 
soned and lost his entire lower jaw. 

In 1872 Finland prohibited the use of poisonous kinds of phosphorus 
in matches. In 1874 Denmark likewise prohibited the manufacture of matches 
with dangerous kinds of phosphorus. In 1906 the International Association 
for Labor Legislation meeting at Berne proposed an international treaty 
agreement for the prevention of the use of white phosphorus in making 
matches. Certain manufacturers opposed the change saying the cost of manu- 
facture would be prohibitively high, the matches would not keep, the matches 
would not be as good — the change was not feasible commercially. 

As soon as the recommendation was made by the congress Denmark 
signed the treaty, France signed in 1906, so did Switzerland, Holland, Luxem- 
burg, Italy and Germany. Austria complied in 1908 and England in 1910. 

Contrary to the opinion of the objectors Sir Thomas Oliver said the law 
had not been found objectionable from any business standpoint and it has 
done away with phosphorus poisoning among the workmen. 

When the bill came up in Congress it was proved that phosphorus poison- 
ing in this country was frequent and severe. The Diamond Match Company 
came forward with an offer to give the method of manufacture of harmless 
phosphorus to whomever wanted it. The law gave plenty of time for every- 
body to adjust his business to the new requirement. There remained not 



896 OCCUPATIONAL DISEASES 

a single business objection, while, on the other hand, there was the offer of 
safety for the workingman. Finally the bill was pried out of the pigeonhole 
and passed. The president signed it and before many months this republic 
was protecting matchmaker citizens as well as most European countries do. 

ACCIDENTS AND DISEASES OF IRONWORKERS 

Such was the title of a paper by Dr. Eopke of Solingen, Germany. Iron- 
workers, especially workers in raw iron, have a great many accidents and 
contrary to what one would think mechanical accidents are more frequent 
than scalds and burns. Their disease rates are also higher than normal. 

In raw iron work the men are poisoned by the gases, vapors and dust. 
When air passes over red hot iron it has a burnt odor and it does harm. That 
we have noticed in houses heated with stoves and hot air furnaces. Part of 
the cause is the charring of dust and bacteria; part of it is carbon monoxid 
gas. If the structures are inclosed enough to allow it to accumulate this gas 
abounds in foundries and rolling mills. 

In what he terms the small iron industry the harm, in the main, is from dust. 

1. Blacksmiths suffer from coal dust, coal vapor, from sudden changes 
in temperature and from overwork. The reader will note the distinction 
between the effects of coal dust and smoke and vapor — a distinction usually 
lost sight of by our anti-smoke nuisance friends. 

2. The locksmith trade is not a dusty one. The workmen develop curva- 
ture of the spine from sitting in bad positions for long stretches. 

3. File cutters also develop stoops and postures from working at badly 
placed benches. They suffer from lead poisoning occasionally. Their con- 
sumption rate is rather excessive. 

4. The grinders suffer heavily from the dust diseases. They lead the list 
of consumptives. Eopke found that ironworkers had more than their share 
of eczema and boils. 

Galvanizers were especially subject to eczema. They were nearly always 
deaf after working one year in a noisy shop. They had an excessive amount 
of consumption. Though pneumonia and colds were frequent their rise did 
not keep pace with that in consumption. 

The author lays this down as a basic proposition : "The state, the commu- 
nity, and the employer all have the same interest at heart — to keep the iron- 
worker in good health/' Nor does he neglect to emphasize the obligation of 
the ironworker to keep in good health. A part of the protection is properly 
the duty of the employer. A part of it is the duty of the employee. 

The basic principle of the method laid down is : "Dust and gases must be 
rendered innocuous at the place of their origin." And, again, the almost 
universal note of optimism: "The mortality rate among metal grinders at 
Solingen is much lower than in the good old days." 

REMEDY FOR THE "GASSED" 

One of the least suspected sources of poison is the fumes of wood alcohol. 
Wood alcohol is used to cut shellac and other varnishes. It is used in some 



LEAD POISONING 897 

rapid drying paints. It forms the basis of liniments and is used to cut 
oils. The alcohol vaporizes readily and the air of closed rooms becomes 
saturated with it. When a man has soaked up much of it he is liable to die 
suddenly in coma. 

If he recovers from the first effects he may become pale and anemic, 
develop crops of boils, and in time go blind. The blindness from wood alcohol 
poisoning is hopeless because the nerve of sight is destroyed. 

The preventive is good ventilation. If a few electric fans were properly 
distributed around the beer vats which are being varnished the poisoning would 
be negligible. The remedy is to take the stricken person into the fresh air. 

Workers at vulcanizing of rubber get jagged from the fumes of the hy- 
drogen sulphid inhaled. An acute insanity with destructive tendencies, even 
with a tendency to self-destruction, sometimes develops. In chronic poisoning 
a peripheral neuritis is developed. Some of the nerves become chronically 
inflamed and after months of pain the muscles supplied by the painful nerve 
begin to shrivel. 

The remedy is to provide the workshop with good ventilation, with hoods 
and exhaust fans to draw the gases as directly as possible. The best of bath- 
ing facilities should be provided. The workers should be provided with 
working clothes that their street clothes may not be saturated with the foul 
odors of the work place. Outside eating rooms should be provided. Young 
persons should not work at this trade. The hours of work should be short. 

When a person is "gassed" the remedy is inhalation of oxygen. 

A frequent form of gas poisoning is that due to carbon monoxid. Blast 
gas contains 26 per cent and producer gas 23 per cent of this highly poison- 
ous gas. It is found around steel mills, gas plants and coke ovens. It is even 
present in such places as rooms heated by stoves and tailor shops with their 
coke fires and irons. 

The workers get into an intoxicated condition which they speak of as 
being "gassed." Later effects are insanity and anemia. A striking result 
is a loss of power in the muscles. 

The remedy for the acute condition is oxygen gas. 

To prevent the condition the places should be well ventilated. Drinkers 
should not be allowed to work around blast furnaces, rolling mills or gas 
works. Oxygen should be kept at hand. 



LEAD POISONING 

A mother expects her baby under two years old to have diarrhea occasion- 
ally but when her older children get it she wonders why. She is pretty 
certain to accuse them of eating green fruit or spoiled fruit or something else 
forbidden. Every now and then the children get such attacks and occasionally 
the cramping is so great that a physician is called in. If he be a bright, quick 
witted chap he is likely to suspect lead poisoning. If he turns about a bit 
he will find several ways in which children can get hold of lead without 
knowing it — for instance, from soda water and pop. Every "kid" likes them. 

Soda water and pop are mixtures of plain water and carbonic acid. Car- 
bonic acid dissolves lead wherever it touches it. Lead pipes make the best 



898 



OCCUPATIONAL DISEASES 



and also the cheapest connections for soda fountains and pop machines. Block 
tin pipes or chemically pure lead pipes are much more expensive and less well 
adapted to bottled water work than those made of ordinary everyday lead. 

Pop or soda water that touches ordinary lead gets a small charge of 
lead, not enough so that one bottle of pop or one glass of soda will kill a 
child but just enough to give a child who drinks two or three glasses of soda 
or two or three bottles of pop a week spells of diarrhea and frequent cramps 
in the legs, arms and belly in a few weeks. If the poisoning is worse the child 
may be having convulsions or be pale or have a blue line along the gums — 
occasionally paralysis of a leg or arm will develop. 

The preventive remedy is simple. Allow the child to drink no soda water 
except from fountains which advertise "No lead 
in our soda" ; to drink no pop unless "No lead 
in this water" is blown in the bottle. 

Lots of grown people are suffering from 
lead poisoning. They do not know it, which 
only makes it worse. The report of the Illinois 
Commission on Industrial Diseases proves that 
many suffer from lead poisoning and also that 
most sufferers wonder what the trouble is. The 
symptoms of lead poisoning in grown people are 
much the same as in children. 

When a grown person has a persisting diar- 
rhea there is a reason and the reason may be lead 
poisoning. However, in grown people, as you 
would expect, diarrhea is not so prominent a 
symptom as in children. The cramps, the 
paralysis, the pallor, the blue gum line become 
more important signs. 
Of course, every painter knows he is in danger but there are many other 
trades in which some lead as dust or smear gets on the hands; the worker 
fails to wash his hands before taking a chew of tobacco or eating his meals, 
or drinking water or beer or doing any one of a dozen acts that everyone 
does almost unconsciously but which serve to carry just a little lead to the 
mouth. If the amount carried was great enough to knock the man right down 
he would not repeat the thoughtless act, but it is mighty hard to see the 
importance of a thing which does not show its importance until it has been 
kept up for half a year. 

Among other workers who get lead poisoning are glaziers, plumbers, 
miners, workers in lead, file makers, gun polishers, tinware makers, weavers, 
typesetters and typemakers, rubber goods makers, structural iron workers, 
brass workers and lace-makers. Eather an extended assortment. 




370. — Wrist Drop Due to 
Lead Poisoning. 



PREVENTING LEAD POISONING 

Dr. Francis D. Patterson, having declared that industrial plumbism 
was preventable, gave the following twelve requirements by which a factory 
could prevent it: 

"1. Taking care to make the processes as dust free as possible. 



LEAD POISONING 899 

"2. As it has been found difficult to enforce the use of the ordinary type 
of respirators, we are using with success a respirator which I designed and 
have had manufactured by Johnson & Johnson. It is made of five thicknesses 
of gauze and they are issued clean to the men each day. 

"3. But a slight amount of the lead dust which enters the mouth and nose 
passes into the lungs. Fully three-fourths of it lodges in the mouth and nose, 
where it becomes mixed with saliva and mucus and is unconsciously swal- 
lowed. In order to obviate this as much as possible it is our practice to 
require our employees before taking their dinner and when cleaning up after 
the day's work to thoroughly wash out the nares with warm water and to 
gargle the throat and wash the mouth thoroughly with a 0.2 per cent solution 
of sulphite of soda. 

"4. Each factory should have a room, preferably in a separate building, 
where the employees eat, and no food should be allowed to be carried into 
any other room in the factory. Care should also be taken to see that the 
employees wash properly before eating their dinner. 

"5. Milk being a valuable preventive, it should be provided at the com- 
pany's expense and the employees urged to drink it freely. 

"6. All employees should be provided with clean overalls each week at 
the company's expense. 

"7. Ample facilities for bathing with soap and towels should be provided. 

"8. The carrying and the chewing of tobacco at work should be prohibited. 

"9. Too much stress cannot be laid upon the importance of the employ- 
ment of a competent physician, who will make a physical examination of all 
applicants for employment and reexamine the employees at a weekly interval. 
We do not employ any men under the age of 21 years, nor those who present 
the physical evidences or history of alcoholism, kidney disease, syphilis, rheu- 
matism, or any chronic digestive disturbance. 

"10. Each employee receives a thorough physical examination each week, 
so as to determine those who present the evidences of being in a condition 
of "lead store." The recognition of this in its incipiency and the adminis- 
tration of the proper treatment insure the relief of the condition before it 
has time to progress. 

"11. All employees are given free medical treatment; they are encouraged 
to consult me for any ailment, no matter how trivial, and this further insures 
the early recognition of any cases of poisoning. 

"12. In each room in the factory is a notice which tells the employees 
of the precautions which they should take in assisting in preventing lead poi- 
soning among them/' 

RECOGNIZING LEAD POISONING 

A great many people suffer from lead poisoning. Some recognize the 
condition readily. Some suffer for a long time without knowing it. The 
Illinois state factory inspector reports the following as the more important 
symptoms found in the poisoned workers coming under the observation of his 
department: ■ ., ..-..-.... 

The most, frequent notation is "blue line on gums," "lead line." The 
second .most frequent . notation is "colic," "umbilical cramps," "pain in the 
region of the umbilicus," "abdominal tenderness," "abdominal -pain," "nau- 



900 OCCUPATIONAL DISEASES 

sea," "pallor." Next comes tremor. Other less frequent symptoms are paralysis, 
wrist drop, muscular weakness, dermatitis, constipation, headache and sore 
eyes. 

These are the more immediate effects of lead poisoning. The report does 
not refer to such delayed effects as high blood pressure, apoplexy, Bright's 
disease and premature senility. 

The occupations in which there is especial tendency to poisoning from 
lead are several. The most dangerous of all trades from the standpoint of 
lead poisoning is painting. Among the employees of white lead manufactories 
the lead poisoning rate was about four per one thousand. 

In the smelting and refining of lead conditions are improving rapidly. 
The lead poisoning rate among employees in 1914 was three per one thousand. 
In the paint and dry color factories there was considerable hazard. In the 
former it was found that the men would often eat without washing their 
hands. In the latter the danger from soiled by lead hands was augmented by 
the danger from lead dust. 

Among workers in battery factories the number of cases of lead poi- 
soning was high, about six per one thousand. The worst rate of all was in the 
tinware establishments. The lead sickness was eleven per one thousand. 

Other dangerous trades are manufacturing car seals, electrotyping, enam- 
eling, brass foundry work, litho transfers, decalcomania work and galvanizing. 
In some of these trades the care taken is reducing the hazards to reasonable 
limits of safety. In some processes lead sulphate is being substituted for 
other forms of lead because of an opinion that lead sulphate is not poisonous. 
The Illinois officials found lead sulphate about as poisonous as other forms 
of the metal. 

Painters using different forms of rapid dryers are subject to another 
form of poisoning. The evaporating solvent in these rapid dryers is either 
benzin or wood alcohol. Painters who use them are subject to vertigo, head- 
ache, nausea, and ringing in the ears. These symptoms are the same as are 
found often in garages and dry cleaning establishments. They are due to 
the fumes of benzin, petrol or wood alcohol. 

To prevent lead poisoning it is necessary (1) to have ample washing 
facilities, (2) to require that the lunch be eaten outside the factories and that 
before eating the face and hands be washed, (3) to wear respirators in dusty 
places, (4) to use hoods and artificial ventilation wherever needed. 



MERCURY POISONING 

Both Professor Teleky of Vienna and Professor Tylecote of Manchester 
told the hygiene congress that acute mercury poisoning as a trade disease 
was becoming less but that there was an increase in chronic poisoning with 
mercury. ' 

The use of mercury to gild mirrors has materially decreased. Euro- 
pean mercury mining has been made safer. Fire gilding has been replaced 
by galvanic gilding. These industries caused the more acute forms of mercury 
poisoning. On the other hand, chronic mercury poisoning among hatmakers 
is on the increase. 



ARSENIC AND BENZIN POISONING PREVENTION 901 

The symptom which makes the hatmaker think there is something wrong 
is a fine tremor first appearing in the hands and then spreading to the 
body entire. The hand does not jerk so coarsely as it does in paralysis 
agitans or in disseminated sclerosis. It is a coarser jerk than the very fine 
tremor of goiter. Later it affects the speech and gait. The teeth turn black 
and some of them loosen and drop out though this symptom is not nearly 
so great as it is in the salivation from calomel which the older people re- 
member. 

Felt plankers' hands are cracked and calloused but this is from the acid 
in the bath more than from the mercury. 

Tobacco chewers suffer more than men who do not chew. They get mer- 
cury on their hands, then on their tobacco and then into their mouths. 

There is no special susceptibility to consumption. 

The methods of prevention proposed applied, in the main, to hat facto- 
ries, felt factories, and the places where pelts and fur were handled, cleaned, 
dyed, and worked. Workmen in such places should receive a monthly medical 
examination. No hat work should be done at home. Women and children 
should not be allowed to do hand planking. In fact, hand planking should 
be done away with. The factory should be spacious and well ventilated. The 
workers should have an average of 800 cubic feet of space each. The room 
must be frequently sprinkled. Every machine must be provided with a hood 
and a dust exhaust. Government inspectors must make periodic examinations 
of the air to keep down the amount of dust, and particularly mercury dust, 
it contains. As far as possible all hand processes must be supplanted by 
machines so as to keep the hands away from the mercury mixtures as much 
as possible and to keep the dust down to the minimum. There should be 
ample toilet facilities conveniently located and appealing to the esthetic sense. 



ARSENIC AND BENZIN POISONING PREVENTION 

Men who work in making and cleaning wallpaper, those who manufacture 
dyes and some workers at the manufacture of chemicals, suffer at times from 
arsenic poisoning. Chronic arsenic poisoning causes the hair and nails to 
fall off and produces shin eruptions, bronchitis, bleeding gums, neuritis and 
Bright' s disease. Acute arsenic poisoning causes violent vomiting and purging. 

To prevent chronic poisoning the general ventilation should be of the 
best. Where hoods and exhaust fans can produce results they should 'be made 
use of. Sometimes respirators should be used, and ample washing facilities 
must be provided. 

As an antidote for acute poisoning with arsenic take white of egg, then 
produce vomiting; after that take milk. 

People who work at the manufacture of celluloid articles develop cough, 
bring up bloody sputum and in time become asthmatic. The principal neces- 
sity is that there should be provision against fire. Fire apparatus, and espe- 
cially fire smothering cloths and sand for the same purpose, should be kept 
at hand. The factory should be well ventilated. 

Cleaners, dyers, and all others who work with benzin or similar substances 
are greatly hazarded by their occupation. To prevent explosions add a small 



902 



OCCUPATIONAL DISEASES 



quantity of oil soap to the benzin (1/10 to 1/100 of 1 per cent). Such soaps 
are on the market. 

Oliver gives the following as the method of manufacture of an oil soap : 
One part of caustic soda or caustic potash is mixed with four parts of alcohol. 
To this mixture there is added oleic acid in the proportion of one and three- 
fourths parts of the acid to one part of the alcohol-alkali solution. The mix- 
ture is heated and to it is added benzin or benzol in the proportion of two 
and one-half parts of benzin to one part of the mixture. This forms the oil 
soap which is added to the benzin. 

Those who work in an atmosphere of benzin get benzin drunks. They 

later develop headaches and gid- 
diness, and then they vomit and 
become stuporous. The meas- 
ure of prevention is fresh air. 
Hoods and exhaust fans should 
be used, and the body of the 
room must be well ventilated. 
Separate lunchrooms must be 
provided. 

Benzin affects women more 
than men. Anemic girls should 
not be allowed to work at trades 
in which much benzin is 
used. 

To sober the jag nothing 
is so good as plenty of cold fresh 
air. A glass of milk internally 
helps some. 



CAISSON DISEASE 

In some engineering proj- 
ects to prevent walls from fall- 
ing or water from flowing in, 
the workman must work in air 
compressed chambers called cais- 
sons. This is all right for the 
work but it is hard on the 
worker. A man entering a com- 
pression chamber has in his 
blood the amount of gas proper 
when the atmospheric pressure 
is normal. Compressed air drives into his blood an excessive amount of 
gas. This does no harm so long as the pressure is kept up but when the 
man gets out of the high pressure air the extra gas tries to get out of his 
blood. It goes out of solution and accumulates in the blood vessels as bubbles 
of nitrogen gas. 

Caissons are usually badly ventilated; they are too hot and too humid, 




Fig. 371. — Drager Oxygen Apparatus for Use 
in Mines. (Report of Illinois State Commission 
of Occupational Diseases, Jan., 1916.) 



DUSTY TRADES 903 

and for this reason a man in a caisson can only do half a mans work. 

But the great harm comes when the man goes from the bad air of the 
caisson into the good air of the outside. The bad air of the caisson eats into 
the employer's pocketbook but the attempt of the worker s body to readjust 
itself rapidly to outside conditions after working in the caisson causes com- 
pressed air to eat into his life. 

When the Hudson River tunnels were being dug Moir's air locks were put 
in and thus the death rate from caisson disease was reduced from 25 per cent 
to 1 per cent. In the New York river tunnels the rate fell to 1/5 of 1 per 
cent. 

Schroetter recommended that where men work under one and one-half 
atmospheres they should work in eight-hour shifts and after work they should 
pass through the decompression chamber in less than fifteen minutes.* Where 
they work under three atmospheres they cannot work in shifts of longer than 
four hours and a longer time must be consumed in decompression. 

Haldane has shown that decompression should be accomplished with a 
rapid drop at the beginning, followed by a slow, gradual fall, and that if dur- 
ing the process bubbles begin to form in his blood and the man gets into 
trouble the air pressure should be run up again until the bubbles go back 
into solution, whereupon decompression should again be undertaken with 
watchfulness and care. 

An oxygen tank is kept handy and ready for use. When gas bubbles 
form in the blood the hemoglobin works at low efficiency. Inhalation of 
oxygen for a few minutes will keep the patient going until the bubbles are 
got rid of and the difference between inside and outside pressure is adjusted. 
Working in a caisson and diving are dangerous occupations but the degree 
of danger is determined by the degree of obedience to proper rules and reg- 
ulations. This presupposes an equipment to make life safe. 



DUSTY TRADES 

Men who are at work need air which is neither too hot nor too cold, too 
wet nor too dry, and which moves in currents strong enough to be felt. 

There is another quality of great importance and that is that it should 
be fairly free from dust. A good deal depends on the kind of dust. The dust 
from a country road on a hot, sunshiny July day is much less harmful than 
street dust in a large city and is almost harmless as compared with the dust 
of a metal polishing establishment. The most harmful of all dust is that 
containing large numbers of live disease-producing bacteria. 

Next comes inorganic dust such as stone, metal and glass dust. Of less 
importance is organic dust such as that of starch and flour mills. The report 
of the Department of Commerce and Labor on the baking industry states that 
flour dust is more harmful than starch dust because there is more gluten in 
the former. These are illustrations of gradations of the harm done by dif- 
ferent kinds of dust. 

It is advisable for the manufacturer to ascertain the quality and the 
kinds of dust in his factory. Breathing large quantities of dust gradually 
impairs the efficiency of the workers. Haldane, Martin and Thomas report- 



904 



OCCUPATIONAL DISEASES 




Fig. 372. — Respirator. (From Rauch und 
Staub, III, 9, June, 1913.) 



ing to the Secretary of State for the Home Department of the British govern- 
ment in 1904 said: 

"So far as the Cornish miners are concerned, it seems evident enough 
that the stone dust they inhale produces permanent injury of the lungs — ■ 
gradually in the case of ordinary miners and rapidly in the case of machine 

drill men — and that this injury, while 
it is apparently capable of gradually 
producing by itself great impairment 
of the respiratory functions, and, in- 
directly, of the general health, also pre- 
disposes enormously to tuberculosis of 
the lungs/' 

The thirty-fifth annual report of 
the Local Government Board of Eng- 
land says: 

"The behavior of consumption 
toward dust-producing occupations 
lends support to the theory of predis- 
position to infection by some induced 
alteration of the lung substance." 

It is the opinion of those inves- 
tigators that, aside from the disease 
caused, dust causes inefficiency. 

The manufacturer can have a de- 
termination made of the character and quantity of dust in his factory. How- 
ever, he can get a pretty good line on it by a careful study continued suffi- 
ciently long of the consumption rate of his men. The study should be careful 
enough not to mislead. The number of men who have fooled themselves on 
this point by shallow observation would fill a book. 

The above cited report gives figures for consumption among English 
workers. Using farmers at 100 as 
the base they report as follows: 

"Ironstone miners, 133; carpen- 
ters, 148; coal miners, 166; corn 
millers, 166; bakers and confection- 
ers, 177; blacksmiths, 177; lock- 
smiths, 194; wool workers, 202; tin 
workers, 204 ; carpetbag makers, 213 
bricklayers, 215; ropemakers, 220 
coopers, 238; cotton spinners, 244 
lead workers, 247 ; brass workers, 250 
stone quarriers, 261; iron workers, 292; copper miners, 307; copper workers, 
317; lead miners, 319; glass workers, 335; filemakers, 373; cutlers, 407; 
earthenware workers, 453." 

Miss Brandt's table for the United States places marble and stone cutters, 
cigar makers, plasterers and printers even higher than cutlers. 

The relation between consumption and dust is easily seen. A manu- 
facturer by careful study of the bad air diseases among his men can get a 
fair idea of the harm his factory is doing. 




Fig. 373. — Showing the Choking with 
Soot of a Breathing Pore of a Leaf of 
a Silver Fir Tree. (Arthur C. Ruston, 
University of Leeds.) 



DUSTY TEADES 



905 




DUST IN SHOE FACTORIES 

Such statistics as we have show that shoemakers have an undue propor- 
tion of lung and throat disease. Their consumption rates are high. In part, 
this is due to contagion, for the chance of catching consumption is high in a 
trade where the man at the next bench is exceptionally liable to be a 
consumptive. 

Another reason is the dustiness of the air in a shoe shop. Sir Thomas 
Oliver says dust causes colds and pneumonia as well as consumption. There- 
fore, we are prepared to believe 
that shoemakers frequently are 
laid up with colds or, having a 
cold and needing the pay, they 
stay at the bench and get through 
the day without making much for 
themselves or their employers. 

Drs. Hansen and Wolcott, 
having studied the boot and shoe 
industry in Massachusetts, made 
a report on existing conditions 
and recommended certain meth- 
ods in a paper distributed in 
the" exhibit of the Massachusetts 
health department at Washington. 

To estimate the amount of 
dust, they exposed slips of paper, 

sometimes dark paper, sometimes light, at the point usually occupied by the 
workman's head. A piece of heavy gummed paper, 10 by 7, was painted with 
a mixture of thirty parts glycerin and seventy parts water. This was ex- 
posed while moist in the position usually occupied by the workman's head. 

The exposure was for a definite time while the machine run by the 
operator was doing its regular work in the regular way. The cardboard was 
then covered by a thin rice paper ruled into one-inch squares or else by a 
gelatin film. The preparations for microscopic examination were made by 
treating glass in the same way and then exposing it as in the case of the 
paper. 

The amount and the type of dust having been determined the experi- 
menters proceeded to calculate the size of the hood, its location and the size 
of the ducts leading from it. Next they calculated the amount of negative 
pressure needed to lift the shoe dust and therefrom the size and speed of the 
fan required. And finally the results were checked by an examination of the 
dustiness of the air at the breathing zone. 

Shoemaking should not make men inefficient. The factories in Massa- 
chusetts were generally well lighted and fairly well ventilated. The advan- 
tage of good lighting is so great that most of the factories are surrounded 
by yards and most of the machines except the stitchers are close to win- 
dows. The only poisonous fume is that from naphtha and that is easily 
controlled. An effective control of dust should make shoemaking in factories 
a healthy trade and its workers men of high efficiency. 



Fig. 374. — Cabinet for Sand Blasting. The 
operation directs the blast against the casting 
(b), a current of air driven by a fan (t) carries 
the dust into a duct through which it is sucked 
by the fan shown at the right. (From Ranch 
und Staub, II, 5, Feb., 1912.) 



906 OCCUPATIONAL DISEASES 



MEN WHO WORK IN WET AIR 

There are certain trades where the workers are kept in moist air and 
are thereby made uncomfortable, inefficient and sometimes ill. Dr. 
Graham Rogers investigated 215 workrooms in New York State. In 18 per 
cent the humidity was over 70 per cent saturation. The worst offenders 
are pearl button factories, bakeries, clothing manufacturers, cigarmakers, 
printers and laundries. The British parliamentary commission found humid- 
ities high among cotton spinners and weavers. Cooks, greenhouse workers, 
tunnel diggers are among a long list of workers who are subjected to air which 
is too wet. 

Fluegge in Germany and Haldane in England have shown that when 
the temperature rises to 80° with moderate humidity or much above 70° with 
high humidity depression, headache and dizziness come on. When the air 
reaches 78° temperature and 100° humidity Haldane found that men begin 
to get fever. Those who work in warm, moist air suffer from heat more than 
any other group. They get headaches and presently fall over from heat 
stroke. They are subject to rheumatism, asthma, colds and all kinds of 
infections. 

That is to say, if one hundred men as nearly alike as possible were divided 
into two groups and one was put to work in a warm, damp bakery and the 
other in a well ventilated room with a temperature of 68° and a humidity of 
60°, more of the first group would develop inflammatory rheumatism than of 
the second. If a group of women were similarly divided and one half put 
to work in laundries and the other half in places with a proper humidity and 
temperature the latter group would be freer from colds. 

Winslow in his address before the National Educational Association on 
July 14, 1911, said: 

"We have thus the somewhat paradoxical condition that excessive moisture 
increases the bad effect of either heat or cold." 

The man who works in wet air cannot do a full day's work in either winter 
or summer. This the "traffic must bear." He is sick or otherwise knocked 
out more than the average. This also the traffic must bear. 



SANITATION IN THE CLOAK INDUSTRY 

[From the Bulletin of the Joint Board of Sanitary Control in the Cloak, 

Suit, and Skirt Industry] 

Human Engineering for 1911 quotes as follows: 

''Workmen in safe and sanitary shops are not only more healthy; they 
are more efficient. Efficiency is the very soul of industry. Ours is the first 
attempt in the history of industry in this and other countries of a trade to 
control its own destiny. This is the first common ground upon which or- 
ganized labor and organized capital may peacefully meet, and consists in safe 
and sanitary shops/' 

Proceeding on these basic principles the Joint Board of Sanitary Control 



WHAT THE WORKINGMAN SHOULD DO 907 

of the Cloak, Suit, and Skirt Industry conducted "a shop to shop sanitary 
inspection of the cloak making industry in Greater New York." 

The board consisted of two inspectors, one office secretary and one mes- 
senger. They made a total of 1,693 inspections, appointed twenty-five shop 
committees, gave twenty-four noon lectures, and distributed 58,500 bulletins 
and cards. They circulated this notice: 

"To Shop Owners: Our sanitary certificates are ready. All owners of 
shops which conform to the following standards are entitled to a certificate, 
which will be granted upon application and inspection. The possession of our 
sanitary certificate will be a positive indication that your shop is safe and 
sanitary." 

There follow twenty-eight sanitary requirements. Among them are 
such as: 

"No shops to be allowed in a cellar. 

"Sufficient window space to be provided so that all parts of the shop will 
be well lighted from 9 a. m. to 4 p.m. 

"At least 400 cubic feet of space, exclusive of bulky furniture and mate- 
rials, should be provided for every person within the shop. 

"The shop should be thoroughly aired before and after working hours, and 
during lunch hours, by opening windows and doors. 

"All seats to have backs." 

Some of the remaining twenty-three requirements are quite as important 
as these which have been cited. Some requirements of great consequence 
are not found; but the leaven is there and it will continue to work until 
things become as they should be. When that time comes Ghetto consumption 
will rapidly diminish and the workers, relieved of this great burden, will be 
more contented and happier. Inevitably business will be more secure. 

The movement is emphatically right. No better business policy could 
be conceived than for manufacturers engaged in other lines to follow this 
example. Workingmen have a right to demand safe and sanitary shops. Em- 
ployers have a right to demand of workingmen personal cleanliness, help in 
keeping the shop clean and good home hygiene. 



WHAT THE WORKINGMAN SHOULD DO 

Some of the unions are assuming their duties. The cigarmakers, printers 
and bakers are doing well; others are taking up their duties in a less satis- 
factory way. The unskilled laborer is the point where the line of progress 
lags — the wandering laborer who lives in lodging houses, the newly arrived 
immigrant, the country boy newly come to town, the average negro. 

The first obligation of the employee is to go to work in the morning in 
the best possible physical condition. This means good food, good air and 
good sleep at home. His home should be the most sanitary that his means 
will afford, his foods the most nutritious that his wages will allow. Several 
things are needed for a sanitary home some of which are expensive while< 
many cost effort only. 

If the employee works at a dusty trade he can contribute his part toward 
keeping the dust down as much as possible. He can keep from infecting the 



908 OCCUPATIONAL DISEASES 

dust by not spitting on the floor. If he works at a poisonous trade he can 
wash his hands with frequency. He can wash especially well before eating. 
He can wear gloves in certain processes. He can be careful of dangerous ma- 
chinery. He can help in the maintenance of standards by a proper use of 
the toilet facilities. He can stand with those who insist on fresh, cool air 
in the working room. He can do his part to prevent the spread of venereal 
diseases, smallpox, consumption, diphtheria and colds among the workers. 

The employee can block the wisest efforts to improve that an employer 
can make. On the other hand he can lend his support to plans for improve- 
ments and thus double their efficiency. 

Regarding Matches. — 0. L. S. writes : "Can you advise me whether there 
is any way by which the consumer can distinguish the poisonous white 
phosphorus matches from the red phosphorus or the sesquisulphid matches? 
Do the so-called 'Swedish' or 'safety' matches belong to any one of these 
processes of manufacture?" 

Reply. — From the standpoint of the consumer white phosphorus 
matches are about as harmless as those of red phosphorus. The object 
of the Esch bill was to help the workers in match factories. They were 
the sufferers from phosphorus poisonings. Consumers were asked to use red 
phosphorus matches in order to help the workers in the factories. The 
law has passed and the white phosphorus match industry is at an end in 
this country. I understand that Swedish matches do not contain white 
phosphorus — neither do American matches now. 

Brass Chills. — Foundry Worker writes: "I am a brass foundry worker 
and am often subjected to so-called 'brass chills/ which are due to the in- 
haling of zinc fumes when smelting yellow brass. Is there any way to pre- 
vent it?" 

Reply. — Brass chills result from inhaling the fumes from the pots. The 
poison, probably zinc, causes the red blood cells to become stippled. Under 
the microscope the blood cells look as they do in malaria and the symp- 
toms are a little like those of malaria. Of course there is no relation be- 
tween the two diseases. Dr. Hayhurst of the Illinois Commission on Occu- 
pational Diseases advises (a) isolated furnace rooms, (b) hoods over fur- 
naces and pouring places, (c) ceiling ventilators with suction fans, (d) 
ample space, adequate light, wet cleansing, frequent whitewashing, (e) 
eliminating boys, women, anemic and tubercular men and alcoholics. As to 
what you should do, by all means ask the state factory inspector to see to 
it that your working place is made safe for you. 

Danger from Dust. — H. K. writes that he works in a grain elevator 
and has a racking cough. The room is dusty and smoky. He breathes a 
great deal of dust and smoke. He has had this cough for six months and 
wants to know if the breathing of dust and dirt can turn into consump- 
tion. 

Reply. — Nothing more frequently turns into consumption than breath- 
ing dust and smoke from working in a dusty place. By all means be care- 
fully examined and without delay. 

Writer's Cramp. — W. E. E. writes : "I am a commercial artist and have 
been considerably worried on different occasions by a dull, throbbing ache 



OCCUPATIONAL DISEASES 909 

in my working hand. This ache extends as far as the elbow. I would 
like to know what the symptoms are, and what precautions, if any, may 
be taken to avoid writer s cramp." 

Reply. — Writer's cramp is a paralysis from overuse. It means that 
the pitcher has been to the well too often. There is no cure except to "let 
up" before it is too late. Sometimes methods of using the hands so as to 
spare the overused muscles and nerves can be devised. You should see a 
nerve specialist. 

Protecting Workers from Heat. — E. D. D. writes that he has a factory 
with an occupied basement. In one corner the boilers are located. The re- 
mainder of the basement and the floors above are occupied as workrooms. 
The men complain that the rooms, are too hot; that they get heated and 
the cold air rushing in chills them. In the summer they are much too 
warm. Can anything be done about it? 

Reply. — In the dairy husbandry building of Cornell University they 
have a large workroom in the middle of which is a sterilizing room. The 
milk cans are run into the sterilizing room, the doors shut tight, and the 
steam is turned on. The temperature of the sterilizing room gets to 200°. 
The large workroom is not heated by it. How is it done? 

The walls of the sterilizing room are made of hollow tile. The doors 
are heavy and double walled, with insulation between. Try it. You will 
get more work from your men. They will have less pneumonia and be 
generally healthier. 

Telegrapher's Palsy. — S. writes: "I am now middle aged. During all 
my working life my occupation has been office work, telegraph operator, 
bookkeeper, clerk, etc. I am right-handed. For several years my right arm 
has been losing its activity and willingness to do its work. It is only with 
great effort that I am able to use it. The effort to make it work causes 
me mental pain and distress. It wants to cling to my side; when idle it 
squirms and twists around towards my body; when I attempt to write I 
cannot hold it down to the desk; it wants to fly up or drop down and hug 
my side. I cannot write in a straight line — the finish of a line will be con- 
siderably higher than the commencement ; there is a dull pain in the upper 
arm and shoulder, also in my right side directly under and in front of the 
arm; there is no swelling. Is there any way I can restore my arm to its 
activity and usefulness?" 

Reply. — The dull ache and the pain described by you suggest that you 
have telegraphers' palsy. The tendency "to cling to your side, squirm and 
twist toward your body, to fly up or drop down and hug your side" sug- 
gests a mind cause. Perhaps it is partly due to each. If you have teleg- 
raphers' palsy get into the best hands possible and follow directions. If 
you are going to tinker with yourself you had better quit telegraphy and 
take up something where your telegrapher's hand is not important. As 
it is, your hand is your tool. Give it the best attention possible. 

Case of a Painter.— C. W. H. writes: "Early in the spring in part of my 
right hand would come and go a peculiar sensation as if it were asleep and 
partly numbed. It gradually got worse and reached to the elbow. Some- 
times during an attack I could not use the hand. Two months ago I placed 
myself under treatment by a doctor who says it is a touch of paralysis 
brought on by lead poisoning. I am a painter. The treatment seemed to 



910 OCCUPATIONAL DISEASES 

benefit me at first, but later the attacks were more severe and more fre- 
quent. My general health is good. Will massaging and electricity help 
meV 

Reply. — Lead poisoning is much more frequent than generally sup- 
posed. As your disease is not of long standing or far advanced you should 
get well. Massage and electricity will help you after your disease has 
ceased to progress. In other words, when the disease has subsided they 
help you to regain the use of the muscles and nerves. Keep in the open air 
and keep your bowels open. Lead poisoning brings on premature old age 
and heart and kidney disease. After you get well change your trade or else 
be much more careful about keeping your hands clean than you have 
been. 

Cause of Lead Poisoning. — 0. L. writes: "When you speak of a disease 
as 'lead poisoning' what do you mean ? What causes it?" 

Reply. — A disease affecting the nerves and blood, and, in some meas- 
ure, all of the tissues. It results from prolonged drinking or swallowing 
of lead. It is found most frequently in painters and is then known as 
"painter's colic" or "lead colic." With them it results from white lead 
which gets into their food from their hands, though some absorbs through 
the skin. It sometimes results from the use of bottled or charged waters 
which have been allowed to become contaminated with lead. An ulti- 
mate effect is premature senility. This results from thickening of the 
arteries. 

Too Long a Workday. — N. L. writes: "I am a man about 20 years of 
age. I have been working in an office for six years. Since the first of this 
year I have been given a position which keeps me sitting most of the day. 
I naturally have to bend over the desk somewhat, as I have to write a 
good deal. I have been troubled with backache almost every afternoon for 
the last few weeks. Otherwise I am feeling pretty well, considering that 
I am working almost twelve hours daily. I have tried exercising, but it 
does not seem to help me any." 

Reply. — You are bending over too long, working too many hours. 
Backache means nerve tire with you as with nearly everybody else when- 
ever the work is too hard. There is a backache work line. Neurasthenics 
get to it quickly. The well balanced get to it more slowly. But twelve 
hours at a desk would give it to a truck horse. The cure is shorter hours, 
fresher, cooler air in the office, and exercise, preferably play, after work. 

Quit Working There. — Reader writes: "7 have been working in a dark 
basement for one year and five months where I consider the conditions 
insanitary. Could I continue to work there without harm? The place, 
being a corner, has three wet walls covered with slime, which smells like 
mushrooms. Water comes in constantly, decays, and smells bad. Mold 
forms on everything. It is poorly ventilated." 

Reply. — You cannot continue to work there without harm. A dark 
basement is bad enough but one with damp walls covered with slime and 
where mold forms on everything is intolerable. If you stay there long you 
will get rheumatism, consumption, blastomycosis, or some other sort of 
bacterial disease. 



CHAPTER XL VIII 

Hot Weather Advice 

Coming north on an Illinois Central train I read a booklet got out by the 
immigration department of that road. The write-ups of Mississippi towns in- 
variably stated, "We have no sunstroke." These statements I know to be 
substantially correct. What is the solution ? 

First, the place of atmospheric heat in causing death is subject to a 
good deal of interpretation. Cities anxious to refute the charge that heat 
causes deaths amongst its people are careful to see that old age, heart disease, 
Bright's disease and baby complaint get their deserts. Towns that do not care 
call every death in hot weather where heat can be dragged in a death from 
heat. 

After proper allowance has been made for these considerations there 
still remains the fact that summer resort Chicago has more heatstroke than 
Mississippi. Why ? 

There is an art in bearing heat and many people in Chicago have not 
learned it. The suffering is greater in the beginning of the season than later 
on, because experience teaches the art to some. 

1. The first item of the art to master is in dressing. The clothes should 
be as few as the law allows and as light and porous as possible. Coming 
in today I met some boys wearing two garments. If they were suffering they 
did not show it. Our intermittent warm and cool weather makes us more 
susceptible to heat than others and it is one of the reasons which makes us 
wear hot clothes in hot weather. 

2. The second is eating. Fruits, salads, vegetables, buttermilk, cereals, 
bread and lean meat (and not over much of the last two) are proper. The 
most important item to control is quantity. Next are fats and greases — 
cream, butter, gravy, salad dressings, olive oil, fat meat and nuts — a tropical 
diet for tropical weather. One-half of the usual diet will suffice when the 
temperature goes over 90°. A part of every man's boiler capacity is used to 
make work-steam, the remainder is a heating plant. For comfort's sake 
shut down the heating plant when the air sizzles. 

3. Drinking. Avoid beer and every sort of cooling drink containing wine. 
Alcohol burns with a quick, hot flame that blisters the boilers and then dies 
down. Heatstroke is a blistered boiler. 

4. Bathing. Promote sweating by baths, internally and externally. 
By baths internally is meant drinking plenty of water. 

5. Elimination. Keep the excretory organs working. 

6. Crowding. Keep out of the crowds. Why burden yourself with the 
other man's heat? 

7. Drafts. Keep away from still air. Keep close to a draft. 

911 



912 HOT WEATHER ADVICE 

8. Sleeping. Sleep cool. Eooms were invented for winter necessities. 
Some can sleep under the trees, some on porches, some on roofs. Three hours 
after sundown the roof is cooler than the room and the pavement is cooler 
than the porch. 

9. Worry. Never mind the weather. To think hot is to feel hot. Deserve 
to be cool and then forget what you can't help. 



WORK IN HOT WEATHER 

The human stove has two major and several minor fires going. The 
fires go all the time, night and day, sleeping and waking, still and moving, 
so long as life lasts and for a short time after. But the more the fires 
are fed the more heat the stove makes. It is not within our power, com- 
patible with life, to end the fires, but it rests with us to make more or less 
heat. 

The most important fire, and one that can be turned up or down, is that 
fed by food. The next most important contributor to the sum total of heat is 
muscular movement. 

Every act of the body is attended by the production of heat. The 
digestion of food is a pretty good heat producer. The liver cells, albeit well 
oiled, work so as to produce considerable heat. The flow of blood in the 
vessels, the coursing of air in respiration and the oxidation of blood in 
the lungs — each of these is a heat producer. 

The great heat making organs are the muscles; and the amount of heat 
produced by them is under considerable control. Thompson in his "Dietetics" 
computes the number of calories required when a man is working hard as 
4,150, with 2,700 for a man at rest. 

By calory is meant the amount of heat forming substance in a given 
amount of food. When fifteen grams of fuel burned give off enough heat to 
raise the temperature of 2.2 pounds of water 1.8 degrees we say it gives 
one calory. A man at hard work, then, needs about one and a half times 
as much food measured in heat units as when at rest. 

Scientists have had a way of checking such conclusions as these. By using 
an instrument called a calorimeter they are able to measure the amount of heat 
made by a man at work as compared with the same man at rest. 

The human stove has an engine attached. These scientists have found the 
engine a most efficient machine. They find that a man at work makes more 
heat than a man at rest and the difference almost exactly equals the added 
number of calories required as food. 

The practical application is that all unnecessary muscular labor be cut 
out during hot weather, at least during the torrid part of the day. 

The people in Eome shut up their stores and rest from twelve to two. The 
people of the southern states do a good deal of their work during July, 
August, and September at night when the moon is shining, and in the early 
morning and late afternoon at other seasons. 

During the long days of summer an eight-hour day can easily be managed 
without making use of the heat of the day. 



DISEASE IX HOT WEATHER 913 



DISEASE IN HOT WEATHER 



When hot weather comes on some of our disease enemies get less active 
and some more so. The ordinary contagions diseases become much less 
harmful. Smallpox almost disappears. Whenever a community carries a 
smallpox epidemic over into hot weather it is certain there is something wrong. 
Either the government is weak and ineffective or else the cranks are unusually 
numerous and active. 

A large city in this part of the United States is certain to have some 
smallpox poured into it in the winter and spring. It cannot be blamed 
for that. It may spread a little in the spring months — it cannot be blamed 
for that. But when the smallpox cases continue to bob up during sizzling 
weather somebody should be punished. 

Diphtheria, scarlet fever and measles can also be expected to let up. 
Pneumonia runs to less than a half of the February rate. In the parts 
of the country where pneumonia, contagion and colds are the principal 
diseases the physicians take their vacations in summer. On the other hand 
certain diseases are more abundant and some of them more hazardous in 
summer. 

First on the list is summer complaint in babies and next in importance 
comes malaria. Typhoid is of more importance in summer than in winter, 
though autumn is the typhoid season. During the hot months typhoid 
seems to be laying the foundation for its fall work. The people who are 
having typhoid are infecting wells and milk supplies. The flies that are 
to carry it later are multiplying. The amount of pellagra increases, and 
so do the less important intestinal disorders. 

The heat of the sun's rays is too great for bacterial prosperity. Certain 
parts of a ray of sunlight are actively bactericidal. Then why is it that in the 
season when the sun's rays are hottest some bacterial diseases are at their 
worst ? 

There are two reasons. Enough of certain germs escape the great heat 
and the bright light to effect their part of the harm; in the second place, the 
effects of spoiling are greatest in hot weather. 

In summer complaint in babies a very important factor is spoiled milk — 
not badly spoiled milk, not milk that is offensive to the smell or is even off 
in taste but which is spoiled so far as baby feeding is concerned. There 
are those who claim that pellagra is due to spoiled meal. The minor digestive 
disorders are also due to spoiled food. 

To prevent these disorders ice is required. The heat of summer is bad 
enough on the baby but it is worse on his food. It is not feasible to keep the 
baby on ice. It is feasible to keep the baby's milk on ice and, though not so 
important, the food of the grown up should also be kept on ice — and some 
very great authorities think this injunction should apply also to meal in 
summer. 



914 HOT WEATHER ADVICE 



THE LIVER IN HOT WEATHER 

Ordinarily the liver comes down as low as the edge of the ribs, about three 
inches to the right of the median line. Therefore whenever it swells it must 
push downwardly for it cannot bulge upward. 

The volume of the liver changes constantly. It is a great Mood reservoir 
and its volume is changed by change in the amount of blood within it. Its 
own cells increase and decrease in size according to the work they do and this 
changes the size of the liver. 

The liver is a favorite place for the storage of surplus food. Man is a 
provident animal. Socially he hoards his treasure in savings banks, ware- 
house bins and cold storage houses. But what he learned in a social way 
as he emerged from savagery his body cells had always practiced. This 
statement is true of almost every principle of community life. For example : 
When a man eats more than he needs the surplus is converted into easily 
burned fat and stored in the liver tissues toward the possibility of a "rainy 
day." The liver is one of the most elastic and most serviceable of these great 
warehouses. 

As the liver enlarges trained fingers can easily feel it pushing down- 
ward below the ribs and under the softer muscles. Amongst people in hot 
climates the liver nearly always swells in August and September. It comes a 
half inch farther below the ribs than in cold weather. This condition of hot 
weather liver enlargement is almost the rule in the people of the Gulf 
states and is frequent even as far north as Chicago. 

The question comes up, Is this the result of the heat? If not, to what 
is it due? The answer is, It is not due to the atmospheric temperature but 
is due to eating too much. 

The engineer of an office building runs his fires so as to make steam 
for the elevators and heat for the radiators. In summer time he uses less 
coal and carries less steam because the radiators are not in use. When the 
thermometer is over 85° a man needs little steam in his radiators. If he 
continues to eat cold weather rations the surplus piles up somewhere. The 
favorite somewhere is the liver. 

When, in August and September, a man finds his liver swollen — or his 
physician finds it for him — he commonly takes a course of calomel "to 
touch his liver." A wiser course would be to stop eating until he has burned 
up his surplus, in the meantime taking milder laxatives. Of course, the 
really wise plan is to cut down his food beginning June 1 and thus prevent 
his liver from swelling in August. 

Now, everybody knows that the desire for food lessens in hot weather. 
People who eat ravenously are willing to nibble in hot weather. Many people 
know that heavy eating makes the heat worse — increases the discomfort from 
the heat. 

But the habit of eating is so strong that many people eat too much in 
spite of these two considerations. It may help some of these to control them- 
selves to know that the swollen livers of hot weather are due to overeating 
and that a large liver persisted in means eventual organic or functional 
disease, 



CROWDS IN HOT PLACES 915 



CROWDS IN HOT PLACES 

A Chicago theater carries this advertisement: 

Temperature in this theater, 70°. 
Temperature in the" street, 90°. 

I do not vouch for the accuracy of this advertisement. I do not know 
anything about it one way or the other but the advertisement of itself stimu- 
lates a demand for a cool theater and it is certain that that demand will bring 
about cool theaters. 

We have faith enough in the good of it to advertise the advertisement. 
I do not know but I presume the theater chills the air with which it ventilates. 
This method is used in restaurants in the basements of two Chicago hotels. It 
may be true of others. If it is not it should be. 

When a thousand people are together you are dealing with a thousand 
stoves. In the winter such a crowd would make heat enough to heat them- 
selves and the walls of the room but not enough to heat the needed fresh air. 
In the summer they make enough heat to make life a burden wherever there 
is no proper effort to control it. 

The excess heat can be removed if air enough is used, but it is easier done 
(and in some places it can only be done) by chilled air. Cooling a room with 
air at 90° does not get very far. Great crowds and very artificial conditions 
demand very artificial remedies. 

When a man says our grandfathers never had chilled air and therefore 
why should we, the answer is — 15,000 of our grandfathers never crowded 
into one room located on ground worth a million and a half an acre. We 
can quit crowding at one end of the line when they quit crowding at the 
other. 

Whenever we have congestion of occupation we get congestion of heat 
making. Now, when a man makes heat he must pass it on or he gets a self- 
made heatstroke, sometimes called sunstroke. If the air around him is cool or 
moving fast he can dump his load of heat with ease. If the air is warm, or 
stagnant, or wet, or all combined, he becomes uncomfortable and is soon over- 
come. Whether it be summer or winter the man is the hottest thing in the 
room. The next hottest is the air which is next him. 

It is all right for the restaurant keeper to tell the man to wear loose 
open clothes, dark underwear and white top wear and to keep his own fan 
going. But has not the man a right to demand that the room temperature 
be kept as low as 70° and the humidity as low as 50 — the first that he may 
radiate heat directly; the second that he may lose it by evaporating sweat? 

How many places in town could advertise a cool dining room and make 
good? 

How many could advertise a cool kitchen and make good? Food pre- 
pared by hot cooks in hot kitchens is liable to have something in it which 
is not nice to think about. 

How many men refuse to patronize a hot theater or restaurant? Heat 
kills many people; cold but few. 



916 HOT WEATHEB ADVICE 



SLEEPING IN HOT WEATHER 

Sleeping in the hot weather is a difficult proposition for some people. 
The night hours are short ; the streets are noisier ; Morpheus, the god of sleep, 
has difficulty in getting his orders obeyed. 

In summer time, when the rising sun is about to catch up with the 
setting sun, when the birds are singing, the sparrows chattering, the rooster 
crowing, the milk cans rattling, and the neighbors gossiping — all in the open 
air and in the . heart of the sleeptime of the early morning ; and when 
the thermometer keeps above 85° all night long Morpheus' job is liable to give 
the old man nervous prostration. We can do a good deal to help him out. 

We can scarcely claim much flexibility in our sleeping customs. The 
house is no place in which to sleep in hot weather. More than half the liv- 
ing places will permit of sleeping on a porch. In case there is no porch in 
some instances a fire escape may be made use of. In other cases the roof 
is available. 

Many have the idea that a roof is always hot because they know that 
rooms just underneath the roof are generally so. 

The contrary is true. On the roof it is always cooler than on the pave- 
ment and once the sun has gone down on the roof it shortly becomes a com- 
fortable spot. The moving air can reach it far better than it can reach the 
pavement. 

This factor, the ability of moving air to reach the sleeper, is the deter- 
mining factor in an under-the-roof room. If such a room is so arranged 
that the side walls can be dropped or lifted and the air allowed to blow 
through it will not be a hot sleeping place. 

For some of those not able to sleep on roof or porch yard space may be 
available. Where none of these is to be had, why not sleep in the parks 
and squares? Many men of small earning capacity have to choose between 
sleeping in the park and sleeping in a room the walls of which feed heat to 
the room all night long as well as keep out the air. 

Would it not be advisable for park boards to take note of this and then 
extend invitations to the people to sleep in the parks? 

The added expense for policing would not be great but the gain in work- 
ing capacity as well as in health would be enormous. 



CHAPTER XLIX 

Insects 

PARASITICAL PESTS 

RED BUGS 

As a rule red bugs do not bore into the skin. They remain on the 
surface and suck through the skin. They sometimes get into the ducts of 
sweat glands and occasionally get well into the skin. Herrick describes one 
case in a chicken in which there was a berrylike cluster of them below the 
surface of the skin. 

Both Herrick and Eiley advise that to keep them off the body the stock- 
ings and underwear be dusted with flower of sulphur. Chittenden advises that 
the underwear be dusted with powdered naphthalene. Sulphur ointment, car- 
bolized vaselin or salted butter 
will kill the parasites on the 
skin. To allay the irritation 
bathe the itching patches with 
a saturated solution of soda in 
water. 

STRAW ITCH 

Men who work around 
straw or who sleep on fresh 
straw are liable to develop an 
acute eruption as the result of 
bites by a straw parasite. The FlG - 375.— A Harvest Mite. (Ealand.) 

name of this disease is derma- 
titis Shamberge. The name is worse than the disease. 

There are no parasites in old straw. The man who must work in fresh 
straw can protect himself by the use of powdered sulphur or naphthalene. 
Goldberger recommends greasing the body with lard. The best wash is soda 
water. Salt water and dilute ammonia water are good. The best local applica- 
tion is sulphur ointment. 

ITCH PARASITES 

Fifty years ago the skin disease now known as itch went by the name 
of the seven-year itch. Now we know that the cause is a mite which burrows 
in the deeper layers of the skin, and acting on this knowledge, we know how 
to cure it in a week. Seven-day itch is a better name than seven-year itch. 

Stiles' method of cure is as follows: 

917 




918 



INSECTS 



1. Eub the entire body except the face with green soap and water for 
twenty minutes. 

2. Stay in a warm bath for thirty minutes. Eub with green soap while 
in the bath. 

3. Eub sulphur ointment into the skin for twenty minutes. Leave the 
ointments on for five hours. 

4. Wash off the ointment with soap and water. 

5. Sterilize the clothing, especially the underclothing, with heat. As 
this does not kill the eggs, five days later repeat in order to kill the parasites 
which have hatched meanwhile. Thin-skinned persons should modify the 

above plan. 

LICE 

There are three varieties of lice which regularly live as human parasites — 
the head louse, the body louse and the crab louse. It has been proved that lice 

transmit typhus fever. Furthermore, it has been 
proved that a mild form of typhus fever known 
as Brill's disease is present in many portions of 
the United States. 

We learn that the European soldiers in the 
trenches pull off their clothes and leave them on 
ant heaps as a means of ridding themselves of 
lice. This may work with body lice. It will not 
work with the other two varieties. 

For the body lice the clothes must be baked, 
steamed, or washed in gasoline. Two treatments 
at intervals of a week are required. 

For head lice several washes are effective. 
Kerosene, 2 per cent carbolic acid and a tincture 
of cocculus indicus are good. The treatment must 
be repeated as nits are not easily killed. Mer- 
curial ointment applied will kill crab lice. 




Fig. 376. — Louse and Nit, 



BEDBUGS 

From the standpoint of disease, bedbugs are not important. They have 
been known to spread plague, kala-azar, trypanosoma, relapsing fever, Aleppo 
boil, typhoid fever, tuberculosis, and syphilis. All but the last three of these 
diseases are of little importance in this portion of the world. It is not thought 
that bedbugs are important factors in the spread of any of them. 

Bedbug eggs hatch in six to ten days. If the bug gets plenty of food 
it reaches the adult size in thirty-five days. If poorly fed, one hundred and 
fifty days may be required. A bedbug can live without food for more than 
a year. 

While they prefer to bite human beings they do not hesitate to feed 
on cats, dogs, rats, mice, swallows, canaries, sparrows or any other acces- 
sible warm-blooded animals. 

Much the most efficient method of destroying bedbugs is by the use of hy- 
drocyanic gas. This method is too. dangerous to be used except by persons who 
have had experience with it. 



STINGING PESTS 



919 



The burning of sulphur is not satisfactory. Herrick thinks probably 
this has been because not enough was burned and the exposure was not for 
long enough. He suggests that the cracks be thoroughly stripped; that two 
pounds of sulphur for each 1,000 cubic feet of air be burned ; that everything 
be dry; and that the gas be allowed to act for eight hours. 

As local applications kerosene, gasoline, boiling water, and a mixture of 
alcohol one pint, spirits of turpentine one- 
fourth of a pint, and corrosive sublimate one 
ounce are all effective. Whichever of these 
is used to get results treatment must be 
thorough and it must be repeated at least 
four times at intervals of four days. 

FLEAS 

Fleas certainly spread plague. Possibly 
they also spread leprosy at times. They may 
spread one form of tapeworm. They may 
spread trypanosoma. 

Eiley recommends lotions of carbolic 
acid, 3 per cent, or camphor and carbolated 
vaselin to relieve the irritation of a flea bite. 

The best fumigation against fleas is that by hydrocyanic gas. The best 
single measure against fleas is to get rid of the nits, especially in the cats 
and dogs. Riley tells of a woman who held a half-grown kitten in her lap 
for a short while and then gathered up a teaspoonful of flea eggs which had 
fallen from the kitten to her dress. 

Perhaps the second best single procedure is to get rid of the rugs and 
carpets and to keep the bare floors clean. Dr. Skinner scatters five pounds 
of flaked naphthalene on the floor of a room, closes the doors and windows 
and leaves things for twenty-four hours. He then sweeps up the powder 
and sprinkles it on the next room. Riley quotes him as saying, a The flea 
question is solved." 

TICKS 

In the Rocky Mountains a form of spotted fever is spread to human 
beings by ticks. The Public Health Service rids an infected mountain side 
of ticks by grazing it with sheep. Grazing is begun in the valley and the sheep 
are slowly worked up the mountain side. 




Fig. 377. — Bedbug. 



STINGING PESTS 



Spiders do not deserve their bad reputation. None of them will bite 
if escape without biting is possible. Most of them are harmless when they 
do bite. Only two varieties are dangerous to life — the tarantulas and the hour- 
glass spiders — and these are only dangerous under most exceptional circum- 
stances. On the other hand they are efficient insect destroyers. 



920 INSECTS 

Spider webs do not soil a wall. They show up a dirty wall as such — that 
is all. 

A solution of cooking soda in water should be applied to the bite. If 
there is need of it thirty drops of aromatic spirits of ammonia in a wine- 
glass of water may be given. 

SCORPIONS 

The bite of a scorpion less than two inches in length is no more irritat- 
ing than a bee sting. Large scorpions may carry a dose of poison capable 
of producing a good deal of local irritation and causing some disturbance of 
the system. Strong soda water should be applied locally. Aromatic spirits 
of ammonia may be given internally if the face is pale. 

CENTIPEDES 

The centipedes of the United States do not carry enough poison to 
endanger human beings. The treatment of centipede bites is the same as 
that of tarantulas. 

BEES, HORNETS, WASPS AND YELLOW JACKETS 

The stinging apparatus of these insects is a tube barbed at the farther 
end. This stinger is a part of the apparatus for depositing eggs. Therefore 
only the female can sting. 

As the barbs hold the stinger in the wounds the insect stings but once 
in a lifetime. At the base of the egg depositor are two glands. The secretion 
of one of these is acid; of the other, alkaline. The poison does not become 
poisonous until the secretions mix. 

For a sting there is no better application than wet soda or strong soda 
solution. 

Hornets, wasps and yellow jackets do not make bad neighbors. Her- 
rick quotes an English entomologist, Westwood, who visited us in 1840, as 
having written the folks back home : "The Americans, aware of the service of 
hornets in destroying flies, sometimes suspend a hornet's nest in their parlors." 

To destroy a yellow jacket's nest pour carbon bisulphid into the opening. 
If you are prudent you will do this at night. To destroy a hornet's nest 
plug the opening and pour kerosene on the nest. 

BLACK FLIES 

Probably the most annoying and most dangerous of all American biting 
insects per se is the black fly. The studies of Dr. Stokes suggest that the 
best applications to make to black fly bites is a solution of muriatic acid in 
water (1 to 200). Perhaps a solution of pancreatin and baking soda in water 
would answer the purpose. 

To destroy the larvae in the breeding places Conradi recommends phinotas 
oil. He used half a gallon on a body of water five feet wide by twenty 
feet long, as a repellant. Forbes recommends a mixture of oil and tar. Eiley 
recommends that equal parts of kerosene and oil of pennyroyal be applied 
to the face and hands. 









PANTEY PESTS 



921 



PANTRY PESTS 

From the standpoint of public health the insects which infest meal, 
flour, and other foods are of no importance. Nobody wants to eat food 
infested with bugs or worms, and that is objection enough; but the question is 
one of taste rather than of health. 



INSECTS INJURIOUS TO CEREALS 



The darker mealworm and the yellow mealworm eat meal, flour, bread, 
cakes, and cereals. The confused flour beetle and the rust red flour beetle, 
infest meal, flour, and cereals. The chief source of annoyance is from the 
presence of the larvae of worms in the cereal. 





Fig. 378. — Trap for 
Cockroaches. 



Fig. 379. — Cockroach. 



Fig. 380. — Larder 
Beetle. (Herrick 
Sanitary Science 
Series No. 3, Cornell 
Reading Course, 
Oct. 1, 1913.) 



The Mediterranean flour moth, the Indian meal moth, and the meal 
mout moth also eat meal, flour, bread, cakes, and cereals. The chief source 
of objection to the members of this group is that they web up in the cereal. 

The insects which show a liking for grain rather than the products of 
grain are the cadelle, the saw toothed grain beetle, the angoumois grain moth, 
the granary weevil, and the rice weevil. 

The body of the granary weevil contains an irritating poison somewhat 
similar to cantharidin obtained from Spanish fly. It was used as a substitute 
for Spanish flies in the southern states during the war. Herrick suggests that 
if granary beetles are ground up in flour the mixture might prove seriously 
injurious to persons eating it. 

Other pests capable of infesting pantries are the pea weevil, the bean 
weevil, the broadhorned flour beetle, the coffee bean weevil and a fruit fly 
which attacks dried, canned, and pickled fruits. 

The insects injurious to meats, cheese, and condiments are several. 
Among them are the larder beetle, the red legged ham beetle, the cheese and 
ham mites, the cheese and meat skipper, and the drug store beetle. 



922 



INSECTS 



METHODS OF CONTROL 



The most efficient method of killing insects is with hydrocyanic gas. This 
gas is produced by mixing pure cyanid of potassium, commercial sulphuric 
acid and water. A portable apparatus for fumigating with this gas is now 

available. Its use is safe enough for those 
accustomed to it, but others dare not risk it. 
Perhaps before long men making a vocation of 
fumigating with cyanid will be accessible. 

The second best fumigating agent is car- 
bon bisulphid. The chief objection to carbon 
bisulphid is that it is highly inflammable. An- 
other objection is its odor, but this is not last- 
ing. Flour exposed to carbon bisulphid does 
not bake quite so well as flour not exposed. 

To fumigate with it 
stop all cracks, vaporize 
three pounds for each 1,000 
cubic feet of air and leave 
the fumigated space closed 
for twenty-four hours. This 
gas kills grown parasites 
satisfactorily. It is not very 
efficient against larvae and 
eggs. Therefore it is usually 
necessary to repeat the fu- 
migation one or more times. 
Thorough cleansing of 
all flour bins and meal and cereal boxes is necessary. These should be emptied, 
brushed out with a stiff brush, and in proper cases washed. The infected food 
might as well be fed to poultry and hogs. 





Fig. 381. — Larva of Larder 
Beetle. (Herrick Sanitary 
Science Series No. 3, Cornell 
Reading Course, Oct. 1, 1913.) 



Fig. 382. — Croton 
Bug Carrying 
Egg Capsule. 
Natural Size. 



BROWN-TAILED MOTH 

BROWN TAIL RASH 

Children are instinctively afraid of caterpillars. Mothers try to con- 
vince them that these loathsome worms are harmless. In the main the 
mothers are right. The great horned tomato worm and others of his species 
are harmless. In fact, not one of the butterfly moths can poison by its 
bite or sting with its tail or with its horns. 

Herrick tells us that of the six thousand species of caterpillar in the 
United States only twenty are poisonous. These twenty poison not by biting 
but through the hairs. 

Very much the worst offender is the brown-tailed moth. In the Middle 
West but little is known of this form of caterpillar but Eiley tells us that, 
introduced into this country from Europe twenty years ago, it has spread 
Over New England and New York and "there is every prospect that the pest 



BROWS-TAILED MOTH 



923 




will continue to spread throughout the eastern United States and Canada, 

and wherever it goes it will prove a direct pest to man, and to his plants." 
The poisoning effect from the brown-tailed moth results from chemical 

substances contained in the shaft 

of the long barbed hairs carried 

on the abdomen and back. These 

hairs can be carried by the wind 

and can produce the rash in 

people who have not been in con- 
tact with the caterpillar. 

The ordinary effect is rash 

similar to hives, the brown tail 

rash. The usual site is the skin 

of exposed portions of the body — 

the neck, face, and hands. 

The rash may be similar in appearance to hives ; or it may be like eczema ; 

or there may be oozing bumps; or there may be small boils or pustules. 

The hairs may get into the nose and bron- 
chial tubes causing colds and coughs that may be 
mistaken for consumption. They may get into 
the eyes causing small lumps like proud flesh. 
Sometimes these lumps have been diagnosed as 
granular lids and sometimes as tuberculosis. 



Fig. 383. — Case-making Clothes Moth (en- 
larged) (Herrick Sanitary Science Series No. 3, 
Cornell Reading Course, Oct. 1, 1913.) 




Fig. 385. — Black Carpet 
Beetle. (Herrick Sanitary 
Science Series No. 3, Cor- 
nell Reading Course, Oct. 
1, 1913.) 




Fig. 384. — Webbing Clothes Moth (enlarged). 
(Herrick Sanitary Science Series No. 3, Cor- 
nell Reading Course, Oct. 1, 1913.) 



Eiley studied some small eye granulations under the microscope. In the 
center he found a caterpillar hair. Around the center the tissue had an 
arrangement very like that of tuberculosis. Of course none of the lesions was 
tubercular. Xone was caused by tubercle bacillus. 

Tyzzer found that the poison from the brown-tailed caterpillar hair caused 
great changes in the red blood corpuscles. Herrick recommends that the 
ordinary hives eruption be washed with a solution of baking soda in water. 
For brown tail rash he uses menthol, ten grains; zinc oxid, two drams; lime 
water, eight ounces, and carbolic acid, fifteen drops. 

Eiley says that the patches must not be scratched. Sometimes soda 
water is the only wash required. In other cases he advises washing with soda 
water and then applying a 10 per cent ichthyol ointment. A weak solution 
of creolin, one teaspoonful to a quart of water, is also recommended. 



924 



INSECTS 



FLIES 

FLIES AND TYPHOID FEVER 

In 1898 our army preparing for Cuba was disabled by typhoid fever 
and diarrhea, and the commission appointed to investigate (Drs. Vaughan, 
Reed, and Shakespeare) reported that flies were responsible. 

Evidently as recently as the beginning of 
this century our antagonism to flies had no great 
grip on public opinion. Perhaps those of us who 
are now the Pauls in this crusade are the more 
Pauls because so recently we were Sauls. 

In a study of typhoid fever in Jacksonville, 
Florida, Terry proves that flies are largely re- 
sponsible. Surface closets, 8,500 in number, were 

used by 25,000 (41 per cent) 
.. -sJmmJy of the population. As the 

closets are widely scattered 

throughout the city 75 per cent 

of the population live within 

three blocks of dry closets. 

Sixty per cent of Jacksonville's 

typhoid was amongst the 41 

per cent of the people using 

dry closets. 

The 95 per cent enforce- 
ment of an ordinance requir- 
ing that closets be properly fly 

screened was attended by a 

drop of 56 per cent in the 

typhoid rate, the drop being 

especially marked amongst 

the people who used dry 

closets. 

Terry also investigated the 

possibility of keeping down the 

flies on a garbage dump by 

covering the waste with eight 
inches of sand. He inoculated bread with germs, allowed flies to blow it, 
and then buried it in the ground. The flies were crawling out of the ground 
in a week. Along in November, when the ground in Florida was getting 
cold, it took sixteen days for the eggs to hatch and the flies to get to the 
top. Four feet of ground was not enough to stop them. Stiles had pre- 
viously found that six feet would not suffice. When the eggs hatched the 
young ate the germs on the bread. Bacteria were grown from the fly specks. 
A German who tried inoculating bread with typhoid bacilli found them in 
the fly specks after the flies had been out of the ground twenty-three days. 
Terry's conclusion was that dumps would breed flies however much dirt 



Fig. 386.— Larva of 
the Black Car- 
pet Beetle. 




Fig. 387. — Fish Moth (en- 
larged). (Herrick Sanitary 
Science Series No. 3, Cornell 
Reading Course, Oct. 1, 1913.) 



Wire DO TO 

Where you <2at offen determines whar you eat 




A Dirty Kitcme^ CamotTum OutClea/i foot) 




An underground Kiich<zn undermines heaJfh off he worker* 



A CLEA/S KlTC/iEAi 15 A/1 APPETIZI/16 A55ET 




A Kifchgn &bgvg grougd is n?ore likely ts be &bovg jtbgicion 



A PUBLIC KlTCflEfl 3/10ULD BE OPEfl TO PUBLIC VIEW 



Chicago Mc+JtA Depart)-****, educational fosi*j-*f/° /&g 

Fig. 388. 



926 



INSECTS 



was used to cover them. The policy of covering a dump with some clean waste 
or even clean sand does not keep down flies. 



FOOD AND FLIES 

Flies are of no consequence except as they affect the food. They do not 

start any diseases. They serve to carry them from one place to another. 

Water flows from place to place, there- 
fore typhoid germs that get in at 
Quincy may sicken the people of St. 
Louis. One farmer may get typhoid 
in his milk and then spread typhoid 
to a hundred farmers' milk by empty- 
ing it into a common vat. From this 
common vat five hundred consumers 
may obtain their milk. Thus typhoid 
may be spread all over a town. But 
about the only chance for solid food 
like bread, meat, and sugar to spread 
typhoid is through the help of flies. 
A man's water faucet taps the 
same pipe as that of another man, a 
man's milk bottle is filled from the 
same can as another's — but the only 
link between two men's bread is our 
enemy, the fly. If the one has a com- 
municable disease the fly, forgetting 
all about quarantine, travels with his 
saddle bags loaded with germs from 

him who hath to him who hath not. 

And on top of this there is the esthetic side. Is it not inconsistent 

to have bathtubs and clean linen and all such refinements and eat fly-befouled 

food? 

Eead what Hurty of the Indiana State Board of Health says about it : 




Fig. 389.— The Hodge Fly Trap on a Gar- 
bage Can. 




Fig. 390. — Parasite Ticks on the Body of a House Fly. 



FLIES 

JOURNAL OF A FEMALE HOUSE FLY 



927 



Thursday, Nov. 2, 1911 — Went into winter quarters. Barely lived through 
the long, hard winter. 

April 20, 1912 — Came out of winter quarters and laid my first batch of eggs — 
120 in number — in a manure heap. 

April 21, 1912— My first 120 eggs 
have hatched. 

April 22, 1912 — Larvae have under- 
gone first molt. 

April 23, 1912 — Larvae have under- 
gone second molt. 

April 26, 1912 — Larvae transformed 
into pupae. 

May 1, 1912 — One hundred and 
twenty full-grown flies, sixty of which 
are females. 

May 3, 1912 — Laid my second batch 
— 120 eggs. 

May 13, 1912— One hundred and 
twenty flies came from my second batch 
of eggs. Laid my third batch in a kind 
neighbor's garbage can. 

May 20, 1912 — The city has offered a prize to the school child who will kill 
the largest number of flies. The boy at the house where I live is killing flies 
right and left. And to think — we have all been eating at the same table with him. 

May 21, 1912 — Laid my fourth batch of eggs. Left alone and unhindered, 
by Sept. 10, 1912, my descendants will number 5,598,720,000,000. 




Fig. 391. 



Iowa Health Bulletin. 
Flies — Milk. 



FLY CATECHISM 

Where is the fly born? In manure and filth. 

Where does the fly live? In all kinds of filth and he carries filth on his feet 
and wings. 

Where does the fly go when he leaves the manure pile and the spittoon ? He 
goes into the kitchen, the dining room, and the store. 

What does the fly do there? He walks on the bread, fruit, and vegetables; 
he wipes his feet on the butter and he bathes in the milk. 

Does the fly visit patients sick with consumption, typhoid fever, and cholera 
infantum? He does and he may call on you next carrying the infection of 
these diseases. 

What diseases does the fly carry? Typhoid fever, consumption, diarrheal 
diseases, diphtheria, scarlet fever, and, in fact, any communicable disease. 

How can the fly be prevented? By destroying all the filth about your prem- 
ises ; screen the privy vault, cover the manure bin, burn all waste matter, destroy 
your garbage, screen your house. 

Either man must kill the fly or the fly will kill man. Prevent the fly. 



FLY FAMILY DESCRIBED 



The Connecticut experiment station has made some tests to determine 
how thickly populated with germs are flies from different places. To begin 
with, our old enemy, the blue bottle fly, is not much of an enemy after all. 



928 INSECTS 

In addition to being so shy as to be harmless he is not thickly populated. 
He only carries 300,000 germ passengers. Swill barrel flies average about 
3,000,000, pig pen flies about 1,000,000 and dwelling house flies nearly 
900,000. 

Swill barrel flies, pig pen flies, and dwelling house flies are the same 
species of insect. The only difference is in the degree of dirtiness. It is the 
difference between a man before and after his bath. 

Flies engaged in eating in a pig pen or swill barrel are working at a dirty 
trade. When the fly travels the swill barrel course to the house to finish his 
dinner with dessert taken from the table he is working at a cleaning trade, 
and for his desire to top his meal and incidentally to clean himself, Mr. 
Fly cannot be blamed. The blame rests with the people who are willing to 
drink the fly's bath water. 

The fly is a most voracious eater. We have heard that he is a most 
appalling breeder but his gastronomic ability has not had much notice. A 
satiated housefly, preening himself ou a piece of pie, weighs nearly twice as 
much as when he began to eat. When fed plenty of moist food he deposits a 
fly speck every five minutes. 

Anything is grist that comes to his mill. He will eat anything as well as 
everything. Because sputum, is from a case of consumption or secretions are 
from a case of typhoid is no reason why they do not appeal to the fly's palate. 

Being fond of filth as well as of clean food and being fond also 'of dirty 
places naturally they have many germ diseases of their own. 

There are epidemics affecting flies as well as epidemics affected by flies. 
But what matters it if a few millions are killed by germs when so many 
millions can quickly breed? Nothing with the feeding and breeding power 
of a fly is at any great disadvantage from germs. It is the human being 
that expects to produce but a few of its kind that must fight off the enemies 
to keep the race alive. 

In fighting flies it is most important to concentrate attention on fly breed- 
ing places. Next in importance come fly feeding places. Flies require such an 
enormous volume of food that we can accomplish something by keeping things 
free from fly food. Most important is care of the garbage — no garbage on the 
ground, a clean can well covered and frequent removal. 

But efforts toward diminishing fly food should not stop at garbage. Ex- 
posure of foods to the flies in stores must be stopped. Confectionery, fruits, 
vegetables, meats and general bulk groceries must not be exposed. In some 
states, laws covering this point are enforced. In others they are a dead letter. 
What's the use of fly posters and widely heralded fly campaigns if the law re- 
lating to fly food is not enforced ? 

OPEN SEASON FOR FLIES 

A female fly begins to lay eggs when ten to fourteen days old and it 
takes the young nine or ten days to pass through the various stages from 
egg to house fly. It takes about three weeks therefore to complete a genera- 
tion — from egg laying to egg laying. 

In order to spread typhoid bacilli flies must have access to the excre- 
tion of those having typhoid fever or carriers of typhoid bacilli. Therefore 




I 



§ «j § 5 § $ 



929 




930 



FLIES 



931 



the number of chances for flies to pick up infection increases as the season 
goes on. 

A typhoid laden fly does no harm so long as he stays out in the grass, 
but when the cold night season arrives the house fly fits his name. For 
these reasons there should be no let up on the fly campaign. Another reason 
for continuing the effort is to lessen the number to be carried over into each 
succeeding year. There should be fewer flies hatched each year. Every one 
killed, therefore, represents a decrease in the supply. 



PREVENTING FLY BREEDING 

The fight against flies began with the slogan "Swat the fly." Fly swat- 
ters, fly paper, fly poison, and fly screens are in general use. It was soon seen 
that something else was needed. The next step was the general use of 
fly traps in places not well adapted to 
screens, fly paper, and fly swatting. 

As I go around the country I find 
that the use of fly traps in the vi- 
cinity of fruit and vegetable stands, 
around milkhouses and some other 
places widespread. As one walks 
along the business streets in small 
cities two or three fly traps are found 
on each block. 

Redlands, California, has gone a 
step further. It has appointed a spe- 
cial officer whose duty it is to look 





Iowa State Board of Health. 

Fig. 394.— Fly Food. 



Virginia Health Bulletin. 
Fig. 395. — Giant Fly Trap. 



after the fly traps, to keep them baited, cleaned, and generally in order. 

We are just beginning to work out methods to prevent flies from breed- 
ing. Some ordinances requiring that manure boxes be made flyproof have 
proved a disappointment. Just now special stress is being put on treatment 
of manure in the box to prevent flies from breeding in it. 

The Department of Agriculture has just promulgated the following 
method. Powdered borax is sprinkled over the manure at intervals of five 



932 



INSECTS 



days. The quantity used is .62 of a pound to eight bushels of manure. 

Forbes recommends the use of a solution of iron sulphate two pounds 
to one gallon of water per horse per day. The University of Wisconsin 
recommends the use of arsenic. 

In Bulletin No. 14, Bureau of Entomology, Department of Agriculture, 
Hutchinson says that when manure is so spread out that it rapidly dries out 




Fig. 396. 



Chicago Health Department 



flies will not use it as a place in which to deposit eggs. The department rec- 
ommends that manure be scattered on the fields and thus be rapidly dried out. 
This is even more effective than treating it in boxes with borax, iron sulphate, 
or Paris green. 

Hutchinson found that fly eggs were found in the moister part of the 
pile; that the larvae there hatched but that after a while the larvae sought 
drier areas to change to pupae; that neither larvae nor pupae would remain 
in a light place ; that they could not stand heat ; that they avoided the moldy 
parts of the manure pile. It was these qualities that made it impossible for flies 
to hatch out of manure that had been scattered on the ground. 



FLIES 933 

DEFENSE AGAINST FLIES 

Sometimes it is not possible to do the best thing nor even the second 
best thing; whereupon it becomes increasingly necessary to do the third best 
thing. 

The best fly preventive is to prevent fly breeding. The second best is to 
keep things so clean as to prevent fly feeding. The third best thing is to 
defend oneself against the flies that have come. Sometimes it will be possible 
to screen them away. This works well enough with dwellings. The few 
flies that get into a well screened house can be swatted, or caught with paper, 
or killed with poison. 

Where the doors are opening constantly screens are sometimes of little 
service and sometimes none at all. Under these circumstances what is 
to be done? 

Usually it will be possible to protect the food supply with cases, screens, 
or mosquito bar. Anything kept in the icebox will be protected. Flies sud- 
denly entering an atmosphere of 60° will escape if they can. If not, they 
slow up. At about 48° they lose their ability to fly. At 27°, five degrees below 
freezing, most of them die. 

The best method of ridding a dairy barn, milk house, or store, of flies will 
depend on the number present and on other considerations. When flies are 
abundant the use of fly traps is the most effective method. 

Sticky fly paper has some advantages and some disadvantages. A few 
saucers containing a mixture of one pint of water, one tablespoonful of 
formaldehyd (commonly known as formalin), and one tablespoonful of 
sugar will be efficacious, if not much water is exposed in the room. 

The proposers recommend that pieces of bread saturated with this solu- 
tion be placed in plates and these exposed in places inaccessible to children 
and domestic animals. 

When the place is not being used it should be darkened whereupon fly 
paper, fly traps, or fly poison, placed near an undarkened window, will be 
doubly effective. 

WHY HAVANA IS FLYLESS 

There are no flies in Havana. The temperature does not go below 54°. 
Therefore flies could multiply all winter long. The people eat in the open. 
Therefore there should be plenty of fly food. The smaller towns have flies 
in abundance., Nature has done its share to provide flies for Havana. Why, 
then, is Havana flyless? Because man has done enough to protect himself. 
Obviously what Havana has done any American community can do. 

What has been done? The city has been made clean. The streets are 
clean. The homes are clean. Nothing is thrown on the ground in Havana. 
The courtyards as well as the floors are kept immaculate. The manure of livery 
stables is deposited without delay in a cart. 

At 10 o'clock each night all wastes are hauled out by the city. This in- 
cludes stable manure, garbage, street sweepings, and rubbish. At 12 o'clock 
begins the sweeping and washing of the streets. The street cleaning is not done 
until after the manure wagons and garbage wagons have passed on. 

Wlien there recently I went into the poorer parts of the city looking 



934 INSECTS 

for dirty streets. They were not to be found. I investigated the floors of 
homes and the nagging of interior courts and found that cleanliness prevailed. 
I thought surely the stables would be found below standard. So I went 
there and found the same observance of sanitary law. 

No doubt railroad trains and vehicles bring flies into Havana. And an 
occasional fly is seen. But none breeds in the city and those that are brought 
in die. 

The most important factor in this result is the perfect care of manure 
and garbage on the premises and their daily removal. The next factor in 
importance is the cleanliness of the streets and homes. 

STABLES AND FLIES 

The object of this article is to call attention to two important phases 
of a fly prevention campaign, to wit: a campaign against fly food — in other 
words, a campaign for clean houses and premises; and a campaign against 
fly breeding places — in other words, a campaign against bad stable conditions. 

Drs. Porter and Byrd of Florida have reported the result of a study 
of one hundred and thirteen stables in Jacksonville. They found that chickens 
around a stable were a help. They ate fly eggs and grubs. 

If the stable floor was not perfect they always found eggs or larvae. A 
well dressed cement floor without cracks was the ideal. Practically all of 
the wooden floors were breeding places. Either the female would get through 
a crack and lay her eggs in the dark space below or else bits of flyblown 
manure would fall through the crack. Cement floors were also liable to 
crack but the liability that flies will find them a breeding place is small com- 
pared with wooden floors. 

Worst of all was the record of the earthen floors. When the ground of 
the stable floor was hard and dry throughout no larvae were found ; but where 
a part of the earth floor was soft and moist, larvae were found in those parts 
of the stall floor that were dry and hard as well as in the soft parts. The exam- 
ination was made by digging up and examining the top six inches of the 
ground. 

It is next to impossible to prevent flies from breeding in a stable unless 
the floor is tight, dry, well drained and properly constructed. Taking care 
of the manure pile is easy though even more important. It must be flyproof. 
Furthermore, the manure box must be emptied once a week. It takes flies 
ten days to develop from mother through eggs, larvae and pupae into flies. 
To empty the manure box every week is to kill most of the young and to get 
the balance away from your neighborhood though you may be harming the 
neighborhood where you dump them. 

FALL FLY DANGER 

There are many women who advocate the double standard for their 
homes — one for bugs and another for flies. There are other women who run 
their homes on the single standard — no bedbugs and no more flies than bed- 
bugs. Those single standard women boast of their homes during this summer 
season. They worked on the theory that the flies came in the house for food. 
They kept their homes so clean that the flies found more food outside than 



fig 

s 



I 

Oh 

1 

A 






^a 




936 INSECTS 

in, and, therefore, did not try to find holes in the screens or to get in through 
open doors. 

As the weather begins to get cool they find that their plan does not work 
so well. The reason is that the flies are now seeking the house for another 
reason; they want to keep warm. A clean house is nearly as much sought 
after as a dirty one. 

When the temperature falls well below 70° flies suffer greatly. They be- 
come stiff in wing and leg and they move slowly. When the temperature gets 
about 50° they cannot move at all. 

In controlling disease health officers try to push back the contagion little 
by little until the foci of infection are few whereupon they redouble their 
efforts and try to bring about its disappearance. 

Flies in October have reached the stage where they could be made a dis- 
appearing plague. The August effort to control, if duplicated in October, 
would make them disappear. 

Therefore the single standard housewife should get out her swatter and 
her flypaper for October. 

The double standard housekeeper has had hers out all summer. She prob- 
ably notices fewer flies in her house now than in August. If she stops 
swatting because the flies are fewer she will have to do more swatting next 
year. 

She should proceed upon the plan health officers have worked out for 
contagion: To double the effort as the enemy decreases and success becomes 
possible. 

There is another reason for keeping flies out of the house in October. 
Summer flies, living in the grass, are not so liable to be spreading typhoid 
as fall flies. 

Flies spread typhoid. They do not originate it. They can only spread it 
when it is around. 

Typhoid is a fall disease; therefore be doubly afraid of flies in the fall. 

HOW TO AVERT FLY MENACE 

Flies spread disease. So much has been said on this subject that every- 
body knows it to be true. Flies do not abound in a clean house. If there are 
many flies around it is certain that the house is not clean. These facts are 
known by everybody and nothing is gained from discussing them further. 

The fact next to be stated is that in order to prevent flies from multiply- 
ing it is necessary properly to control the manure situation. Before many 
years cities will remove stable manure as they now remove garbage. Havana is 
a flyless city, likewise a healthy city, because it has adopted this as one 
of the functions of the city government. 

Next in importance to the prompt removal of stable manure is the treat- 
ment of it with chemicals. In Bulletin No. 118 the Department of Agriculture 
gives the advantages of the different chemicals used for destroying fly larvae in 
stable manure. They recommend borax. The method is as follows: Use 
ten ounces of borax for each ten cubic feet (eight bushels) of manure. Sift 
it on the fresh manure with flour sifter and then sprinkle with two or three 
gallons of water. 



FLIES 



937 



This will kill the larvae and eggs. It will not decrease the fertilizer 
value. The cost will be 1 cent per horse per day. 

They found that calcined colemanite ranked second. Colemanite is 
the crude borax mined in California. This is heated to a white heat and the 
product is known as cal- 
cined colemanite. It is 
used in the same manner 
as borax but the quantity 
required is somewhat 
larger (twelve ounces to 
ten square feet). The 
cost is about one-quarter 
of 1 cent per day per 
horse. Colemanite does 
not lessen the fertilizer 
value of manure. 

Calcium cyanamid 
was found to be fairly 
efficient. Twenty pounds 
to eight bushels of ma- 
nure killed 99 per cent 
of the larvae. Four 

pounds killed 40 per cent of them. Calcium cyanamid increased the fer- 
tilizer value of the manure. 

Sodium fluorid was somewhat efficient. Formaldehyd was moderately 
effective. Paris green was fairly efficient. The fact that Paris green is a 
poison was against it. Iron sulphate, salt, kerosene, pyroligneous acid, canal 
larvacide, kainit, copper sulphate, lime-sulphur mixture, potassium cyanid 
and ammoniacal gas liquor were tried and founcf ineffective. 




Fig. 398.— Flies All Over Town. 



HOUSEHOLD FLY TRAP 



The United States Department of Agriculture, Bureau of Animal Indus- 
try, gives these directions for a household fly trap six inches in diameter and 
twelve inches high : 

"Buy two sets of six inch embroidery hoops. I T se two of the small and 
one large hoop for- the trap. Tack twenty inches of twelve inch wire screen- 
ing on the inside of the smaller hoops. The cone requires twelve inches of 
twelve inch wire screening cut in a half circle, with a six inch radius to the 
circle. Lace the selvage edge of the screening together with wire or linen 
thread. Tack the circular edge of the screening on the inside of the lower 
cylinder hoop. Cut a hole one-half inch in diameter at the top of the cone. 
Cover the cylinder with a piece of cloth held in place with the large em- 
broidery hoop. Place trap over a bait of sugar and vinegar, high enough 
from the table to allow flies to get underneath. Clean the trap by scalding 
the flies, removing the cloth, and shaking the dead flies into the fire." 



938 INSECTS 



A NEW FLY TRAP 

Levy of Richmond found that, while fly eggs were laid in stable manure 
whenever possible and there hatched, the maggots would crawl out of the ma- 
nure and burrow in the ground to pass their pupa stage there. He conceived 
the idea of adding a new trap to the list of fly traps, one to catch the larvae 
as they sought to escape from the manure. 

He got a whisky barrel, bored some holes in the bottom, set it on bricks 
in a tub, and rilled it full of manure. 

The next day larvae began to drop through the holes into the tub. After 
about a week the manure was emptied from the barrel and carefully examined 
for larvae. None was found. 

Then an improvement was made. The end of the barrel was knocked 
out and a piece of gauze with a quarter-inch mesh was substituted. This 
worked better because the larvae could get out. 

Levy's practical suggestion is that manure boxes be made with perforated 
bottoms; that they be set in a tank containing an inch or more of some 
poison, such as a solution of Paris green or of sulphate of iron, and that this 
be covered by a close-mesh gauze or that it be kept oiled to keep the mosquitoes 
away. 

Levy says that flies lay in manure before it leaves the stalls. All fly ma- 
nure must be regarded as fly borne; that where the manure box is set flat 
on the ground or in the ground removal should be twice a week, because 
from egg to larva — old enough to crawl — requires but three days and therefore 
when the box is emptied the pupae will be left behind in the ground to 
develop into flies in course of time. 

Another point made is this: Not all of the larvae escape from manure. 
The ordinary box does not lend itself perfectly to such escape. The farmers 
sometimes object to manure from the cities because it increases the number 
of flies and the flies trouble their stock. In fly time the horses get thin and 
the cows give less milk. 

Levy's suggestion is that if the box has a perforated bottom the larvae 
will escape and the manure will not develop so many flies to plague the farmer's 
stock. 

This suggestion of Levy is not to replace fly traps, fly poison or swatters. 
It is only an additional agent. 

I am sure that the number of flies in the cities is getting materially less. 
There is some improvement in the country. 

The more recent movement directed against fly food and fly breeding 
places is much better than the fly swatting with which the anti-fly movement 
began. 

DOOR FANS FOR FLIES 

In De Kalb, Illinois, there is a saloon with a large wooden blade electric 
fan outside the front door. It is suspended from the roof of the vestibule of 
the open corner entrance. It serves a double purpose. Flies do not like a 
windy place. As the outside of the screen doors is kept free from flies the 
number finding entrance to the interior of the saloon is greatly reduced. 

In the second place the cool, well fanned saloon is inviting in hot weather. 



FLIES 



939 



I had never seen or heard of this method until the July number of the 
North Carolina Bulletin of Health came to hand. Some tarheel restaurant 
keeper had beaten the De Kalb saloonkeeper. Dr. Booker writes that the 



A'Day in the 




HAVING HAD A GOOD NIGHTS 
SLEEP IN AN OLD GARBAGE 
CAN 1 BREAKFAST AND AWAY- 




LIGHT ON A HORSES 
FACE FOR A RIDE. 



FIND A DOG ASLEEP 

AND TEASE HIM 

A WHILE 




of a Fly 




TO A BAKERY WHERE I 
HAVE SOME DESSERT 




GO FOR A WALK AROUND THE 
EDGE OF A DRINKING GLASS 




GO IN A WINDOW IN A 
NICE LOOKING MOUSE 




CRAWL AROUND THE 

BABY'S FACE FIND 

IT VERY SWEET 




SEE AN OLD STABLE j£f 
DOOR OPEN 



/AND FIND TME TABLE 
ALL READY FOR DINNER. 




PASSING BY A 

FEW DAYS LATER 

NOTICE A WHITE 

RIBBON ON THEIR 

FRONT DOOR. 



— COFFMAN IN NEW YORK AMERICAS* 



Fro. 399. 



number of flies in the dining room was reduced to almost none. The owner 
had found that the arrangement keeps the flies out and serves as a first class 
advertisement. 

The bulletin says: "Grocers, butchers, bakers, confectioners, hotel and 
restaurant keepers will undoubtedly find the advertising value of such an 



940 INSECTS 

arrangement worth considering, and in a short while the general public will be 
demanding such protection." 

STABLE FLIES 

When Rosenau discovered that stable flies could carry infantile paralysis 
the interest in this fly increased materially. The farmers already knew of the 
harm from this fly. In addition to spreading infantile paralysis Jennings 
and King of the Bureau of Entomology say it may spread pellagra. The 
diseases of domestic animals spread by it are anthrax, swamp fever, glanders, 
septicemia, surra, souma and, maybe, round worm. 

In addition, biting flies worry stock so much that they cannot work 
efficiently. Animals get thin and milk cows sometimes go off 40 to 60 per cent 
in the amount of milk produced. 

F. C. Bishopp of the United States Bureau of Entomology tells in Bul- 
letin 540 what he has learned about the stable fly. It breeds largely in straw. 
Old strawstacks in the fields are the worst offenders. Bishopp's advice is to 
burn these stacks or else to spread the straw and plow it in deep. When 
a heavy rain falls on freshly thrashed straw conditions for fly breeding are at 
their worst. Manure containing straw is another breeding place of importance. 

To keep the flies off, Bishopp advises a mixture of fish oil (one gallon), 
oil of pine tar (two ounces), oil of pennyroyal (two ounces), and kerosene 
(one-half a pint). To keep the flies out of the stable he recommends the 
Hodge window trap. 

DO NOT REMOVE YOUR SCREEN 

This is being written on November 1 in Chicago. We have had one 
blinding snowstorm lasting for more than half an hour. Heavy killing frost 
has occurred several times during the last month. During the first half 
of the month there was a week of rather continuous cloudy cold weather 
with several heavy rainstorms. The grass and weeds are dead. 

The screens were removed October 29. Prior to that time whenever 
a lone fly secured entrance to the house the scouts located him and the 
cavalry speedily demolished him by. the swatter route. Today the rooms are 
full of flies and swatting seems an endless job. 

In spite of the most persistent effort some females will find warm recesses 
in which they will remain until more propitious weather next spring. Had 
the screens remained on another month all the outside flies within a few 
hundred yards of the house would have been killed and our next fly fighting 
job would have been far lighter. After fighting all summer we surrender a 
considerable part of the vantage gained through one mistake. 

I have not seen any mosquitoes lately nor heard of any. It is fair to 
assume that the lady mosquitoes needed to perpetuate the species for next year 
are now under cover in this latitude. Those mosquitoes not in out of the cold 
are dead and are therefore good mosquitoes. 

From the mosquito standpoint in the latitude of Chicago it is safe to 
remove screens as early as November 1. South of the latitude of Memphis 
screens should not be removed during the winter. While the temperature is 
much of the time well below that at which flies are killed and far below 



FLIES 941 

that at which mosquitoes are destroyed removal of screens is not ad- 
visable. 

Insects show a good deal of intelligence and forethought at least in ele- 
mental things. Perhaps they intuit, and Bergson tells us that "intuits" "land 
the goods" while "intellectuals" speculate and freeze. 

A few flies (and perhaps a few mosquitoes) get into warm places on 
warm walls, live through the frosty night and then, the day having warmed 
the air, seek out a warm indoor place in which to hibernate. I have often 
seen a fly infested Pullman running through a section of the country where 
the ground was deeply . covered with snow. Even though all the flies and 
mosquitoes of a given town had been killed off by cold railroad trains 
loosen refugees that must get indoors or die. 

Flies and mosquitoes do little harm in winter. But winter provisions 
against them return many fold. It is easier to kill the one female in cold 
weather than the millions of its descendants in warm weather. 



WHO HAS A NEW FLY SLOGAN? 

What is the matter with "Swat the fly" ? It is short, easy to say, slangy, 
suggests action and furthermore it has been accepted. For a woman who 
will have no flies in her house, who wants to protect her baby, who will not 
stand for flies in the milk — for her "Swat the fly" is an ideal slogan. It is 
possible for her to kill every fly that crawls through her screens. 

However, the grocer, the butcher, and the dairyman cannot swat the fly 
in their places. The best they can do is to limit the number. The ideal slogan 
for them is "Trap the fly." 

Flies have but few impulses. One is the impulse to eat ; the other is 
to propagate. The spreading of disease by them is purely an incident. There 
is no impulse about it. There is no intent, no malice. They go in search 
of food and incidentally they become covered with filth. They move on 
in continued search for food and incidentally they infect milk, butter and 
bread with filth and disease. 

Now the impulse to eat is a force to be reckoned with. Flies come around 
because fly food is about. There is no more attractive fly food than garbage. 
Any dirty place is a fair pasturage for flies. In a certain sense a better 
slogan would be "Starve the fly." 

None of these procedures, though, is sufficient; nor are all of them com- 
bined. A woman can keep swatting the fly and keep her house flyless. A 
grocer can trap the fly and keep his store clear enough of flies to attract 
desirable customers. Careful, cleanly people can keep things clean enough to 
starve the fly. 

However, none of these nor all combined can make a flyless town. In 
order to have a flyless town it is necessary to plan against that other great 
impulse — the impulse to propagate. Years of experience prove that the only 
fly campaign which can result in a flyless town is one which removes the fly 
breeding places. 

The fly situation can be controlled if one type of fly breeding place is 
eliminated. That is horse manure. A daily removal of all horse manure has 
made Havana a flyless town. Santiago de las Vegas, twenty miles away, 



942 INSECTS 

has as many flies as Memphis, Tennessee. A weekly manure service 100 per 
cent perfect in warm weather would solve the problem. 

To get this done we must have laws. To have laws we must have public 
sentiment. To have public sentiment we must get everybody to talking about 
it. For this we need a slogan. Who has one? It must be short and easy to 
say. It must tell enough but not too much. It must carry the essence of 
the idea but not too much of it. It must suggest action. It must affirm. 
If it is slangy, so much the better. Who has it ? 

Case Against Flies Proved. — Mrs. E. H. S. writes : "If house flies are 
transmitters of disease,, why were the periodical visits of cholera to the 
United States distinguished by their absence, so much so that forecasts for 
the coming of the dread disease were based on the presence or absence of 
these insects?" 

Reply. — House flies are transmitters of disease. That has been proved 
by positive and incontestable evidence. I do not know why the epidemics 
of cholera fifty years or more ago were preceded by absence of flies, if they 
were. My opinion is that they were not. It is so easy for such loose state- 
ments to start and when the facts are half a century in the past it is 
impossible to run them down. 

Plague of Small Flies. — Desperate writes: "Four years ago I moved 
into a house where small flies collected around the sink and in the bathroom 
and I have tried every means of getting rid of them without success. I had 
diphtheria and the house was fumigated, but I still have the flies. Can 
you tell me what is the cause? I never leave anything around that would 
cause them to come, and I never have one of the ordinary flies, just those 
water flies." 

Reply. — Generally this kind of fly keeps away from food. Therefore, 
they are not of importance as disease spreaders. Fumigation with formal- 
dehyd does not kill insects. These flies breed in soggy wood. Burn pyre- 
thrum powder (insect powder) around the sink and bathtub; spray the 
woodwork of the sink and bathtub with Piatt's chlorids. Use an abun- 
dance. 

To Get Rid of Flies. — D. H. W. writes: "Can you tell me some method 
of ridding a small community of flies? As the summer advances they 
gather in clouds around the kitchen doors and stables. We have tried 
every known device." 

Reply. — 1. Enforce proper care of stables as breeding places by 
(a) having manure boxes emptied once a week; (b) screening manure 
boxes; (c) having proper floors in stables; (d) screening stables. 

2. Enforce such cleanliness as deprives flies of food, (a) Through 
garbage being wrapped in clean, covered cans ; (b) through keeping garbage 
off the ground. 

3. Keeping flies out of the house by (a) screens; (b) swatters; (c) 
fly paper and fly poison. 

4. Pay proper attention to butcher shops and creameries. 

5. Regulate or prevent dumping. 

6. Education by posters, fly campaigns, lectures, and by talking flies in- 
stead of the weather. 



IXSECTS 943 

Bothered By Flies. — Mrs. D. J. H. K. writes: "Please tell me how to 
keep flies out of a screened porch, or get rid of them, as we are compelled 
to leave the door open in order to run the washing machine on the inside 
with a gasoline engine on the outside." 

Reply. — Catch them in traps and on fly paper. Around a washing ma- 
chine fly poison would not be of much service — the flies get plenty of un- 
poisoned water. Fly repellants are of little service. 

Smudge Plan to Kill Flies. — S. B. writes: "Kindly let me Tcnow if there 
are any chemicals or other substances that can be mixed and burned, the 
odor of which hills flies, mosquitoes, etc., and if there is such a preparation 
that I can make or mix, will it be possible to have a pleasant odor and not 
objectionable to people in my place of business?" 

Reply. — Insect powder slowly burned after a smudge plan stupefies flies 
and mosquitoes and they can be easily killed or swept up and burned. The 
odor is not unpleasant. Sulphur burning makes fumes which kill insects ; 
but the fumes are highly objectionable. Neither should be relied on. The 
only way to keep out flies and mosquitoes is to screen them out. As to 
flies, no fly food should be left around. As to flies and mosquitoes breeding 
places must be abolished. Burning powders helps a little. 

Try Burning Sulphur. — B. writes: "Will you kindly advise me how to 
rid my basement of small flies? I have tried chlorid of lime and sticky 
and poisonous flypaper without success. They are not the ordinary house 
flies, but I believe have hatched out from eggs laid in cordwood which was 
stored in my basement last winter." 

Reply. — This small fly is found rather frequently around houses. Cen- 
suses show that they make up from 5 to 15 per cent of the house flies. They 
spread no disease so far as is known. They are not killed by ordinary fly 
killing procedures. Try sulphur. Close all openings and burn five pounds 
of sulphur for each 1,000 cubic feet of air space. At the end of eight hours 
let the fumes out. Then clean up thoroughly or a new crop will breed 
within a month. 

How to Bar Flies. — J. A. S. writes: "1. What is the best way to dis- 
pose of horse manure so that it will not breed flies? 2. Will sprinkling with 
crude oil do any good?" 

Reply. — 1. Keep the manure box screened so that flies cannot enter. A 
female ready to lay will find a hole in an ordinary cover. Empty the box 
once a week in warm weather. In early spring and late fall once every 
two weeks is often enough. 

2. The danger from fire is too great when oil is used. Forbes recom- 
mends that manure be sprinkled with a solution of iron sulphate. He 
advises two pounds dissolved in one gallon of water for each horse each day. 

Iron Sulphate and Water. — H. F. writes: "Please give the formula for 
a preparation to put on manure to prevent flies from breeding in it, but not 
to destroy the fertilizing qualities. We keep two horses." 

Reply. — Dissolve four pounds of iron sulphate in two gallons of water. 
Sprinkle this over the manure and the floor of the stalls, if of dirt. The 
above is the quantity required each day for a two-horse stable. 



944 INSECTS 

To Get Rid of Ants. — G. A. C. writes: "Can you suggest any means 
of getting rid of small ants? They have infested our refrigerator and 
kitchen all of a sudden." 

Reply. — The following are methods recommended by the Division of 
Entomology, Department of Agriculture: 

First, see that all food and especially sugar and sweets is in tightly 
closed receptacles. Moisten sponges with sweetened water and place where 
the ants are most numerous. Collect the sponges several times daily and 
immerse them in boiling water, which will kill the ants. 

Also use a sirup of boiling water with borax and sugar dissolved in it 

The odor of camphor is distasteful to ants and gum camphor loosely 
wrapped in paper will often drive them away. 

Another method recommended is to fill a bottle (partly) with sweetened 
water; make a hole in the cork large enough for the passage of a single 
ant; run a thread moistened with the sweetened water from the floor 
through the cork. When once within the bottle the ant is gorged with 
food and cannot get out. 

Bedbugs. — M. A. C. writes to know if anything can be done in a com- 
munity way about bedbugs. He has found them frequently in newspapers 
as delivered and in books as they come from the public library. 

Reply. — Bedbugs are of no particular health importance though of 
course they are highly objectionable. I don't know what department of the 
city government would undertake to get rid of them. The public library 
can do nothing. The bugs can get into the books and papers only from 
the persons of the readers. 

To Get Rid of Fleas. — Mrs. H. W. A. writes: "Three kittens deserted 
by their mother before they were able to care for themselves acquired a 
fine collection of fleas. As soon as the cause was discovered the survivor 
was chloroformed. This was over two weeks ago, but the furnace room, the 
only place they were in, seems to be still infected. There are no other 
animals about the house, but the fleas appear to be spreading. What can 
we do to be rid of them?" 

Reply. — Old floors, mattings and carpets favor the development of the 
flea. Places frequented by them should be thoroughly cleaned, using boiling 
water or dusting with pyrethrum powder, especially in the crevices or 
cracks. A decoction of one ounce of pyrethrum powder to one gallon of 
water boiled for ten minutes filtered and strained and sprayed into the 
infected places helps. Sprinkling with benzin is helpful but of course is 
dangerous, as benzin is highly inflammable. 

Fungus on Insect. — S. A. H. writes: "I killed a large fly in the house 
recently. Noticing a lump formed on its body, I found it to be a mass of 
little worms, just visible, when single, on glass. Was this part of the 
generating process, as with ticks, or was it some parasite or foreign larvae?" 

Reply. — I judge the mass was composed of a fungus — empusa. 
This fungus destroys many flies during the latter part of the season. 

To Get Rid of Mosquitoes. — E. K. writes: "Kindly tell me the best 
way to get rid of mosquitoes. Our basement, although dry and sanitary, 
harbors a flock of them all winter, and has for the last two or three years. 
Even in the bedrooms and bathroom there are a few stragglers that hide in 



INSECTS 945 

and around picture moldings and other out of the way places and come out 
whenever we have a warm spell" 

Reply. — Make a careful search of your house and you will find some- 
where a bucket or pan of water in which mosquitoes are breeding. Upon 
close examination you will find wiggletails. Such accumulations of water 
must be emptied or else treated with a mixture of kerosene and crude oil, 
half and half. The oil treatment must be repeated at two-week intervals. 

The mosquitoes on your premises are too active for hibernators. To 
kill the hibernators the best plan is to freeze them out. In any room 
where the temperature remains at or below freezing for a few days, the 
hibernators will be killed. 

Where the freezing method cannot be applied use sulphur fumigation. 
Close the room very tightly; stop all cracks; burn two pounds of sulphur 
for each 1,000 cubic feet of air space. Allow the fumes to act. 

Insects in Flour. — Mrs. S. R. writes: "Will you please tell me if it is 
safe to use flour in which there are small brown insects, which in one stage 
are tiny worms? Is there any way of destroying these insects?" 

Reply. — I infer that you have got rid of most of the insects if not all 
of them. I should say that you would be safe in using the flour. 

When flour is riddled with them it might not be safe. Certainly it 
would not be fastidious. 

It is not an easy matter to get rid of flour weevils. The pantry and bins 
must be thoroughly cleaned. Use scalding water freely. Carbon sulphid, 
two pounds to each 1,000 cubic feet of air space, is recommended. The gas 
is inflammable. Cyanid gas is better, but it is too dangerous for gen- 
eral use. 

Go to the public library and read up the subject in Herrick's "Insects 
Injurious to the Household." 

To Get Rid of Flour Bugs.— H. S. B. writes: "We believe that some 
time ago you gave a remedy for the elimination of flour bugs, which 
appear to thrive in flour bins and barrels. We are having trouble in this 
direction in our flour bin in our kitchen cabinet." 

Reply. — Much the most effective remedy is hydrocyanic acid gas. This 
gas is so dangerous to human life that the method should not be used 
except by experienced people. Where it can be used an effective method is 
the use of carbon bisulphid. Stop all cracks, spray the floor, the bins, 
sacks, walls, etc., with carbon bisulphid. Use two pounds for each 1,000 
cubic feet of air space. The gas is inflammable. Beware of lights. After 
some hours ventilate and then clean thoroughly. As the gas penetrates 
poorly it is advisable to use up or otherwise dispose of the flour in the 
bins before applying the gas. 

When to Remove Fly Screens. — W. L. wants to know when fly screens 
should be removed. Her neighbors have removed theirs. 

Reply. — Fly screens should be removed when it is necessary to do so 
to put in storm windows. Storm windows should not be put in until as late 
in the winter as possible. Around Chicago, they should be put on about 
Thanksgiving; around Indianapolis, about December 15; around Kansas 
City, about Christmas. Around Memphis and from there to the Gulf the 
fly screens should stay on all winter. 



946 INSECTS 

This is written on November 16 on a Sante Fe train between Kansas 
City and Chicago. Looking out of the window, the ground is seen to be 
covered with snow and the ponds with ice. A fly is hovering around this 
writing table. There were four in the washroom an hour ago. There 
were fifteen flies in the washroom of the Baltimore Hotel in Kansas City 
yesterday. The school superintendent's office in Gary was full of flies 
two weeks ago. The flies which furnish the swarms of summer are those 
which get into the warm places for winter. 

The flies which are wintering with your neighbor may get out of doors 
some warm day next week and later come into your house when the weather 
turns cold. 

Flyless Havana. — 0. R. M. writes: "Cannot you print what was done 
in Havana by the United States government to make it a flyless city and a 
cleaner one than any in the States?" 

Reply. — I have the method. It is available for any health officer or 
other city official who asks the Havana officials for it. Not all of it can be 
given in this space but certain essentials can be referred to. 

The first is that the city is thoroughly cleaned every night by the 
authorities. There is a daily garbage removal service. The city removes 
the stable manure every night. After the refuse removal has been com- 
pleted between that and breakfast time the streets are swept and washed. 
The daily removal of stable manure and garbage is the largest factor in the 
city's wonderful freedom from flies. 

It has a mosquito brigade. Accumulations of water are drained. Pools 
and puddles that cannot be drained are kept oiled. The oiling brigade gets 
into the field almost immediately following each rain. 

Keep Screens Up. — Housekeeper writes: "The janitor of our building 
insists on taking out the screens in our apartment now [fall]. Is it not too 
early? Although I had no flies in the house all summer, I have two or three 
now that seem to stay." 

Reply. — Do not allow the janitor to remove the screens until the flies 
have disappeared. Do not allow him to remove them now. The flies try 
harder to get in the house in cool weather than in hot weather. Besides, 
this is the typhoid season. 

Moth Miller Trouble. — Mrs. H. J. C. writes: "We have a new, well 
ventilated house. The sun shines in every room. Last summer we were 
away for several months. This spring we are having trouble with small, 
light colored flies. They are active, and hide in dark colored goods. They 
are hard to catch. When we do catch one and mash it all that remains is 
a mark of light colored dust. Are they moth millers? What harm will 
they do and how shall we proceed to get rid of them? I think we have 
aired about everything in the house." 

Reply. — My guess is that you have moth millers. They are of no health 
consequence. Clean everything you can with a vacuum cleaner if possible. 
Pack woolens in moth balls. Use mothproof chests and mothproof bags. 

Flies Like Electric Mixers. — L. A. writes: "If you want to give the fly a 
large, healthy swat you can certainly do so by calling the attention of the 
public to these little electric shakers or mixers that are found at practically 
every soda fountain in Chicago. They are used principally in mixing sweet 



INSECTS 947 

drinks, such as malted milk and frappes. Between drinks they stand ex- 
posed to the air and are absolutely unprotected from flies. I have given 
special notice to them almost every day for the last two weeks and I have 
never watched one for over a couple of minutes when it was not in action 
hut what there were at least a couple of flies roosting on it." 

Reply. — I hope you did not buy. 

Duty of the City. — J. A. suggests that a little pan he put under the fly 
trap. He says: "Let us have a law to have a fly trap at every place 
which attracts flies. Let the city operate them in puhlic places where 
necessary." 

Reply. — The type of trap which I would advise would not be any more 
efficient with a tray or frying pan. 

The suggestion to have a law requiring fly traps in all places where flies 
abound and where screens do not suffice to keep them out is most excellent, 
and should be adopted by the city council. The suggestion that the city 
operate fly traps in public places where flies are abundant is a good one, 
at least as far as dumps are concerned. 

There are dumping grounds in the city on which a good deal of organic 
matter is placed. They are owned by private parties but receive some part 
of the public refuse. For years the city has used a fly repellant on these 
dumps. Experiments have shown that this repellant is of no service. 

To set out fly traps and keep them in order would cost much less money 
than this repellant and would be infinitely more effective. 

"Sewer Bug." — J. W. W. writes: "Is there such a thing as a sewer 
hug, and if so, what does it look like? We occasionally find an ugly 
looking hug — sometimes two inches long — crawling about the walls or 
floors; it has numerous legs. Someone told me they were sewer hugs, and 
as I once found one in a stationary washbowl, it occurs to me that this 
may he correct." 

Reply. — I know of no bug called a "sewer bug." Several bugs seem 
to prefer sewers. None of them do any harm or make themselves objec- 
tionable. When you catch another send it to Prof. S. A. Eorbes, State 
Entomologist, Urbana, Illinois, and ask him to let you know what it is, 
whether it does any harm and how you can get rid of that kind of bug. 

Lice In Girl's Hair. — New York inquirer writes: "Will you kindly 
advise a cure for lice in a hig girl's head — something drastic that would 
clear it readily? She has never heen troubled like this before." 

Reply. — Saturate the hair thoroughly with tincture of larkspur. 
Rub in well. Be careful not to let the mixture get into the eyes or into 
a scratch. Wrap the head in a bath towel. Leave on for six hours. Then 
wash the head thoroughly. Take two quarts of hot water and add one tea- 
spoonful of carbonate of soda. Wet the hair with this mixture. Soap 
thoroughly with castile soap for ten minutes. Wash the soap out with 
plenty of warm water. If nits are abundant, repeat the above several 
times. 

How to Remove "Nits."— Mrs. A. P. writes: "My little girl, age 5, as 
a result of playing with unclean children, has become troubled with vermin 
in the hair, which we seem to he unable to get rid of. We have had the 
head washed several times and also have made frequent applications of 



948 INSECTS 

tincture of larkspur and of coal oil. Still the vermin remain, as the daily 
use of the fine comb discloses. Her hair shows a mass of 'nits' and the 
child is becoming nervous from the constant itching. The hair is naturally 
curly, and has been admired greatly. We naturally hesitate to sacrifice the 
hair, if there is any remedy we could make use of to rid it of this condi- 
tion. Will it be necessary to cut off the hair, or can you suggest some 
remedy that will overcome this condition?" 

Reply. — Use the following: Mix equal parts of kerosene oil and olive 
oil. Rub the mixture well into scalp. Then cover the hair with a piece of 
muslin and fasten it about the head avoiding contact with a lighted gas 
jet or name of any kind. The following morning the scalp should be 
washed with soap, hot water and vinegar. A fine toothed comb wet in 
vinegar should be used to remove "nits." Dry the hair thoroughly with a 
towel. This treatment should be repeated three or four times. You have 
probably failed by not being thorough enough. Follow each detail exactly. 

Butter and Jiggers. — J. W. P. writes: "Red bugs, chigo, chigro, or 
jiggers are a source of great annoyance in Alabama during summer and 
fall. What preventive can be used? Also what eradicates them after the 
bugs have become imbedded in the skin?" 

Reply. — I do not know what will repel them. When I was a child the 
custom was to grease with butter. This was supposed to kill them. 

Butter Fatal to Chiggers. — W. F. P. writes: "How can I get rid of chig- 
gers? How can I avoid them?" 

Reply. — Grease the bites with butter; this will kill the chigger. 

Seeks a Preventive. — Experience writes: "For the benefit of J. W. P., 
I wish to state that spirits of camphor, applied once or twice, will relieve 
permanently the pain and irritation due to jiggers, and time will cure 
the marks." 

Reply. — J. W. P. was especially interested in a preventive — something 
to keep the bugs from biting. 



CHAPTEE L 

Longevity 

EFFORTS OF METCHNIKOFF 

MetchnikofT had heard that there were many exceedingly old people in 
Bulgaria. He also heard that the sour milk in Bulgaria was the sourest 
ever heard of. 

He grew some bacilli from this sour milk and he found that they 
could produce about four times as much acid as the ordinary stable variety 
and that when the milk became extremely sour, instead of curling up and 
dying, they were just getting in good fighting trim. Therefore he recom- 
mended Bulgarian bacilli as a preventive of senility. 

x4t once everybody went to it. They gained no good from it. Why? 
Because the manufacturer went out to the stable, scraped up any and every 
old acid-producing germ and flooded the market with lactic acid cultures 
that could scarcely sour milk, to say nothing of licking colon bacilli in 
mortal combat. 

The people who took them did not know what they were trying to 
accomplish. They took lactic tablets as they were accustomed to taking 
quinin pills or headache powders. 

The object sought is to get lactic acid bacilli to growing and fighting in 
one's large intestine, to make them at home there, to get oneself permanently 
infected with this microbe — a result that cannot be measured by the same 
standard as can quinin pills and headache powders. 

MetchnikofT s first recommendation was that we consume a large number 
of live, very active acid-producing bacilli of a certain species; that this large 
dose be swallowed every day for a few days. The thought was that a few 
out of each dose would survive the stomach juices and that in a few days 
they would get a foothold in the large intestines and there would overgrow 
and kill out other bacteria. This first method, Metchnikoff now tells us, 
was imperfect. 

BELIEF OF METCHNIKOFF 

Professor Heinemann of Chicago does not think taking lactic acid 
bacilli will postpone old age because in the intestines there are ounces of 
lactic bacilli normally present. 

To this the Metchnikoff school answers that the lactic acid bacilli 
normally present are a weak-kneed lot capable of producing only extremely 
small quantities of acid. Even when the Bulgarian takes enough of the strong 
bacilli to make 150 grams of lactic acid a day the bowel movements are but 

949 



950 LONGEVITY 

feebly acid. The ordinary lactic acid germs do not make them acid at all. 

When, as an argument for sour milk, Dr. Wiley was informed that 
Marie Prion who died in 1838 at 158 years of age lived for the last ten years 
of her life entirely on cheese and goat's milk, he replied: "That does not 
prove much, as she lived for 148 years on an ordinary diet and thus had 
already established a reputation for longevity ." 

While men of scientific standing were breaking their lances against the 
sour milk conclusions of Metchnikoff that great scientist went on perfecting 
his methods. 

We are liable to get an idea that MetchnikofFs plan for postponing old age 
consists solely in the use of germs and soured milk. One who reads his 
"Prolongation of Life" will not be of that opinion. 

In Minot's introduction to the book he says of Metchnikoff: 

"One suspects that cheerfulness and optimism are in Metchnikoff inborn 
temperamental qualities, and, in the present volume, optimism is the domi- 
nant note." 

Metchnikoff died of heart disease at seventy-two. It is impossible for 
him to escape being regarded as the final test of the truth of his theory. 

Such a test, though, has in it the elements of unfairness. He was born in 
Eussia where the average age at death is low. He worked his way up to a 
professorship at Odessa; was dispossessed of his means of livelihood by one 
of those peculiarly Eussian happenings; wandered around Europe as an 
unattached scientist from 1882 to 1892 since which time he had a haven and 
an opportunity at the Pasteur Institute. 

He was nearly sixty when he began to investigate the Bulgarian bacillus, 
and, at sixty, it is supposed that inheritance and experience have already 
determined about how long a man will live barring death from infection or 
other forms of accident. 

Presumably for the last eight or ten years he made use of the sour milk 
features of his method. 

Inherently and therefore since youth we are told by Minot he made use 
of Cheerfulness, serenity and optimism as another feature of his method. 
Students at the Institute were accustomed to meeting him daily as he re- 
turned from market carrying his supplies in a market basket. 

He made use of simple, wholesome living. We are told by the editor 
of "Prolongation of Life" that Metchnikoff believed in "the avoidance of 
alcohol and the rigid exclusion from the diet of foods that favor putrefac- 
tion, such as rich meats, and of raw or badly cooked substances." 

In his book we see that he had studied everything in nature bearing 
on the subject; that, searching for truth, he had analyzed the life of every his- 
torical personage who attained exceeding great age, and that he contemplated 
death at the proper time with serenity. 

He believed that in a properly developed cosmos where everything happens 
in its due season there will be a logical instinct of personal death replacing 
the instinct of personal life. 



GROWING OLD GRADUALLY 951 



GROWING OLD GRADUALLY 

If a person is between forty-five and fifty-five his average chance of 
dying is about 1 in 65 — a little higher than the average chance of people at 
all ages. If between fifty-five and sixty-five his chance is abont 1 in 30; if 
between .sixty-five and seventy-five about 1 in 15 ; if over seventy-five about 
1 in 7. 

In the last census period the chance of living to full years increased 
materially. The total gain for men was 10.23 per cent, and for women, 
15.15. The greatest gain was for girls between 5 and 9 years of age, 32.61. 
The greatest gain on the male side was for boys of the same age, 27.66. The 
gain for men was found in all groups before forty-five years of age and for 
women in all groups below fifty-five. The greatest loss for women was between 
sixty-five and seventy-five, 2% per cent. Verily, this is the woman's century. 

Dr. Dublin of the Metropolitan Life, in discussing this question before 
the American Public Health Association, said: 

"The body at 50 is little more than what the preceding years have 
made it. The hereditary factor is largely overshadowed by direct influences 
of environment which have continuously modified the physique." 

The first statement is pretty nearly true ; the second requires some modi- 
fication. 

Studies show that those who live to be eighty and over usually belong 
to long-lived families. Not all the children born to long-lived families live 
to exceeding old age but with some exceptions only members of long-lived 
families are able to fight off the enemies and endure to ripe old age. 

Dublin groups the reason for disease and death in old age under three 
heads: Scarlet fever and other germ diseases in childhood and early adult 
life; habits and modes of life; effects of occupation. 

At the head of the diseases which trouble old people stands heart disease, 
with kidney disease fairly close up and apoplexy third. These diseases are 
largely the after effects of scarlet fever, diphtheria, measles and pneumonia. 

Under habits and modes of life Dublin places the effects of venereal 
disease and alcohol. 

Dublin says that the most important contributor to middle age mortality 
is the effects upon the body of the habits and conditions of work. The working 
conditions of organized factory work is what he has especially in mind. 

That men may live out the biblical command to stay three score years 
and ten among men Dublin advises the following five procedures : 

1. Communities must stop the epidemics among children in order 
to reduce the heart and kidney disease among people in the fifties, sixties, 
and seventies. 

2. The movements against venereal disease and alcohol must be en- 
couraged, aided and fostered. 

3. We must bring about better working conditions. 

4. Death certificates should be better recorded and more carefully studied 
in order that we may better plan to improve conditions. 

5. We must heartily encourage the movement for public education on 
all topics connected with personal hygiene. 



952 LONGEVITY 

The above has to do with the precautions necessary to attain old age. 
Many are interested in knowing how old people should deport themselves in 
order to continue to live and to get the maximum out of life. 

To continue to live the old man should proceed on the supposition that his 
old physique is pretty badly worn and that it requires looking over at stated 
intervals. Once a year, or twice, he should have his urine examined, his 
chest examined and his blood pressure taken. 

His greatest hazard will be colds. When unfortunately he has con- 
tracted a cold with aches and fever he must go to bed and stay there until 
his cold has passed well beyond the fever and ache stage. 

In order to get as much out of life as possible the following general plan 
should be carried out: 

Sleep. — Saundby, in his excellent book, "Old Age, Its Care and Treat- 
ment," tells us that old people who sleep five or six hours a night get enough 
sleep. Nature is automatically saving. When a man has burned "toward 
the end of the string/' nature turns down the fire. 

Old people can destroy their fatigue toxins in five hours. When they 
wake up because they have destroyed the, previous day's stock of fatigue 
poison the process is natural. If they want to get up at 3 or 4 o'clock, let 
them get up. If they want to lie in bed reading or quietly resting let 
them do so. 

However, if the old person wakes up before the fatigue poisons have been 
completely burned to waste, that is another matter. For instance, if two hours 
after going to sleep he wakes and finds his stomach sour and the next day he 
has a backache or his muscles are sore he may know that his insomnia was due 
to poor digestion of his supper. To get relief he may take a dose of soda. 

If, though, he' thinks that thereafter he can be reckless with his supper 
because he can escape the consequences by taking soda he will have done him- 
self harm when he took the first dose. 

It is doubly essential that the old should go to bed with empty stomach 
after a simple meal and properly poised mentally. 

Exercise. — The old must get some exercise each day. If it is at all 
possible, the exercise should be taken out of doors. Morning is the time 
for exercise. 

At Battle Creek it was noticed recently that a large portion of the people 
in the gymnasium were elderly. An onlooker laughed derisively. As a 
matter of fact the elderly persons taking exercise were wise. 

Children can be left to get their exercise from play. Middle-aged people 
must exercise to keep themselves supple. Otherwise their joints stiffen 
and creak. The wisest of them recognize the absolute need of keeping them- 
selves fit. 

Old people need a daily "suppling" stunt just as much as do middle- 
aged people. They do not need to do so much; but they need to take some 
exercise each day. 

Clothes.— Old people are poor heatmakers. Their blood vessels do not 
carry so much or change size so readily as do those in the young. The blood 
vessels of the skin in the feet and hands commonly do not carry enough 
blood to keep the extremities warm on a decidedly cold day unless they are 
warmly covered. 



GEOWIXG OLD GRADUALLY 953 

Old people should wear woolen underwear, woolen stockings and woolen 
gloves in cold weather. The old heavy red flannel underwear has no advan- 
tages in warding off rheumatism but is a good heat-saver. 

A cold skin saves heat but it is uncomfortable; and there is no reason 
why an elderly person should suffer the discomfort. 

The night clothes should be of wool or flannel. The old-fashioned night 
cap was a good institution. 

Bathing". — Old people should bathe for cleanliness. They have no busi- 
ness using cold baths for stimulation or hot baths for sedatives. The old man 
who has "broken the ice each morning to take his plunge" should discontinue 
it. There is no reason for continuing it just to show his hardihood. 

Turkish baths are not justified under any circumstances. The violent 
sweating is too hard on his skin. One compound cathartic pill will cause him 
to eliminate more waste than he could sweat out in a year's Turkish bathing. 

On the other hand the heat and general strain is liable to stop his 
heart or break one of his fragile blood vessels. 

Care of the Skin. — The fat is apt to disappear from the deeper layers 
of skin in old people. At the same time the skin loses some of its elasticity. 
The fat disappears also from the tissues beneath the skin. Besides the changes 
in the tissues from the disappearance of fat the organs actually shrink some- 
what. This is the reason for wrinkles. 

The skin of old people dries out. The dead layer thickens. There is a 
great tendency to the growth of warts and other kinds of thickened areas. 
These occasionally crack and bleed. The old need massage. They need 
massage for the muscles. They need skin massage. 

Their skin will be better off if some form of grease is rubbed into them 
twice a day. A good ointment for the purpose is cold cream mixed with five 
per cent boric acid. 

On account of the tendency of the skin to tan and crack old people 
will do well to keep out of dry living-rooms and offices. 

Diet. — The old must be careful against overeating. Their teeth are 
usually poor. 

If they do the necessary chewing they should be twice as long eating 
as in their younger years. Eating slowly makes light eating. 

However, occasionally an older person gormandizes. Xow elderly people 
require less food than young people. Von Xoorden says that between sixty 
and seventv the amount of food should be reduced 10 per cent; between 
seventy and eighty the reduction should be 20 per cent; over eighty, 30 
per cent. This is on the basis of a good deal of exercise taken. When the 
old person settles down to a quiet, inactive life he should eat a great deal 
less. 

Saundby gives the following as a fair diet for a person of seventy, weigh- 
ing 130 pounds and not notably active : 

BREAKFAST 

Ounces Ounces 

Milk S Bread 2 

Sugar 2/3 Butter 1/6 



954 LONGEVITY 

DINNEK 

Ounces 

Bread 3 Vegetables and fruit .... 2 ounces 

Meat or fish 2 Beer y 2 pint 

SUPPEB 

Ounces Ounces 

Bread 3 Light pudding 4 

Eggs 2 Whisky 2V 2 

If a person has been accustomed to beer and whisky with his meals, 
he should be allowed to continue them when he gets to be old. At the 
same time I do not think much of the man who allows himself to develop 
the habit of whisky with his meals. 

Generally speaking, no efforts should be made to change the habits of old 
people. This is true of tea and coffee, of tobacco, of habits of sleeping, of 
room ventilation, of habits of every sort. It holds true also of work habits. 
It is a bad plan for an old man to discontinue the work that has come to 
be a habit to him. 

When old people are allowed to do things in their own way and at their 
own speed they can do a lot without fatigue. In fact, they fatigue less 
than younger people under the circumstances noted above. The reason is that 
they worry and fret less. With them there is less lost motion. 

It is another case of the fretful colt hitched with the seasoned work 
horse. The former comes in at night hot, wet and tired ; the latter cool, quiet 
and not overfatigued. This only holds true where the old man is allowed 
to do his task in his own way and at his own speed. 

Beturning to the question of diet — Saundby advises the free use of 
soured milks by old people. The easiest secured of these is buttermilk. In 
winter time the old person may need a good deal of heat, in which event 
he can take a buttermilk made out of whole milk with a culture. In warm 
weather ordinary skim milk buttermilk is better. Cottage cheese, clabber, 
whey kumiss, and kefir are easily secured. 

Saundby uses sour milk made after the following plan : Hand skimmed 
milk is sterilized or thoroughly pasteurized to kill all the disease germs 
and also all those of the ordinary barnyard kind. The milk is then heated 
to 100° and put in a thermos bottle. Half a dozen yogurt tablets are crushed 
and added to the warm milk. The mixture is then put aside for twenty-four 
hours. The soured milk is sweetened and eaten. 

Old people are apt to be troubled with constipation. A part of this is due 
to errors in diet; but the greater part is due to change in the walls of the 
large intestine. 

In the first place, the walls lose some part of their sensitiveness and 
therefore do not keep the intestinal content on the move as is normal. In 
the second place, the muscle of the intestinal wall becomes flabby like the 
general muscular system. 

I have known of old people becoming so constipated that when the largely 



SOME PLAXS FOR A LOYG LIFE 955 

dilated lower bowel was finally emptied it was found that the accumulation 
amounted to many gallons. 

Perhaps the accumulation had been gathering for years, a little each 
day. At times during this period the bowels had been constipated; at other 
times they had been normal; at still other times there had been diarrhea. 

After a while the old person became sick with a low fever, then had some 
delirium. The doctor had been sent for. 

In his examination he felt a large peculiar tumor in the abdomen. He 
diagnosed this as an accumulation of feces. When oil and enemas had 
produced the desired result the fever disappeared and all the symptoms passed 
away. 

For constipation in the old soured milk is excellent. A pint of the 
yogurt milk described above may be taken each day. In making yogurt 
for daily use some of the soured milk of today may be used to sour the 
milk for tomorrow. It is not necessary to use tablets each day. 



SOME PLANS FOR A LONG LIFE 

In the sixteenth century Cornaro wrote a book entitled "How to Eegain 
Health and Live a Hundred Years." As he wrote the third edition of his 
book in his ninety-fifth year and lived to be over a hundred his advice is 
worth listening to. 

He lived abstemiously and carefully avoided all extremes of heat and 
cold, all extraordinary fatigue, all interruptions in his usual hours of rest 
and all bad air. He avoided melancholy, hatred and other evil passions. 
He laid especial stress upon eating a small quantity of food. At eighty he 
ate four meals a day. His diet list included bread panada, yolk of eggs, 
soup, kid mutton, poultry and fish. 

Hippocrates advised good air, baths, friction and physical exercises. 

Milton makes the Archangel Michael say of the way to reach old age: 

"The rule of not too much by temperance taught 
In what thou eatest and drinkest." 

Lord Strathcona at ninety-two ate two meals a day. ate little or no 
meat, took a great deal of exercise, slept six hours and did not smoke. 
Frederick Harrison at eighty-one gave golden rules of health : 

1. To abstain from tobacco, spirits, made dishes and all such terrible 
things. 

2. Eise from a meal with an appetite. 

3. Walk every day for two hours. 

4. Sleep eight hours. 

5. Be content with what you have. 

Tolstoi taught that the secret of long life is in fresh air day and night, 
daily exercise, moderation in eating and drinking, a hot bath a week and a cold 
one every day. 

Yon Moltke at ninety said he maintained his health by great moderation in 
all things and by regular outdoor exercise in all weathers. 



956 LONGEVITY 

The Prussian historian, von Ranke, rose at eight, took a cup of tea, 
worked unti) one, took a long walk in the park, ate a full afternoon dinner 
of plain fooc including two glasses of wine, worked until seven, took tea with 
his family worked or talked with his family until eleven and then went 
to bed. 

Sir Herman Ueber, when over eighty, lectured to the Royal College of 
Surgeons on the means for the prolongation of life. He took a daily walk in 
all weathers, went walking for four hours once a week, and once a year he 
went on a walking holiday. He recommended mental occupation, gardening, 
intellectual games and traveling. 

He spent his winters on the Riviera. He took breathing exercises for 
five to fifteen minutes each day. He slept six to seven hours and then arose to 
a bath followed by friction of the skin. He especially advocated regular bowel 
habits and simple, plain food. 

He used no alcohol, stimulants, narcotics or soothing drugs. He advised 
the cultivation of mental tranquillity and hopefulness, the avoidance of grief 
and the control of the passions. 

Goethe, after a youth of poor health, lived to be more than eighty. In his 
old age he became an optimist. This helped him to live on in spite of enormous 
portions of roast goose and bottles of red wine. He died of pneumonia. 
Metchnikoff said of Goethe in his last illness: 

"If he had not been a drinker of wine, he would have been able to with- 
stand this attack and to live still longer." 

The germs that produce acid live on sugar. The food sugars com- 
monly absorb out of the intestines within fifteen feet of the stomach. 
The fight against the germs which produce indols and phenols does not 
begin until the food has traveled thirty feet down the intestine from the 
stomach. 

How to keep the sugars in the intestine for the lactic bacilli to feed 
on in order to fight each other was the question. Metchnikoff concluded that 
it could not be done, so he set himself to find a way to make sugar for the 
germ to feed on. 

He found some germs which could do that. He now recommended that 
this germ be combined with the lactic acid producer: one to make sugar in 
the intestines and the other to eat the sugar and make acid. 

However, Metchnikoff said he was sure the method was not yet complete 
and many changes would have to be made before the Methuselah type of man 
was made universal. 

That does not spell defeat, however. The automobile today is quite 
different from the monstrosity that caused Ford's arrest in Detroit a quarter 
of a century ago. Yet Ford going down the street that day was starting 
something. The locomotive engine had to be shifted around a good deal to 
travel from the Stephenson type to that of 1916. 



CHAPTEE LI 

Cancer 



Many are the theories as to the cause of cancer. The disease is so 
palpable, so easily seen, and in its early behavior so different from the normal 
that men assumed there must be a definite cause in the early stages of science 
and, with a starting point established, speculation ran riot. 

The disease was caused by eating meat and a case in some meat eater 
was the proof. Then somebody bowled out that explanation by citing cancers 
in vegetarian men and animals. The disease was due to eating tomatoes, 
or cabbage, or some other vegetable. Then came the days of bacteriology 
and its multitude of diseases with bacterial causes and surely cancer must 
belong in the list- 
As a natural corollary there arose the group of speculators who said : 
"Since yellow fever has its stegomyia. malaria its anopheles, plague its flea, 
and typhus its louse, cancer must have its host transmitter." And wasps, 
earthworms, and itch mites have been accused. 

In the meanwhile a group of microscopists was plugging away and from 
them has come the evolution of a theory which is illuminating and through 
which some material and practical advance may be made. 

The theory of Bibbert is that cancer cells are anarchists ; that the cancer 
state is a state of anarchy, and that cancer is anarchism. 

Every cell in the body is an individual, lives its life and does its work as 
an individual; but that work is thoroughly adjusted to the work of every 
other cell. The human body is the community of cells. The laws of 
physiology are the laws of the commune. 

Normally each cell stays in its appointed place, lives out its life, does 
its work, divides into new cells — each act being in relation to the need. 
Sometimes a cell will get away from its proper place, will get into a wrong 
area, will get away from its proper work, and will multiply and make 
new cells. 

To show how fast the cells multiply and grow Bashford says that you 
could start with a cancer in a mouse and keep inoculating it, doing everything 
possible to promote growth, and in three years all the tumor derived from 
the small beginning in the mouse massed together would make a giant 
mouse as large as a St. Bernard dog. 

Ehrlich inoculated a mouse weighing one-half an ounce with cancer. In 
a week the cancer weighed thirty grams, in three weeks forty-five grams, 
and in two months the tumor weighed as much as the mouse. 

The essential point is that the cancer cells do just what normal cells 
do but they do it out of relation to need. The individual cell does its 
individual stunt in its individual way but with entire forgetfulness of the 
general good, and, though having more individual liberty than it ever had 

957 



958 CANCEE 

before, with fatal results to the community — and when the man dies the cancer 
dies. Could there be a better illustration of anarchy ? 

Many men have worked on the contributing causes of cancer. There 
is some proof that cancer is contagious. Husbands have developed cancers 
after nursing wives with cancer and vice versa. Seemingly a better proof 
of contagiousness is the easily proved inoculability of cancer. 

Every well equipped research laboratory now has some cancer mice, 
and from time to time pieces of cancer from these are used to inoculate 
new mice. Every domestic animal is subject to cancer and not infrequently 
research students succeed in inoculating domestic animals of various sorts 
with cancers derived from other animals. 

Biologists say that this does not prove that cancer is due to a microbe 
but that the explanation is easy on other lines. 

Cancer houses, cancer streets and cancer towns are recognized. There 
are damp walled, illy sunned and badly ventilated houses in which cancer 
seems to thrive. 

Burnett's "The Campaign Against Microbes" recites pages of illustrations 
of cancer houses, cancer streets, cancer towns and cancer districts. His 
theory ties it up with thick, impervious soils, bad town drainage, marshes, 
and absence of sewers, bad house drainage, damp walls, wet floors, dark cellar 
sleeping rooms and poor ventilation. 

Some cities make cancer reportable and have cancer spot maps just as 
they have scarlet fever spot maps. A Prussian sanitary ordinance passed 
in 1797 required that cancer be reported like other contagion. The proof 
seems conclusive that these are contributing factors of importance in cancer 
though there is no evidence that they act through microbes. 

Ten years ago a Chicago physician — Dr. Stofer — proved that blasto- 
mycosis, a disease closely akin to cancer, was due to a microbe which grew 
on moldy, wet bedroom walls but nobody has gotten any closer to cancer 
in the intervening time. 

There are those who think cancer is inherited. They do not think the 
disease is inherited but that a weakness toward it is. 

They are right. There are cancer families. As Davenport shows, if we 
can compare the causes of death of people between forty-five and sixty-five in 
certain families with the same data for others we find great variance among 
them. 

Of those dying during that period one-tenth should die from cancer 
according to the law of averages. If a family has a larger proportion of 
cancer deaths than ten per cent then that is a cancer family. But this, too, 
is only a contributing factor. 

However, if the body is a commune and individualism is subjected to 
socialism there must be some machinery of regulation. What is it? There 
is an automatic something which automatically terminates pregnancy at nine 
months. The proof seems quite good that the something is the development 
of chemicals similar to antitoxins or, maybe, vaccines. 

This is about the most striking illustration that I could give. There 
are scores of others going on inside the body incident to everyday life ac- 
tivities, some of which are somewhat worked out and others of which are 
pretty well thought out. Some of the men who are trying to cure cancer 



CANCER ACURABLE DISEASE 

The hope of curing cancer lies in early 
reco g nition and prompt surgical treatment 



SURGERY IS SUCCESSFUL 

,N Percentage of Cures 

Early Delayed 
Operation Operation 

Cancer of the Breast 807° 257° 

Cancer of the Lip 951*607° 

Cancer of the Tongue 307° 157° 

Approximate estimates furnished 
by the American Society for the Control of Cancer 



Cancer causes 80000 deaths every year in the 
United States. 

At ages over 40 one death in ejght among women 
and one in fourteen among men is due to Cancer. 

Yet cancer is not a hopeless incurable disease and. very 
many of these deaths are unnecessar y and preventable . 

Cancer is at first a tocal disease beginning in a tiny spot. 

At that time it can be easil y removed by the surgeon 
and a cure is almost certain. 

If neglected, it grows and is carried to other parts 
of the body and rapidly gets beyond control. 

New York State Board of Health. 

Fig. 400. 

959 



960 CANCER 

are working along this line and what they are getting looks like pay 
dirt. 

The serum from animals cured of cancer will cure cancer in other 
animals. No way to make it work in men has been found. On account 
of a biologic resemblance between the young tissues of a fetus and the 
young cells of a cancer the tissues of still births are being used for the pur- 
pose of developing a vaccine. Pleuritic fluid, extracts of organs, various agents 
of this type are being used by men trying to cure cancer. 

Some of the reports of cases treated in this way are promising. Analysis 
of cancer has shown that the cells are rich in glycogen. Glycogen is the 
form in which sugar is handed out to tissues. Tts presence in quantity in 
tissue is a sign that that tissue is working hard. 

Other men have found that when Roentgen rays were turned on tissues 
they pick out those rich in glycogen and shrivel them up while those poor 
in glycogen are not touched. 

At once the idea grew that X-rays would cure cancer. It does cure some 
cancers pretty well but not all. In the first place, X-rays cannot penetrate 
well and therefore they are good for skin cancers but not of much account 
for deeper ones. Another limitation is that the rays are not selective enough. 
They pick out cells rich in glycogen and all young working cells are rich 
in glycogen. Therefore they get some good ones along with the bad ones. 
All in all we need some agent which can pick out cancer cells better than 
can X-rays. 

The old arsenic and zinc paste cures were alleged to pick out the cancer 
tissue and leave the other behind. The ads had pictures of the roots which 
we were told were the roots of the cancer. 

Unfortunately for the business of certain gentlemen it was easy to show 
that cancer has no roots and that what is left behind by plaster was seen 
under the microscope to have plenty of cancer tissue. What came away 
and was called roots was nothing more than strings of gristle. 

Drs. Loeb, McClung and Sweek of St. Louis tell us their partial suc- 
cesses by injecting colloidal copper into the blood. Professor Leo Loeb is a 
brother of Professor Jacques Loeb and a most careful, painstaking and 
courageous investigator himself. For twenty years he has been working to 
find a cancer cure. 

Ten years ago he found that he could cure cancer in animals by injecting 
cyanide of potash. But the dose required to cure the cancer was little short 
of the dose required to kill the animal. You see he had to take another tack. 

A dozen of the best men in Europe had been working on colloidal 
selenium and eosin as a cure, and recently a report of a case of cancer of 
the stomach treated by injections of selenium was made. In the meanwhile 
Loeb and his associates had been working on copper injections into the 
blood. They could cure cancer in animals — why not try it on men ? 

A few months ago their courage got to the sticking point. They got 
hold of some cases that had to die— they were hopeless. They had been 
operated on sometimes more than once: the disease had returned; further 
operation was impossible. It did not seem possible to make things worse. 
Why not try to make them better? 

They began injecting these men, throwing into the vein from one-fifth 



CANCER 



961 



of a pint to a pint of watery solution of colloidal copper. Many of the 
symptoms improved under this treatment and the early reports are favorable 
enough to warrant the experimenters in advising that the method be still 
further tried out on cases where the diagnosis is certain and the cases are 
in a hospital where they can be watched properly; otherwise not. 

It hardly seems likely that copper would be able to seek out the cancer 
cells to kill them off and leave the other cells alone. It probably has some 
such action. But is it superior in this capacity to X-rays or radium or 
the streptococcic serum? 

The experimenters summed up as follows : 

"We may state that we are now able to cause the gradual retrogression 

DIAGRAM SHOWING RELATIVE IMPORTANCE OP CANCER 

AS A CAUSE OF DEATHS IN MICHIGAN DURING 

THE SEVEN YEARS 1901-1907. 





HEART DISEASE 
PNEUMONIA 
TUBERCULOSIS 
CANCER 
APOPLEXY 
BRIGHT f S DISEASE 
OLD AGE 

Michigan Public Health. Fig 401. 

of human cancer, and furthermore that the treatment does not seem to be 
limited to one kind of cancer, but is applicable in the effective treatment 
of various kinds of cancer. A definite judgment on the ultimate outcome must 
be suspended/' 

They also announce that they have arrived at two other conclusions. 
The first is that human cancer is more amenable to treatment than is mouse 
cancer. 

As mouse cancer is being cured right along this opinion is fraught with 
hope. If the opinion be correct the little faults of procedure in curing human 
cancer should not delay discovery of cure for long but of course experimen- 
tation with men cannot go so far as experimentation with mice. 

The second opinion is that there is no essential difference between mouse 
cancer and human cancer. Scientists have been agreed for some time that 
there was not a great fundamental and necessary difference between cancers 
and sarcomas — epitheliomas, carcinomas and sarcomas. 

A long time ago the elder Krebs described a kind of tumor as a sarco- 
carcinoma because he could not say to which group it belonged. The little 
pigmented moles that develop into violent cancers in man and on the tails 



962 CANCER 

of gray horses into fatal sarcomas have always been a battleground between 
the carcinoma and the sarcoma school. 

Leo Loeb held views as to the cancers in the deeper layers of the skin 
which were much contended over. Some of the tumors in dogs and other 
lower animals were held by some microscopists to be sarcomas and by others 
to be carcinomas. 

The meaning of all these contentions was that the differences between 
the varieties were superficial and changeable. For instance, Ehrlich inocu- 
lated an animal with carcinoma. He took the carcinoma from this second 
animal and inoculated a third. He kept this up for ten generations, when 
the growth began to change to a sarcoma; by the fourteenth generation it 
was a straight sarcoma. Burnett quotes Loeb as doing the same experiment 
with the same result. 

From another standpoint, it does not matter so much. For instance, 
an epithelioma on the face is so mild as scarcely to be malignant at all but 
an epithelioma on the womb is exceedingly malignant. A carcinoma in the 
womb is mildly malignant; in the stomach it is violently malignant. 

From certain curative standpoints there was a difference. For instance, 
Coley's toxin was much more powerful as a remedy against sarcoma than 
against carcinoma. X-rays did better with superficial epitheliomas than with 
sarcomas. 

In the light of all this the hope of Drs. Loeb, McClung and Sweek 
that colloidal copper will be as useful against sarcoma as against carcinoma 
(and vice versa) has some foundation in the kinship of the tumors and makes 
unnecessary refinements in diagnosis on which some insistence is now put. 



IMPORTANCE OF CANCER KNOWLEDGE 

Lombroso held that criminals were marked by certain features which he 
called "stigmata of degeneracy." His view was that an expert could pick out 
criminals without any knowledge of the history of the men indicated. 

When I first began examining specimens of tissue microscopically for 
cancer the average doctor thought cancer cells could be picked out as 
Lombroso picked criminals. For that matter it has not been long since 
it was the custom for an ailing man to walk up to a physician, poke out his 
tongue and say: "Doc, what's the matter?" If the physician began to ask 
for a history the sick man would take in his tongue long enough to say: 
"I came to get, not to give, information" whereupon he would stick out his 
tongue again. 

The physicians now know that there is no such thing as a cancer cell 
and that as far as cancer roots are concerned nobody now believes in that 
fake except the worst of the fakers such as Chamlee and that the only way 
he can make it go is to follow the plan of the evil resort — split the money 
with the cabby. 

Lombroso was wrong. The idea that there is a cancer cell is wrong. 
A cancer cell is an ordinary cell in the wrong place and doing the wrong 
thing — that is all. 

Yellow fever has disappeared from this country. So has cholera. 



IMPORTANCE OF CANCER KNOWLEDGE 963 

Malaria is going. Twenty years from now all portions of the United States 
will be free from this disease. Hookworm is in the way of being banished. 
Consumption is on the run. Cancer and pneumonia are the next two 
problems. 

The way must be found. The way to find the way is to turn on the 
light. 

Hoffmann says that the number of deaths from cancer in the United 
States in 1913 was 75,000. Of this number, 30,000 were from cancer of 
the stomach and liver; 12,000 from cancer of the uterus and other organs 
of generation of the female; 10,000 from cancer of the peritoneum, intes- 
tines, and rectum; 7,000 from cancer of the breast and the remainder from 
cancer among the other organs. 

The cancer death rate in 1912 in New York State was 86 per 100,000 
living; in Greater New York, 80.9. The average rates for the last five 
years were: for Greater New York, 77; London, 94; Paris, 109; Berlin, 
107; Chicago, 78; Philadelphia, 86; Boston, 107. 

The rate for the old city of New York has increased in fifty years from 
24 to 86. The principal increase has been in people over fifty-five years of age. 
There has been an increase in the cancer of every organ but one — the skin. 
Cancer of the skin has decreased. Note that fact, for presently it will be 
referred to and used as the foundation for the one big point in this article. 

There is no reason for pessimism over these figures. Fifty years ago 
most of the people were dying far below the cancer age. The average age 
of death was far below forty-five to sixty-five — the cancer age. Again, fifty 
years ago microscopes were not in common use; everything was a guess and 
the records were not well kept. 

Rittenhouse tells us in "The Human Factor" that between 1880 and 
1910 the cancer rate in Massachusetts and New Jersey rose from 42 to 85. 
The statistics of Massachusetts and New Jersey were fairly well kept as long 
ago as 1880. 

In ten registration states the increase in cancer between 1901 and 1911 
at the different age periods was as follows: Twenty to twenty-four years 
of age, increase, 23 per cent; twenty-five to thirty-four years of age, increase, 
4 per cent; thirty-five to forty-four, 1 per cent; forty-five to fifty-four, 14 
per cent; fifty-five to sixty-four, 31 per cent; sixty-five to seventy-four, 35 
per cent; seventy-five and over, 45 per cent. 

The impression is general that the reason for the increase in the deaths 
of people past fifty is because more people live beyond fifty than in olden 
times. That is a part of the reason and a large part but for years Ritten- 
house has been contending that it was not the whole reason. 

To prove his point he has been using the statistics of New Jersey and 
Massachusetts, states whose figures of thirty years ago are fairly dependable. 
Rittenhouse proves that old people are having a harder time and showing 
higher death rates than a generation ago. One of the important factors is 
the increase in the deaths from cancer. 

The second reason for writing about cancer is that a better way of 
diagnosing it must be found. The microscope has told us everything that 
it can about cancer. What it has told is not enough. 

The biological chemists are now trying their hands. The old chemical 



964 CANCEE 

methods failed. The methods now being tried are the much more delicate 
methods of biological chemistry. 

It may be that they, too, will fail but they have demonstrated enough 
to show that they are entitled to a trial. Institutions in which such trial is 
being made must have support. 

However, the part of the diagnosing end now chiefly at fault is the 
postponement of the effort at diagnosing until it is too late for our ineffective 
methods to be of any service. The surgical method of treating cancer, while 
the best we now have, is a poor one. In time it will give way to a better 
method. 

Most of the cancers are not diagnosed until surgery cannot cure. Dr. 
William Mayo says the largest number of patients with cancer of the stomach 
tell their physician of symptoms from which they have suffered from one 
to three years. 

In 1890 Dr. Agnew of Philadelphia, then a distinguished surgeon in 
the evening of his life, said that he had never cured a patient of cancer 
of the breast by operation. He had operated on thousands. Dr. Agnew 
never operated until the signs of cancer of the breast were fully developed. 

A few weeks ago Dr. Bloodgood examined a patient operated on by 
Dr. Halsted in 1890. The cancer had not come back. The statistics show 
that five years after operation, 47 per cent of the patients operated on at 
Johns Hopkins for cancer of the breast have had no recurrence. 

Those are not exceedingly good figures. They are less than half as good 
as they should be. Some day a method will be found more than twice as 
good. However, they are much better than Agnew's — 47 per cent of cures 
as compared with nothing. 

The difference between the Agnew and the Halsted methods is that 
Halsted operates on suspicion : Agnew required "the signs of cancer to be 
fully developed." 

In the Halsted method the tumor is removed, frozen, and examined 
microscopically, and what the microscope shows determines whether the 
operation is limited to the removal of the knot or made to include much 
beside. Furthermore, the microscopic sections of the tumor are made a part 
of the permanent record of the case. 

As to cancers in general, Bloodgood tells us that in Johns Hopkins, 
where they have operated on suspicion 80 per cent of the cases have had 
no return of the cancer five years after the operation. Where the diagnosis 
of cancer was certain — from the looks of it and the way it acted — 25. per cent 
of the cases have had no recurrence five years after. The one method cures 
eight out of ten, and the other, one out of four. 

To stop the scoffers let me repeat that every growth is examined micro- 
scopically during the operation, or before, or after, and, if the microscope 
does not show cancer, it does not get into the list. No non-cancer cases enter 
into the statistics. 

Hoffman tells us that in the last five years there has been a slight 
decrease in the deaths from cancer of the skin. The reason runs to the main 
point of this story. The skin is right before our eyes. We are constantly 
examining it. If a blotch the size of a pinhead appears it attracts attention. 

Information about things is getting general. When we notice some ulcer, 



IMPORTANCE OF CANCER KNOWLEDGE 965 

knot, or growth on the skin, we give it care. The care is often foolish care. 
Often we do the wrong thing. We do not do the wrong thing so often as 
we did. The proof? The falling rate from skin cancer. 

If the stomach could be put upon the surface cancer w T ould diminish 
there. As that cannot be two things must happen — the people must know 
more about their bodies, must get accurate information in place of the 
foolish ideas, fears, and forebodings that now prevail; and the diagnosticians 
must improve their methods. 

Cancer is not a blood disease. It is not always a local disease. In the 
later stages of certain cancers the cancer cells get into the blood but they 
do not stay there. In less than a minute they are thrown out of the blood 
and into some tissue, forming there a new growth called a metastasis. 

In certain other cancers the cells try to get into the blood but they fail. 
They get into the lymph but the lymph glands filter them out before they 
reach the blood. 

Cancer is not a blood disease nor even a disease present in tlie blood. 
At the beginning it is local and at that limited to a space too small to see. 
For a long time it grows only where it started. 

Operated on at that time it is cured. As we have already said, at that 
time the surgeon has suspicions; he cannot be certain. If he waits to be 
certain the case is extremely apt to get beyond the range of cure. 

Bloodgood tells us that in the state patients reach physicians from 25 
to 50 per cent of them have passed into the hopeless stage. Many of these 
will live longer without operation than with it. 

It is plain that toe must have the cases come into view earlier than they 
now do. It is plain that the people must know more about these earlier 
stages than they now do. 

In time a better method of treating cancer will be found. Many are 
being tried. The copper salts may yet offer something. For sarcomas Coley 
proposed an injection of streptococcus. At first they dared to inject more 
virulent material and they got some results. Later they seemed afraid of 
the pain, fever, and generalized infections and injected less virulent mate- 
rial, which fell short of expectations. 

The Neiv York Medical Journal has great faith in radium. In reporting 
the meeting of the College of Surgeons in Philadelphia lately [they] say had 
it not been that the speakers were men of the type of Howard Kelly and 
Robert Abbe, the positiveness with which they urged that radium would 
cure cancer when it could be placed in contact with it would have inspired 
skepticism. Fortunately the results obtained by them are in keeping with 
those of others, notably Louis Wickham of Paris. 

The men taking part in the discussion were of the opinion that surgical 
removal should be done whenever it was possible. Radium should not be 
used just to stave off surgery. 

Then, to summarize, the light must be turned on cancer because: 

1. The disease is of great importance. 

2. Our diagnosis is faulty, partly because the scientists do not know 
enough and largely because the people do not know enough. 

3. Our cures are faulty, partly because our scientists do not know enough, 
and largely because the people do not know enough. 



966 CANCER 



CANCER KNOWLEDGE NECESSARY 

The New England states have been trying to discover whether cancer is 
more prevalent with them than elsewhere in the country. 

The Census Bureau reports that in 1913 the death rate from cancer 
in the registration area was 78.9 per 100,000. The rate in Connecticut is 
85.1; Rhode Island, 93.3; Massachusetts, 101.4; New Hampshire, 104.4; 
Maine, 107.5; Vermont, 111.7. 

Why talk about cancer? For one reason, the people want to know 
about it. They know that it is a menace and that it is getting to be more so 
year by year. For another reason, we have something to say. It is not neces- 
sary to paint a grewsome story and stop. The way out is unfolding. 

Miss Slye has told us that a person whose family are very subject to 
cancer can mate with a person not of a cancer stock and be certain that his 
children will not be in much danger from cancer. In three generations the 
susceptibility to the disease will be negligible. 

For another thing, protection of the different organs of the body from 
prolonged nagging irritations will prevent cancer even in those of cancer 
stock. The intelligent person, alert in the care of his body and understanding 
something of his machine, can discover cancer or cause it to be discovered in 
him at a stage so early that cure is possible. 



CANCER OF THE BREAST 

Cancer of the breast starts with a lump in the breast. Not all lumps 
in the breast are cancerous. In the first place the normal breast has a lumpy 
feel. A tumor, however, feels harder and better walled around than does a 
lobe of the breast. 

The most frequent tumor of the breast is fibroma. Fibroma is a hard, 
fibrous tissue tumor. It is as harmless as a wart or a wen or nearly so. 
Cysts of the breast are also frequently found. They, too, are harmless. 

Caking of the breast results from infection with pus cocci. The infec- 
tion travels from the skin up the milk tubes. The dairyman calls it garget. 
Caking of the breast grows rapidly, develops quickly, and hurts from the 
start. 

At the other end of the line are fibromas and cysts which develop slowly, 
grow at a snail's pace, and usually give no pain. Occasionally some rub 
causes a tumor of this type to get a little sore, but the soreness is slight. 

In between comes cancer. Pain is given as one of the earliest signs of 
cancer. The pain is sharp and shooting. It is due to the destruction of 
other tissues (microscopic, however, in extent) by the cancer cells. 

Often this symptom is the first to direct the attention to the breast. 
A woman having such a pain feels for the hurting point, and her fingers make 
out a small hard lump. 

If there is no lump the pain is probably a neuralgia but she had better 
feel carefully before concluding that there is no lump. 

Later the cancer grows from the milk gland into the skin. The skin no 



CANCER OF THE FACE 967 

longer slides over the tumor. Still later the nipple retracts. Still later 
the glands in the armpit enlarge. 

Now, what is good judgment? To wait until the glands enlarge or 
the nipple retracts is not good judgment. To wait a few weeks, say four 
or maybe eight, after the growth is noticed or the first pain is felt may be 
good judgment if the person watching the growth will do so in earnest. 
A judgment is to be formed on the rate of growth and the amount of pain. 

To wait until one is sure the growth is a cancer is not good judgment. 
Statistics show that operations based on shrewd guesses when these guesses 
are based on moderately extensive watching are good judgment. After the 
skin is cut and the tumor can be felt and seen by the operator he can form a 
much better opinion about it. He can even cut off a small piece and have 
it under the microscope in fifteen minutes. 

If he finds the growth to be a fibroma or a cyst he will remove it through 
a small incision leaving little scarring. If he finds it to be a cancer he 
should remove not only what he can see to be the growth but also all of 
the tissues into which experience has taught that cancer of the breast 
promptly spreads. 

To remove what he can be certain is cancerous is not enough. He 
must guess how far the cells have spread and remove accordingly. 

Proceeding on this plan nearly half the breast cancers are cured; by using 
plasters death results. 

CANCER OF THE FACE 

The mildest of cancers are those on the face. Some of them get well 
without treatment, some with pastes, some with X-rays, some with operations. 
As cancers are generally thought to be incurable (most of them are when 
they are diagnosed) and as cancers of the face are so frequently cured they 
constitute the stand-by of cancer cures. 

A man will use a paste on a face cancer and the cancer will be cured; 
whereupon the man will believe he can cure any cancer anywhere on anybody. 
If he is a plausible rascal he may make a good deal of money before he is 
found out. Amongst his list of cancers of the breast and elsewhere that 
have not been cured will be enough cancers of the face and skin eruptions, 
improperly called cancers, to keep him afloat for a number of years. If he 
is an altruist and gives away his formula for a paste, accompanying it with 
a statement of cures, he will do but a limited amount of harm. 

It is the advertisement that makes the harm of cures possible. Unless 
a good deal of money is spent on printer's ink cures do not spread. Even 
those that have merit are but slightly contagious and unless at least 50 per 
cent of the receipts go into advertising, there are but few takes. 

Cancer of the lip is nearly always on the lower lip, the proportion being 
20 to 1. Cancer of the lower lip is seven times as frequent in men as in 
women. It is not often found on the upper lip, but the few cases found 
are equally distributed between the sexes. 

Why men have lip cancer more frequently than women is just a guess, 
but the guess is that it is because men smoke. Women also smoke at times 
but — there's the difference. Women smoke at times — some men smoke all 



968 CANCEK 

the time. It is just those smokers who constantly irritate their lips with 
a pipe or cigar that get lip cancers. 

The surface of a lip cancer soon breaks and makes an ulcer. Around 
this ulcer is a hard area. When a man gets a lip ulcer, how is -he going to 
know it is a cancer? Pain will not tell him because any ulcer of the lip 
is painful. Hardness is a fairly good sign but several ulcers on the lip 
are hard. The glands under his chin will enlarge but that test is not of 
much service because it is what is known as a late sign. Cancer spreads along 
the lymph vessels to the lymph glands. The lymph glands that swell when 
the lips are long out of order are those in the neck below the chin. 

In cancer of the lip some of the cancer cells are easily broken loose by 
the muscles of the lip, whereupon they are swept along the lymphatics to the 
lymph glands under the chin. Therefore enlargement comes early as those 
things go. Nevertheless enlargement of the lymph glands is a late sign. An 
alert physician should be able to make a diagnosis before the sign appears. 

Up to now we have not named any very good signs and there is no sign 
by which a man who has an ulcer on his lip can judge finally. A more sensible 
question is : What should make a man suspicious ? 



CANCER OF THE MOUTH 

Cancer in this location is rare in women of any age and men younger than 
forty-five. But a man past forty-five, especially if he is a smoker who lets 
an ulcerated tongue drift on, ought to have a guardian. The "Index of 
Differential Diagnosis" says : "Any ulcer of the tongue occurring in a middle 
aged man, and lasting for more than two or three weeks, should awaken 
suspicion." 

Cancer of the tongue rapidly develops into the ulcerated form. Therefore, 
when cancer is in mind the feature to look for is an ulcer. But inflammations 
of any sort when located in the tongue are apt to become infected and cause 
ulcer. 

In the list of ulcers are the aphthous stomatitis (bad mouth cankers) 
and dyspeptic. Ulcers of these types should not last two weeks. If they show 
any disposition to hold on a free purgative followed by two weeks of milk, 
cheese, bread and fruit will cause them to disappear. 

The above types of ulcer are too acute and too painful for cancer. 
The dental ulcer is generally an acute ulcer. However, that is not a good 
sign to go by. 

The ulcer is the result of injury from a sharp tooth or a decayed one. 
The way to tell about these ulcers is to have the dentist pull the tooth, fill it 
or polish it, as the need may be. The dental ulcers disappear when the offend- 
ing tooth is made unoffending. 

The hardest of all the tasks is to distinguish the syphilitic ulcer. Time 
was when mistakes on this point cost many lives and there was no remedy. 
Now a microscopic examination of the secretion of a venereal ulcer will show 
the germ. A Wassermann reaction will be positive and an injection of salvar- 
san will cure the ulcer in a week. 

The ulcers of cancer are liable to be on any part of the tongue though 



CANCER OF THE STOMACH 969 

they are more frequent along the side. In addition to hurting and bleeding 
the cancer ulcer causes a hardness in the tissues around the ulcer. 

There are several conditions that cause hard, boardlike areas to appear 
on the tongue. The name by which the doctors know these conditions is 
leukoplakia. Leukoplakia is not cancer. It is not an acute condition. The 
patches stay unchanged for years. 

In time, however, cancer develops on leukoplakia patches. An ulcer 
develops in the midst of the boardlike tissue. If, then, a man has had one 
of these patches for some time and an ulcerated area develops on it he should 
seek counsel at once. 

It does not pay to temporize with cancer of the tongue. The growth 
promptly spreads to the glands of the neck. A manana policy means in- 
operable cancer. 

CANCER OF THE STOMACH 

The most frequent cancer is that of the stomach and liver. The two are 
grouped because cancer of the liver is generally secondary to cancer else- 
where and the stomach is the most frequent location. That cancer of the liver 
is secondary is true even when the cancer of the liver is very large and the 
other cancer is small. The liver is not a good starting place for cancer but 
when it reaches there after starting elsewhere it finds growing conditions 
good. 

The leaflet of the Chicago Medical Society on "Early Signs of Cancer" 
gives the following early signs of cancer of the stomach : "Indigestion, slight 
distress or pain in the stomach, and general weakness and loss of flesh." 

Of all cancers our methods in cancer of the stomach are about the most 
unsatisfactory. This is true both of methods of cure and of diagnosis. When 
a tumor can be felt or a knot appears in the neck diagnosis is easier; but 
what is the use of knowing when nothing can be done? 

"The Index of Diagnosis" gives the following suspicious signs: Indiges- 
tion beginning abruptly in a patient above the age of 40 and not yielding 
to diet or treatment — a mild gnawing pain coming several times a day. 
(This pain is much less severe than the sharp neuralgic pain of too much * 
acid. It is less violent than the pain of ulcer.) Loss of appetite in a person 
of cancer age and without any good cause, especially a loss of appetite for 
meat; vomiting, not violent, but a little disposition that way nearly every 
day. (One case out of five will vomit a little blood.) A steady loss in weight, 
for which no cause can be found. Seven cases out of ten occur in persons 
between 40 and 60. 

These are the suspicious signals. Any one who guesses that he has cancer 
because he has any one of these afflictions is not wise. Any person who has 
several of them and fails to have a careful examination made is not wise. 

A careful physician after inquiring into the above points will start 
his examination. He will give test meals, empty the stomach of its contents 
and then analyze the material pumped up. He will carefully examine both the 
stomach contents ancl the bowel movements for occult blood — that is minute 
traces of blood. He will illuminate the stomach, fill it with bismuth and 
X-ray it, and probably will try some of the new biological tests for cancer 



970 CANCER 

recently proposed by the German scientists and now being tried out in hos- 
pitals and laboratories the world over. 

He will make an examination of the blood. Cancer of the stomach 
destroys blood cells all out of proportion to its general destructive work, just 
as it interferes with nutrition and causes a great loss of flesh even before it 
has reached any great size. 

LAY DIAGNOSIS OF CANCER OF THE STOMACH 

Is there any one sign by which a person can tell that he has cancer of 
the stomach in a stage in which anything of importance can be done? The 
answer is in the negative. Cancer causes a tumor. Unless the tumor is on 
the back portion of the stomach it can be felt through the abdominal wall. 
But that symptom is not worth much, since it means a late not an early stage. 

Rapid loss of weight with stomach symptoms is a good sign, but it means 
late not early cancer. Vomiting of blood, anemia, and loss of appetite, espe- 
cially for meat, are good signs, but they come too late to be of much service. 
Pain in the stomach is the best of this group of symptoms, but there are 
several other causes of pain. 

Are there any feelings which should cause a person to suspect cancer of 
the stomach and, acting upon the suspicion, to have a careful examination 
made; I mean feelings which should put a man on guard when the disease 
is in its beginning? I think this question can be answered in the affirmative. 

If a person past 30, man or woman, has a pain in the pit of the stomach 
for a week or two or has indigestion for that length of time he should eat very 
lightly for three or four days. He should eat one slice of bread or toast and 
one cup of coffee, tea, beef tea or warm water three times a day for that length 
of time. It is well to begin the period of fasting by taking a mild purge. 

If the pain and discomfort, nausea, indigestion or vomiting continue 
after the stomach has had a chance to rest and recuperate (say if it continues 
beyond the first day) the person is justified in going to a skilled diagnostician 
for an examination of the stomach contents for blood, acid and other ingre- 
dients ; of the feces for minute traces of blood ; of a drop of blood for general 
traces of the disease; and for a physical and X-ray examination. 

The examination to be of any value must be painstaking and thorough. 
Superficial examination will not "find" cancer at a stage when anything is 
gained from having the information. 

Cancer of the stomach belongs to the cancers which spread slowly. The 
growth does not spread to the glands until it has been present for months. 
The seriousness of cancer is dependent upon the degree of spreading to the 
near-by glands. All of these considerations make us believe that operation 
on very early cancer of the stomach should give good results. 

Smithies tells us that at the present time only one of seven people oper- 
ated on for cancer of the stomach dies from the operation. 

One great need is for some certain sign of early cancer of the stomach. 



CANCER OF THE SKIN 971 



CANCER OF THE SKIN 

Cancer is a local disease. At the beginning it is limited to one spot or 
location. After a while some of the cells are carried to new locations. It 
then is still a local disease but it is growing in more than one locality. In 
no proper sense is it ever a blood disease. Blood impurities, so-called, never 
have anything to do with cancer. 

Cancer, then, being a local disease and a disease occupying in the early 
stages little space in a single locality the most important of all questions is 
how to know it. 

When we came to know about consumption (by we I mean John, Henry, 
and Pat) we found that early diagnosis was the key to the situation. When we 
(meaning the general run of people) begin to know about cancer we shall 
find that early diagnosis is the key to the situation. 

Then the question as to how to tell cancer in the early stages is a most 
important one. Some of the old ways of telling fail to interest us because they 
do not help. For instance, the odor of cancer is of no interest because the 
odor does not develop until the disease is far advanced. A better way of 
putting the question that interests the general run of people is : What should 
make one suspicious of cancer? 

Let us try to answer the question for the more important organs. 

The skin : The suspicious growths are those in which the symptoms are 
between the acute infections and the slow, harmless growths. Infection 
of the skin causes boils and bumps. These quickly become sore and give 
pain. In ten days or two weeks the soreness and pain have lessened or 
disappeared. Ordinary warts and gouty patches do not get sore, cause inflam- 
mation, or produce pain. The cancer conditions come in between. With 
them there is no soreness or pain for some weeks. Then the discomfort 
begins slowly and gradually increases. Generally speaking, small cancer 
nodules cannot be slid around with the skin as can warts and moles. 

Generally speaking moles are much more suspicious than warts. Most 
skin growths, and especially warts, need to be trimmed off occasionally. They 
pile up scales, scabs and horny masses. These are hard, irritate, and cause 
some tenderness to develop. These need attention just as the nails and hair 
need to be trimmed. 

The moles stay about the same size. If any mole gets sore or grows the 
matter should be investigated. The growth there is deeper in the tissues. A 
certain amount of attention to warts and such growths, what may be termed 
toilet of them, is proper. Moles should be left unmolested. 

If an ulcer of the skin develops slowly and persists it is a cause for sus- 
picion. It may be due to infection (tubercular, syphilitic or some other), 
but it is better to have someone pass on it. 

The location has much to do with the case. If the knot or ulcer develops 
on the lip or at some other point where there is frequent irritation it is more 
suspicious than if it develops in other areas. 



972 CANCER 



CANCER OF THE UTERUS 

I am sure there are many right-thinking people who will be sorry to 
see this subject touched upon. While they think it all right for themselves 
they think there are other readers of this volume for whom this article will 
prove too plain spoken. If we can persuade each reader to settle the question 
for herself alone we shall make some headway. 

On the other hand, a national organization composed of some of the 
ablest, most conscientious people in the country is quite convinced that, 
as a result of false modesty and a lack of plain speaking seyeral thousand 
women annually lose their lives unnecessarily. It has, therefore, appointed a 
committee charged with the duty of public education on this necessary 
subject. 

Cancer of the body of the uterus is one of the milder forms of cancer. 
When removed it is not expected to return. It is frequently found rather 
advanced at the time diagnosis is made. Nevertheless, operation is suc- 
cessful. 

Cancer of the os, as it is termed, is one of the wildest and most malig- 
nant forms of cancer. It develops rapidly and after removal comes right 
back. In 60 per cent of cases it is back in six months. This unfavorable 
outlook is because the disease is not recognized until a late stage when it 
might just as well not be recognized at all. 

A committee appointed by the Chicago Medical Society has issued a 
circular on cancer with a short statement on: (1) "How to Eecognize Cancer," 
(2) "When Cancer Can Be Cured," (3) "How Cancer Can Be Cured," (4) 
"The Nature of Cancer." 

"The chief symptoms of cancer," it says, "located anywhere, are a 
growth, pain, bleeding (when near the surface), weakness and loss of flesh. 

"The earliest sign of cancer of the uterus, and the most important one, 
is marked by some irregularity in the monthly period. 

"Cancer, in its early stages, is a local disease. It is at this time that 
it can be cured by a simple cutting operation. Cancer, if neglected and 
allowed to develop, will become an extensive disease, and then it cannot be 
cured by any method. Advanced cancer cannot be cured by surgery (the 
only real cure), hence the necessity of seeking surgical aid promptly." 



SARCOMAS 

Sarcoma is a kind of cancer. Scientists have been trying for a long 
time to divide sarcomas off from the cancers but they have never succeeded 
in making a distinction that was of practical importance. Every now and 
then a tumor run through a series of lower animals will change from one 
class to another. The main reason for trying to keep the class sarcoma to 
itself is because the sarcomas act so much more like infections than the 
carcinomas. 

Half a century ago the changes in the lungs brought about by consump- 
tion were held to be due to cancer and men wrote about them as if they 



TO WARD OFF CANCER 973 

Were cancers. Then came the discovery of the tubercle bacillus whereupon 
tuberculosis was permanently taken out of the cancers. 

Along about the same time the gumma was called a cancer. However, 
after we learned about venereal disease and mercury the gumma was taken 
out of the group of cancers. This happened a long time before the spirochete 
was discovered. 

Scientists keep looking for a germ for sarcoma and some day they will 
find one whereupon it will come out of the cancer list where it now is. 

The large, massive cancers which do not ulcerate are usually sarcomas. 
Again, it is the sarcoma of young people as contrasted with ordinary cancer, 
the cancer of older people. It is the cancer which follows a single injury as 
compared with ordinary cancer which comes from long nagging injuries such 
as the cutting of the tongue by a ragged tooth, of the lip by a pipestem, of 
the breast by a corset steel. For instance, I have just seen a boy who was 
struck on the bone of the arm and shortly thereafter a swelling commenced 
and in time it was found that the swelling was a sarcoma of the bone. 

All cancers grow rapidly (at least at times), tend to destroy the tissues 
around them, tend to come back after they are removed and tend to form 
metastases; that is, in them there is a tendency for some of the cells of 
the tumor to break away and be carried to other parts of the body and there to 
grow. In ordinary cancers these cells are carried to near-by lymph glands 
and cause these to swell. Until late in the disease the cancer sticks rather 
close by. In sarcoma the cells get into the blood and are carried everywhere. 
They are liable to locate anywhere in the body and there to stay and start 
new tumors. 

How is one to know that a given tumor is a sarcoma? 

If the growth is coming up like an inflammatory swelling but not fast 
enough for that, if it is not painful enough or hot enough or red enough for 
inflammation but still is coming one should be on his guard. If it is a pretty 
well denned tumor he had better let his physician pass on it. If the physician 
cannot form a judgment right away he is justified in watching it for a 
few weeks only. By that time, the mass growing meanwhile, he had better 
take out a piece the size of a good-sized pea and examine it microscopically. 



TO WARD OFF CANCER 

Let us say that a young man takes stock of his family strain. He 
finds that several relatives who have descended from his great-grandparents 
have had cancer. The percentage of those who died between 40 and 60 
years of age who had cancer was large — let us say twenty-five. He is of a 
cancer family. Perhaps neither of his parents had cancer. That makes no 
difference. 

The eugenists say that cancer is a recessive. Diseases of the recessive 
group such as cancer, albinism and bleeding often skip a generation. What 
shall he do? Choose a wife who does not belong to a cancer family. But 
you will say that he may protect his children and his grandchildren but not 
protect himself. What can he do to protect himself ? 

Miss Slye says: "Cancer is not transmitted as such, but rather as a 



974 CANCER 

tendency to occur from a given provocation, probably in the form of overirri- 
tation. The elimination, as far as possible, of all forms of overirritation to 
the tissues of an individual of high cancer ancestry should go far to get rid 
of the provocation of cancer, and the eugenic control of matings, so that 
cancer shall at least not be potential in both sides, ought to eventuate in a 
considerable decrease in the frequency of human cancer." 

Suppose a man has discovered that he belongs to a cancer family, is an 
"individual of high cancer ancestry." Specifically what should he do to be 
saved from his family tendency? He should give up smoking. It has been 
proved that smokers, and especially pipe smokers, are unusually subject to 
cancer of the lips and tongue. The harm results from irritation by the pipe- 
stem. 

If he is an inhabitant of the Philippines he should give up the chewing 
of betel nuts. About the only Filipinos who have cancer are the betel nut 
chewers. They have cancer of the cheek. 

He should have all ragged teeth removed or smoothed off. He should 
not wear a dental plate if it irritates. If he has any chronic sores anywhere 
on his body he should have them healed up. If his work irritates any part 
of his body he should change his occupation. For instance, in olden times 
there were a group of men who made their living by cleaning chimneys. In 
doing their work they sat straddling the top of the chimney, working their 
long-handled brooms. The position which they constantly occupied caused 
sores to come on the inside of the thighs. Most chimney sweeps died of chim- 
ney sweeps' cancer, cancer of the inside of the thighs. 

A man with a cancer ancestry should not neglect any chronic stomach 
trouble which he may develop. Cancer of the stomach often grows out of un- 
heeded dyspepsias and neglected ulcers of the stomach. 

If a woman has the bad family history she must be extra careful with her 
breast glands. Corset steels must not be allowed to irritate nor must the 
clothing be irritating in any way whatsoever. The breasts at nursing and 
pregnancy periods must not be neglected. It is almost as important that 
there shall not be neglect of the generative organs. In the first place, venereal 
diseases must be avoided or having been contracted must be completely 
cured. Pelvic suppurations and discharges must not be allowed to continue 
indefinitely. 

Eisks that a person of another family strain can safely take the person of 
a cancer strain cannot. The latter must avoid all forms of chronic irritation. 



CAN ANYTHING BE DONE TO CURE CANCER? 

Not very much. If the disease is discovered early and operation is done 
promptly the chance of cure is fairly good. If the disease is advanced, opera- 
tion, radium, and X-rays are of limited value. The only cancers cured by 
pastes are not cancers at all. Somebody has been mistaken, honestly or other- 
wise. 

Can anything be done to prevent cancer? Yes. Cancer is to be classed 
as a preventable disease. As soon as the information can soak into the general 
public's mind, that fact is most important. 



CAN ANYTHING BE DONE TO CURE CANCER? 975 

There are three phases to the cancer prevention question. In a certain 
sense cancer is an inheritable disease. Inheritance can be prevented. 

Cancer results from long continued irritation of the tissues of a locality. 
This irritation can be prevented. Cancer develops most readily and grows most 
readily in overnourished people. Over nourishment can be controlled. There- 
fore, the statement that cancer can be prevented. 

Now for the details of the first of these proposals. The statistical proof 
that cancer runs in families has been known for a long time. Of the people 
who die at the cancer age about one in ten dies of cancer. If, in a given 
family, the death rate from cancer among those dying at the cancer age is 
one in five or higher, we say that they belong to a cancer family. There are 
families in which the cancer rate among the people concerned is much more 
than one in five. 

For several years Miss Slye of the University of Chicago has been pa- 
tiently working out the proof that cancer runs in families. She has made 
thousands of observations. Mice have cancer. As mice multiply abundantly, 
breed when very young, and, in their breeding, can be completely controlled, 
she chose to study the family histories of mice rather than that of men. 

She had one family of cancer mice under observation for twenty-five 
generations. As the result of these thousands of completely controlled ex- 
periments she is able to state certain conclusions with great positiveness. 
She says : 

"Cancer follows the laws of heredity with an inevitableness which makes 
it a character which can be manipulated." 

The inheritance law of cancer is exactly the same as that of albinism. 
There need be no albinos. The condition can be absolutely prevented. 

Continuing, she says : "Cancer can be bred into or out of a strain at will. 
It can be put into a strain where it has never existed before. It can be 
bred out of a line one side of which originally carried 100 per cent of 
cancer." 

She knows these statements to be true, because she took a strain of mice 
in which cancer had been inbred for twenty-five generations and in which 
all the members suffered from it, and she bred it out until the line was free 
from it. She took another strain in which there was no cancer, and by mating 
them with cancer strains bred cancer into the stock. 



RADIUM, X-RAYS, AND ULTRA-VIOLET RAYS 

There is reason to believe that X-rays, radium, and radio-active sub- 
stances and ultra-violet rays can cure certain cases and certain kinds of 
cancer. There is reason to believe that they cannot cure or even benefit other 
cases or other kinds of cancer. The difficulty is for a man to decide which 
group his cancer is in. If he decides rightly, he will have a good chance to live. 
If he decides wrongly he will throw away his chances of living. 

Cancer cells are young, actively growing cells. The chemists tell us they 
are rich in glycogen. Glycogen is the form in which sugar is put when it is to 
be used by the cells. As young, growing, dividing cells need a great deal 
of glycogen and older, resting cells need but little, analyses of cancers show 
a great abundance of glycogen. 



976 CANCER 

When tissue is exposed to X-rays, radium, or the other agents, the cells 
rich in glycogen are destroyed much more rapidly than the other cells, pro- 
vided the curative agent can get at the tumor cells. This proviso is the 
key to the limitation of these agents. 

The skin is for the purpose of keeping things out. That is what it was 
built for. It will keep out sun rays, X-rays, ultra-violet rays, and radio- 
active substances. 

If the cancer is on the surface and not covered by skin these agents 
are of service. If their rays must penetrate to reach the cancer, or any con- 
siderable part of it, or any secondary growth of it, they do no good. 

They can cure cancer of the skin. Possibly they can cure cancer of 
the neck of the womb. And that is about all. 

They cannot cure cancers of these tissues if the cancer has jumped 
(formed metastases, the doctors say) in the lymph glands. 

Some of the cancers in these localities can be better cured, cured with 
less pain and more certainly cured by operation than by any one of the different 
forms of radiation. Just which cases are best suited for radiation and which 
for operation call for good judgment founded on knowledge and experience. 

Internal cancers are not cured by these agents. There is no reason for 
thinking they can cure or even help cancer of the stomach, liver, or intestines. 
There is no reason for thinking they can cure cancer of the breast. Cancer 
in this locality does not break through the skin until the disease is far 
advanced. At such time it is certain to be in the muscles and also in the 
glands. Even if the cells under the ulcerated area were killed those tucked 
away in the muscles and glands would continue the growth. 

They are of no service in cancer of the kidneys, peritoneum, bladder, or 
female generative organs above the neck of the womb. They are of no 
service in bone or muscle cancers. 

They are of service in cancer of the lip. This mild form of cancer is cured 
by almost any "cancer cure." 

They may be able to cure cancer of the tongue, and yet it is doubtful if 
they should be tried on cancer in this location. Cancer of the tongue spreads 
to the glands so promptly that one is not justified in trying time-consuming 
experiments on himself. 

Probably Not Cancer. — M. A. W. writes: "I have a cancerous growth 
on my face as large as a 25-cent piece. 1. What can I put on it to prevent 
it from increasing in size? 2. Is tea made from red clover blossoms injurious 
if taken frequently and in large quantities? I find it some help in retard- 
ing the growth on my face, not so much as is claimed for it, but there is 
more discharge and more rapid growth if I do not drink it" 

Reply. — 1. Nothing. The chance is good that the growth is not a 
cancer. Most so-called face cancers are not cancers. If it is a cancer, 
either keep it clean and do nothing or have it completely removed. 

2. No. 

Needless Cutting Deplored. — A. V. V. writes: "Noting your answer to 
' Adelaide/ regarding a lump in her breast, your advice being that she 'had 
better have a doctor see it and decide whether it is cancer,' I beg to know 
whether you hold that a superficial examination, even by the most ex- 



CANCER 977 

perienced physician, could absolutely determine whether a lump in a 
woman's breast was cancer? It has long been my understanding that 
not until such lump has been removed by the surgeons knife and a 
microscopical examination thereof made can its nature be determined; 
therefore, it would seem best that any lump in a woman's breast should 
immediately be removed, and no chances taken that it may not prove 
to be of cancerous growth." 

Reply. — To remove every nodule in the breast as soon as it is noted, 
making the diagnosis after removal, would lessen the number of deaths 
from cancer if the women would come for examination. It also would 
sacrifice many breasts needlessly. If surgeons were to adopt that policy 
they would save themselves some mistakes but on the other hand, the 
women, knowing this to be the policy of surgeons, would be liable to 
keep away until they were pretty certain that the nodules were cancers. 
This would substitute the woman's opinion in place of the surgeon's. 
The character of the growth, the feel of it, the rate of growth, the loca- 
tion, the presence of pain, the age of the patient — judging by these a 
fairly reliable opinion can be formed. On the other hand, part removal 
stirs cancers to active growth. Cancers should either be removed wholly 
and with a good deal of surrounding tissue or they should not be cut 
at all. 

Cancer of Stomach. — Mrs. 0. M. R. writes: "What are the symptoms 
of cancer of the stomach? Is there any cure?" 

Reply. — What you want to know is what symptoms would make you 
suspect cancer of the stomach and cause you to investigate further. Of 
first importance is your age. The age of maximum liability is 45 to 60. 
In Welch's series of 2,038 cases 24.5 per cent were between 40 and 50, 
and 30.4 per cent between 50 and 60. 

Next is family history. Do you belong to a cancer family? 

Next is a history of ulcer of the stomach. In Rodman's series of cases, 
14 per cent had had ulcer; in Klausa's series, 26 per cent. 

Next is a history of dyspepsia. A prominent sign is a progressive 
decline of appetite. There may be a sense of oppression in the pit of the 
stomach after eating. There may be a little pain and occasionally there 
is vomiting. If there is vomiting there may be a little blood in the vomit. 
The skin begins to show pallor early. The weight begins to drop early. 
The strength and endurance fail inexplicably. 

Anyone inquiring into his condition and history who can reasonably 
decide that these details apply in his case should have an examination. 
When tumor or vomiting or great wasting appears it is too late. The 
examiner will make an analysis of the stomach contents for acid, will 
examine the feces for blood, will make an Abderhalden test and will take 
an X-ray in addition to making a physical examination. 

See Your Physician. — B. S. writes: "I am a widow 28 years old. My 
left breast has little pains in it, and they seem to be moving all around it. 
I can't say they are sharp pains, but I feel somewhat uneasy about it, 
as I think there is something wrong, or these pains would not bother me 
at all. Do you think it could be a cancer coming? Sometimes when I 
raise my breast up it pains me to do so. About two years ago I went 
walnut hunting. Two walnuts, both on the same stem, fell on this left 
breast. It turned black in a few minutes and pained me badly at the time. 



978 CANCER 

There does not seem to he any swelling at all, no sores of any kind, and 
it looks all right. I had a nervous shock from my husband's death, and 
have been nervous since. My hands and head shake, and my nerves are 
sensitive. I have doctored for this trouble, but medicine relieved me only 
for a while. I can hardly sleep, my body jumps so, and the least thing 
scares me. This has been going on for nearly three years. During one 
bad spell I had my heart beat so rapidly in turning over in bed that I had 
to take heart medicine every fifteen minutes. Is there any cure for my 
trouble?" 

Reply. — 1. Probably you are free from cancer. Have a physician 
examine your breast. If there is no nodule pay no attention to the little 
pains. 

2. You should not take heart medicine every fifteen minutes unless 
you are being watched by your physician. Have your physician examine 
you. If you have no thyroid enlargement and no other organic trouble 
then proceed to get your nerves under control. This is not a medicine- 
taking proposition. Perhaps you will succeed best by going to a rest cure. 
Perhaps you can succeed by study of some book such as Courtney's 
"Control of Nerves." 

Senseless Worry. — Mrs. A. W. writes: "I am 56 years old and am 
extremely nervous. I recently saw an article which you wrote about cancer. 
I had a sore breast when my first child was born, twenty-eight years ago. 
I fear blood poisoning started to set in. I always feel a queer sensation 
in that breast. My doctor assures me it is the nerves. There are no 
lumps, but I am always worried, fearing I might get a cancer, as you say 
cancer can come from ulcers" 

Reply. — As you say you have no lump in your breast you have no more 
cause for worry than any other woman. Because occasionally a woman is 
run over by a street car is that any reason why every woman should be 
afraid to cross the street or to worry about the dangers of street cars? 
Be level-headed, do your work, take proper care of yourself and let the 
future alone. 

Cancer Cause Not Known. — H. J. asks the following: 

"1. What is the cause of cancer? 

"2. Can you in any case attribute the origin of a cancer to a previous 
injury ? 

"$. If you assign various causes of cancer for the different parts of the 
body, then please state what is the cause of a lady having cancer of the 
breast" 

Reply. — 1. Causes are divided into main and contributing. The main 
cause of cancer is not known. There are two principal theories : (a) It 
is due to some organism — a bacillus, spirillum, yeast mold or some other 
low form of life, (b) It is due to perverted cell tendencies — the ordinary 
cells of the body get away from where they belong and lose all tendency to 
mature but instead multiply wildly. The food theories have not many 
followers. There are not many facts to support either of these theories. 

2. Yes, injury is a contributing cause. 

3. Among the contributing causes of cancer of the breast are injuries 
from blows, from corset irritation and from abscess. 



CANCEB 979 

Cancer. — Mrs. B. R. writes : "In what length of time would an internal 
cancer develop?" 

Reply. — The question in this form cannot be answered. If you mean 
how soon after an ulcer shows itself will a cancer develop the question 
is nearly as difficult. The theory is that cancer develops from epithelial 
cells that have got out of their proper place. Sometimes cancer develops in 
a few weeks after such displacement. On the other hand, there is some 
proof that cells destined to develop into cancer can lie dormant for a long 
time. 

Stomach Cancer Symptoms. — M. L. S. writes: "Will you kindly advise 
me what the symptoms of cancer in the stomach are?" 

Reply. — Cancer of the stomach causes pain, vomiting and rapid loss of 
flesh. Examination of the stomach secretions shows blood present and acid 
absent. Sometimes the tumor can be felt. The blood may be black or red. 
There are chemical, bacteriological and X-ray bismuth tests that help. 

Unfortunately there is no way of diagnosing cancer of the stomach 
that helps much. When the diagnosis can be made it is too late to operate. 

Anyone of cancer age who has a persisting stomach pain and vomiting 
had better go promptly to a physician and have the diagnosis of cancer 
ruled out or confirmed. 

Cancer Not Inherited. — G. B. S. writes: "1. Is cancer ever inherited? 
2. Is there any danger of contracting the disease by kissing a person suffer- 
ing from an open cancer of the breast? 3. Is cancer communicable through 
the discharge from an open cancer sore?" 

Reply. — 1. No. However, there are families in which the middle- 
aged members are more subject to cancer than the average. 

2. No. 

3. It is barely possible. The danger is slight. 

No Good for Cancer. — S. writes: "Dr. Trebes Ross of London advo- 
cates salts of potash as a help, and perhaps cure, for cancer. What is your 
opinion? Can any harm come from taking it?" 

Reply. — 1. Will do no good. 

2. Not much. Potash salts are slightly poisonous but not highly so. 

X-Ray and Cancer. — D. A. B. writes :"1. What success has the medical 
profession had in treating cancer with the X-ray? 2. Is it not a fact that 
the X-ray causes cancer and is positively dangerous for such uses? 3. 
Would the X-ray have any curative effect on stomach troubles, such as in- 
flammation, gastritis, ulceration, or on a kinked bowel due to muscle dis- 
placement or pressure? If. How are physicians who make such claims and 
secure patients by reason of such, looked upon in the medical profession?" 

Reply. — 1. Very good success with skin cancer; poor success with can- 
cers situated deep in the body. 

2. Yes, X-ray causes cancer. If by the last half of the sentence you 
mean dangerous when used to cure cancer, the answer is no. The worst 
that can be said is that in cancers unsuited for its use some people have 
used it instead of having the growth removed. 

3. No. 



986 CANCER 

4. No reputable physician would claim to cure gastritis, ulceration of 
. the stomach, or kink of the bowel with X-ray. 

Fish and Cancer. — Mrs. M. P. writes: "1. Do you consider a fish diet to 
be a cause, or contributing cause, of cancer? 2. Are fish known to be sub- 
ject to any vicious growths that make them, when so affected, unfit for 
food? 3. If so, can their condition be detected in fresh caught fish?" 

Reply. — 1. No. In speculations as to the cause of cancer fish, toma- 
toes, meat and various other foods have been accused. There is no reason 
to think food a factor of consequence in cancer. 

2. Fish have cancer. Periodically, all kinds of animals have cancer. 

3. Buy none but healthy looking: fish. Buy no fish with a tumor. 
Cancer in a fish shows plainly. Nobody cares to eat a fish with cancer 
even though the chance of so contracting the disease is negligible. 

Need of Cancer Knowledge. — No Name writes: "For pity sake, do let 
up talking about cancers. You are making people morbid on the subject 
and we all are getting sick and tired hearing about cancer." 

Reply. — For years the advertising cancer fakers such as Chamlee and 
Byers have devoted a few hundred words every day in hundreds of news- 
papers to misinforming and misleading the public. Do you not think it 
fair to devote some space to telling the truth? Or let us look at it from 
another standpoint. Out of every 100,000 people in the United States 
seventy-five die each year from cancer. Cancer causes one-twentieth of 
all the deaths. The people who have the disease now in an incurable 
stage once had it in a curable stage. They let it pass beyond that stage 
because they did not know. About 100,000 such die in the United States 
each year. Do you not think you are selfish to wish information with- 
held from these merely because it disturbs your peace of mind? Do you 
not think that you and your group ought to be more patient, consid- 
erate ; and especially more Christian ? The very great majority of you are 
sane enough not to be harmed. A small minority are so ill balanced as to 
be harmed. Should we not try to do the greatest good to the greatest 
number? Be fairer with your unfortunate fellows. 

Cancer of the Bladder. — J. L. writes: "Why is it my urine has such a 
fetid odor? Could it be cancer of the bladder?" 

Reply. — Cancer sometimes affects the bladder. There is no cancer 
odor. Cancers become infected with the germs of putrefaction. The odor 
of a cancer depends upon which one of these happens to get into it. 
Therefore some cancers are odorless and others have odors of different 
kinds. Fetid odor in the urine probably is dependent upon the bacteria 
present. Tour physician may be able to remedy the condition with anti- 
septics which are eliminated by the kidneys. Odors sometimes result from 
certain aromatics in the food — for example, asparagus. 

Should Not Cause Cancer. — J. 8. T. writes: "I have remarked that 
without any other noticeable cause cancer occasionally follows closely 
after a severe case of poisoning by poison ivy. Poison ivy grows in such 
great abundance that it would seem as if it must have some use other than 
just to inflict punishment on hapless children, who so often fall victims 
to its evil effects. Has any experiment ever been made to test whether 
poison ivy would cure cancer?" 



LAXCEE 981 

Eeply. — I have been unable to find that poison ivy has been used to 
cure cancer. I do not think it would hare any effect. Cancer frequently 
follows long continued inflammation and irritation. These influences are 
factors in causing it. An acute inflammation such as that caused by iTy 
should not be a factor. 

Wait Three Weeks. — German writes: "I am a married woman, 25 
years old. For the last week I have noticed a tender spot on my left breast. 
There is no mark or bruise there, and I don't remember ever having hurt 
it. But it feels sore when touched, and there seems to be no swelling. 
1. Do you think this may be a cancer? 2. Should I go to a doctor at once, 
or wait a while to see if it goes away? 3. Will you please describe symp- 
toms of cancer of the breast? I have a good appetite and I am in good 
health otherwise. If. Will the taking of a preventive medicine finally 
weaken the female organs or cause a tumor later on?" 

Reply. — 1. Yes, cancers cause pain when small — small enough to be 
overlooked. The chances are that you have not cancer. 

2. I judge the pain is but slight. You are justified in waiting three 
weeks more. 

3. Any tumor of the breast should be examined and then reexamined 
at intervals if it is not operated on at once. Generally cancers grow more 
rapidly than other tumors. Pain, especially a sharp, shooting pain, is sug- 
gestive. Kernels come under the arms, the nipple retracts and sores form 
but these are late symptoms. The breast should never be left long enough 
for these three symptoms to develop. 

4. Xo. 

See a Surgeon at Once. — Mrs. M. 0. writes: "About a year ago I 
noticed a small lump in my left breast. Since then it has grown till it is 
now the size of a small lemon. It gives me a burning sensation and itches 
at times. I am 39 years old, but never had any breast trouble, and none 
of my people is afflicted with breast trouble. Do you think it is cancer 
and what do you advise?" 

Eeply. — See a surgeon at once. There is no cure for breast cancer or 
a tumor of the breast the size of a lemon (not a cancer) except operation. 
As this growth is so large and has pained so little it may not be cancer. 
If not, the lump should come out. If it is cancer the operation required 
is even more radical. 

Might Be Cancer. — T. J. writes: "What would a small lump in one 
breast mean, about the size of a common walnut? Xo pain or soreness in 
a woman of Jfif" 

Eeply. — It might mean fibroma or cancer or retention cyst. Of these 
fibroma is the most frequent and cancer the most important. The ab- 
sence of pain does not rule out cancer. Have an examination. 

Pork Doesn't Cause Cancer. — Mrs. J. B. writes: "Will you please an- 
swer in your column if there is any truth in the statement that cancer 
comes from eating pork?" 

Eeply. — Xo. 



CHAPTER LII 

Tumors 

What is a tumor? This has always been a difficult question. Every- 
body knows the ordinary superficial appearance of a tumor — knows one when 
he sees it — but when he is asked what is a tumor he would probably have to 
answer, Why, a tumor is — a tumor. 

What is the essential difference between the growths called tumors and 
growths and swellings that go by other names? In answering this question 
two principles stick out: the one that the mass of growing tissue feeds on 
the body but does no part of the body work; the other that the growing mass 
seems to have no limit placed on its growth. 

Let us think about the first of these principles. The body is a com- 
monwealth. Every tissue in that community has its work to do and the 
amount of food distributed to it is automatically determined by the amount 
of its work. The blood vessels come to have a size and arrangement that make 
it possible to carry the amount of food required; but as the amount of work 
varies, and therefore the amount of food must vary, the blood vessels are 
provided with muscles and nerves whose work it is momentarily to regulate, 
increase, or decrease the amount of blood going to the organ. 

These things are worked out with scientific exactness and on the most 
approved basis of community life. It will be centuries before social common- 
wealths come to have the scientific adjustment that has always prevailed in the 
commonwealth called the human body. 

In society we develop groups of parasites called paupers or criminals. 
In the human body we develop similar groups of parasites feeding on the 
body and doing no part of the body work and we call them tumors. 

Some of these parasites are harmless fellows in a certain sense. They 
are drones in the hive. They eat but they do no work. At most they get 
in the way. In these passive ways they may indirectly do great harm and 
they may even terminate life. For instance, a fibroid tumor — and there are 
none more harmless — may grow in the windpipe and cause suffocation; or it' 
may grow in the uterus and cause a woman to bleed to death. 

Pursuing the parallel, a harmless parasitic tramp may innocently, if you 
please, become infected with smallpox and spread it over a good part of a 
state. Such an unusual occurrence has no bearing on the main point. 

In the body politic tramps, hoboes and paupers, such by inheritance or 
whose status is fixed and unchangeable, are not expected to do much harm. 
They are parasites but until community life has been developed much beyond 
its present point society must make provision for the care of such 
burdens. 

Along this line it is possible to distinguish between benign and malignant 
tumors. The pauper is content to be carried by society but toward it he 

982 



TUMORS 983 

b-ars no ill will. He draws upon the thrift of others in so far as his needs 
demand but he has no quarrel with the thrift of any man. 

The criminal takes a different view of the rights of property, life, and 
v.berty. He is supported by the thriftier members of society — yes. He 
contributes nothing to society. He is free to do what he wants. This freedom 
grows out of the fact that the average man, in fact the great majority of men 
respect the rights of others. This feeling results in all law and custom 
being based on the idea that men want to be fair with their fellows. Liberty, 
therefore, becomes wise and proper. 

The criminal in the exercise of his liberty is a parasite upon the general 
liberty guaranteed by the law. So far he is at one with the fixed pauper. 
Where he becomes different is in that he is an active enemy of society whereas 
the pauper is a passive enemy. He is not only a parasite on thrift but he is 
an enemy of thrift. 

A fibroid tumor is content to draw its sustenance from the body and con- 
tribute nothing — and there the matter ends. A cancerous tumor is a parasite, 
contributing nothing to the work of the body and in addition pouring into 
the tissues substances which are harmful. Like the criminal and unlike 
the tramp it is anti-social and would destroy that on which it has been 
sponging. 

The second principle is that tumors seem to have no limit placed On their 
growth. The tendency to automatic limitation of growth by the ordinary 
tissues is one of the wonders that are as non-understandable as electricity. 
We know what electricity will do, what laws it conforms to; but no man 
knows what electricity is. 

We know that a certain cell in the human embryo will start out to make 
an arm, that it will multiply and its successors will develop until a certain 
size and contour is attained and there growth will stop. We say there is an 
inherited growth impulse which carries the arm about so far and its length 
having been reached the impulse automatically ceases. While this states the 
scientific fact it explains nothing. It leaves us no nearer an explanation than 
when we began. 

In normal tissues the impulse to grow is in relation to all the other tissues. 
The two arms grow to the same length and stop, the two sides of the face 
develop evenly — everything fits in about right. In tumors the tissues destined 
to form the tumor pitch in and grow and continue growing without any 
relation to anything except the amount of food they can get. At times even 
a portion of a tumor will break down because the cells needing food have 
grown faster than the blood vessels supplying food. Outside of the food 
feature there is no automatic limitation on the growth of tumor tissue. 

Society has not clone much in the cure of its pauper and crime diseases. 
When we suspect a man to be an active or passive enemy of society we first 
diagnose his case and we then cut him out of society by placing him in a 
poorhouse, an insane asylum, a home, or a prison, depending upon what seems 
to be the best method for society to protect itself against that particular 
enemy. That is about as far as the science of community life has been de- 
veloped. 

When a man develops a tumor we first make a diagnosis, then we arrive 
at a decision as to whether the growth can be safely left alone or whether 



984 TUMOKS 

it shall be cut out. Assuming it is decided that the growth is a menace the 
only treatment developed so far is to cut it out. 

The foundation is being laid for a scientific study of criminality in its 
eugenics and environment relations. The cutting out way costs a lot of 
money for maintenance as well as a lot of strength by reason of its inefficiency. 

Tumors are being scientifically studied with a view of finding something 
better than the cutting out method. These studies are taking three general 
directions. Some of them are trying to find the cause of the malignant tumors 
with a view to going after the problem along the line of prevention. Some 
are trying to find methods of detecting malignancy in its early stages; and 
some are trying to find a specific cure. 

The group engaged in the first type of investigation at the present time 
is working upon the basis of a modified infectiousness. Many characteristics 
of cancers indicate that they are infectious though nothing indicates that they 
are infectious in the same sense that smallpox is. This group has succeeded 
in inoculating several types of animals with cancers. They have been able 
to pass these cancers through animals, cure it in some and then use a serum 
from cured animals with which to cure other animals. 

The group which is trying to find a cure is working to find some form 
of a biological product, maybe an antitoxin, maybe a serum, maybe some other 
type of chemical substance, that will be destructive to cancer cells and harm- 
less to other cells — some substance which will go into the body and pick out 
the cell for which it has an affinity and destroy it just as quinin will go into 
the blood and pick out the malarial organism and destroy it leaving all 
other cells pretty much as it found them. 

The other group is trying to find some chemical or biological test of the 
blood or of the secretion from a cancer area that will serve to diagnose cancer 
earlier and more certainly than the microscope now does. 

The old way of judging a cancer by its odor was of no service at all, for 
the sign was no good until the case was hopeless. The old way of judging 
by the history and the appearance was somewhat better, but very little. The 
microscopic method is a great improvement. Nevertheless it is to be hoped 
the research workers may be able to discover some serum test which will be 
even earlier and more certain. 

The great New York Congress of Surgeons went on record in favor 
of operation for cancer on the basis of microscopic examination, provided the 
diagnosis is made early. So far as late cases are concerned every surgeon 
in the land would be happy if he were never called upon to operate on 
them. They advise against operation in such cases, hold out no hope for ul- 
timate favorable results and are generally persuaded to perform such opera- 
tions against their judgment. 

If somehow the public could he educated to have tumors inquired into 
when they first appear, cancers would come to operation in their curable stages, 
for cancer is like consumption — curable in its early stages but incurable or 
nearly so in the later ones. The cancers that appear on the parts of the body 
that are under observation or are easily made so are often cured now. 

The significance of a cough that holds on, of a little fever in the after- 
noon, of a little fatigue and tire has been learned by a million people within 
the last ten years and in consequence consumption is being diagnosed in its 



TUMOES 985 

curable stages. A part of the work of the committee appointed at New York 
will be to teach the public the meaning of early signs of cancer. Another 
part of its work will be to keep alive public interest in this subject until a 
way will be found to escape the present perplexities of the cancer problem. 

Statistics show that the number of deaths from cancer is rising. I have 
not analyzed the figures closely enough to form an opinion as to whether 
the increase in cancer mortality is wholly due to the increasing age at death 
or not. It may be that like Bright's disease the rate of increase is dispro- 
portionately greater than the increase in the number who live to reach the 
cancer age. 

Davenport in his chapter on the "Inheritance of Family Traits" — sub- 
division "Cancer and Tumor" — says: 

"The question is are there human strains that are easily and others with 
difficulty inoculable ? The whole question is complicated, as cancer is a disease 
of middle or later life. Thus, in the census of 1900, we find that the heavy 
incidence of cancer occurs between 40 and 80 years (84.4 per cent). The 
very high death rates are from 50 to 70 years. 

"The answer to the question of heredity of cancer is to be found in a 
careful analysis and comparison of individual families. One then sees in 
many families no deaths from cancer among ten to twenty persons dying 
at cancer age, while in other families there will be even four deaths from 
cancer amongst those dying at cancer age. Such questions as these are 
suggestive of the many and varied points of the cancer problem." 

See Your Physician. — C. A. B. writes: "Is pain in a breast tumor 
always to be regarded with suspicion? I am Sk and for the last three 
years have had a lump in my breast. The lump appeared first shortly after 
I had weaned my baby, and at that time I was often conscious of a sharp, 
stinging pain, frequent but not severe. My physician examined the breast 
and said if the lump increased in size he would remove it. For a year or 
more it remained apparently the same, hurting only at intervals. Then 
it practically disappeared, although I could always feel a slight enlarge- 
ment, as of a swollen gland. It gave me no further trouble until about 
a month ago, when it suddenly swelled to the size of a walnut and be- 
came quite hard. The pain returned and for several nights hurt enough 
to disturb my rest. I tried both hot and cold applications, and both re- 
lieved the pain. Then the swelling gradually receded until now it is almost 
imperceptible and I feel no pain whatever." 

Reply. — A cancer would scarcely change so in size. Nevertheless do 
not take any correspondence opinion on a point of so much importance. 
See your physician. 

Lump in the Breast. — Mrs. C. T. B. writes: "I have had a small lump 
in one breast for ten years. I noticed recently that this breast is larger 
than the other. There is no soreness. A physician told me when I first 
discovered it not to bother it unless it developed into something later. 
What would you advise? I am in good health and 31 years old" 

Reply. — A lump in the breast for ten years is probably not a cancer. 
Even fibrous tumors in the breast are not safe, and you should seriously 
consider having the growth removed. If you decide not, then have it 
watched by a physician, to whom you should go four times a year. 



986 TUMOKS 

Tumor. — C. E. B. writes: "Can a small tumor in the cul-de-sac he 
removed by absorption, or is an operation necessary? How does it affect 
the system?" 

Keply. — Everything depends on what the nature of the tumor is. If 
it resulted from an infection and the infection has now subsided, most of 
the tenderness is gone. The mass may, and probably will, be absorbed. If 
it is a growth or is an enlarged, tender, displaced ovary the "tumor" will 
not disappear by absorption. If the trouble caused or the nature of the 
growth is such as to call for removal an operation will be necessary. 

Each Case Different. — J. E. writes: "1. How long would you advise the 
postponement of the removal of a fibroid, lemon-sized tumor, exterior but 
attached to the uterus? 2. What disagreeable symptoms should one expect? 
3. How much inconvenience and disturbance should one endure before sub- 
mitting to the expense, inconvenience, and possibilities of an operation? 
^. If not removed at the age of J/O, what later possibilities does it offer?" 

Reply. — 1. This question cannot be answered in a general way. It must 
be answered for each case. The answer depends on the rate of growth, the 
pain, and invalidism caused by it. A fibroid in that location in one 40 
years of age is not necessarily a serious matter. It does not necessarily 
call for an operation. 

2. Most of its symptoms will result from crowding the bladder and other 
pelvic structures. A fibroid in that locality seldom causes hemorrhage or 
gets infected. However, when there is one fibroid there is generally more 
than one. 

3. Until it threatens to cause invalidism or semi-invalidism, unless it 
is growing rapidly, when operation should be done earlier. 

4. Of greatest moment is the progressive increase in size after the 
change of life. 

Let Doctor Decide. — Adelaide writes: "I have had a lump in one breast 
for eight or ten years. I think it grows a little. What caused it and what 
would you advise me to do? Is there any application that will help remove 
it?" 

Reply. — In all probability it is a harmless tumor. If so, let it alone. 
Put nothing on it. Do not rub anything on it. However, you had better 
have a doctor see it and decide whether it is cancer. If cancer it should be 
thoroughly removed. If it is not cancer let it alone. 

Medicine No Cure. — Mrs. F. R. writes: "1. What is a cystic tumor and 
where is it usually located? 2. What are the symptoms? 3. Can medicine 
remove it?" 

Reply. — 1. A cystic tumor may be located anywhere in the body. With 
one exception cysts consist of a bladderlike wall and a cavity filled with 
fluid. 

2. The symptoms depend on the location. 

3, No. 



CHAPTER LIII 

Crile's Method of Anesthesia 

The nerves are the sentinels of the system by which the body is warned 
of enemies without. At the outside is the nerve ending which senses the foe 
and telegraphs the news. In the brain are the cells which receive the tele- 
gram, decide what to do about it and then telegraph the orders to the 
proper place. 

There are certain parts of the body that have always been in danger 
zones. The nerve cells and fibers that have to do with those zones have learned 
by experience to be on the lookout; they are apprehensive and "keened" by 
fear. 

There are other localities that are so well protected that they have never 
trained their nerves to be on the lookout. 

The organs of the first group cannot be operated upon without danger 
of shock ; those of the second are not easily shocked, according to Crile. 

The brain, the lungs, the stomach and intestines, the deep structures of 
the back belong in the second group. Practically all the balance belongs in the 
first. 

When a patient is anesthetized in the ordinary way, every cut of the 
knife sends an impulse to the brain cells. The patient is unconscious and 
in consequence does not suffer mental shock — the horror of being opened up. 
His sensations are paralyzed and in consequence he neither feels pain nor is 
he able to fight back. 

The nerve cells at the center are being shocked, although the patient is 
asleep, feels no pain and is non-resistant. 

Crile says : "We must therefore conclude that, although ether anesthesia 
produces unconsciousness, it is in reality only a veneer, as it protects none 
of the brain cells against exhaustion from the trauma of surgical operations." 

The new method is the natural next step. It uses inhalation anesthesia, 
and it adds to it some procedures to cut off the sources of shock not cut off 
by inhalation anesthesia. 

First, the patient is given morphin before the operation. A person 
under morphin is neither chesty, as after whisky, nor depressed; he simply 
does not care one way or the other. Then comes the ether, chloroform or 
laughing gas, whichever the surgeon prefers. 

The operation is not begun until the field of operation is anesthetized 
with a local anesthetic. The idea is to cut the telegraph wires in the field 
of operation so that the messages cannot travel to the center. 

The pain in and near the wound is fearful for two or three days after the 
operation. To prevent the shock from this pain Crile injects some quinin 
into the tissues near the wound. This anesthetic does not wear off for 
half a week. 

987 



988 CHILE'S METHOD OF ANESTHESIA 

The Crile method then consists in: (a) A dose of morphin an honr 
or more before the operation to prevent the mental shock of fear and dread ; 
(b) ether, chloroform or laughing gas to prevent the mental shock and pain 
of the operation and to make the surgeon feel that he may take the time to 
do things as they should be done; (c) local anesthesia along the wound to 
protect the central nerves from operation shock; (d) quinin along the wound 
to save the nerves from the aftershock. 



CHAPTEE LIV 

Eugenics 

FOR RACE BETTERMENT 

Many years before Galton 7 s time eugenics had been trying to be born. 
Facts were being accumulated: theories were being tried out: the harm of 
bad inheritance and the advantage of good stocks were being referred to: 
society was- sensing both the need and the method. 

Galton. with good judgment and poise, gathered together a lot of this 
material, related the different parts to one another and made a community of 
what was just before a lot of separate individuals. 

Ey® Elf© 

<&\h<b ®S © G!Df<$> is ®(5 & ® 5 (& 



dTiicD® 



Fig. 402. — Pedigree of a family in which the father's parents (upper left) are both nervous (N) 
and have four nervous children. The mother is nervous; so were her father and four of her 
brothers and sisters, while one is insane. Of the three grandchildren one is insane (I), one 
epileptic (E), and one extremely nervous (N). (Cannon and Rosanoff.) 

Factories have what are called assembling rooms to which are brought 
wheels and springs and bodies from all parts of the factory and in which 
these parts are put together to make the product. Galton assembled these 
wheels, springs and bodies with discretion. 

In this sense he deserves the title of the "Father of Eugenics." 

As the average run of people know but little about the assembling of 
facts and as they do know a good deal about the assembling of machines it 
seemed advisable to shift our metaphor from facts to machines. Xow it is 
advantageous to shift it back again. 

The custom is to name beings that are made. Galton got the science 
ahead by naming it eugenics — meaning the science of beginning well. 

Most of the investigation as well as most of the legislation up to the 
present time has been devoted to those who have not begun well. Many 
of them (it is certain in the light of what we know) had no chance of begin- 
ning well. Therefore there are those who say that the science is not well 
named. This does not follow. The health department works nearly all of its 
time on ill-health; it spends its energies in studying disease; yet nobody 
proposes to call it an ill-health department. 



990 



EUGENICS 



1§ 






®rGD n 

[£]<n)[b] Ob (S) |b| (n) *v|b] § |b] 

Fig. 403. — Pedigree of Family with Color- 
blindness (B). ("Heredity and Eugenics.") 



Some day it will be possible to develop the work of increasing efficiency 

and well-being in a positive way until it is of equal importance with the 

work done now against unhealthy conditions. Health properly comprehends 

r— i both points of view, both lines of 

©j[b] (n] activity. Health departments are 

not improperly named. 

I now speak of positive 
eugenics, meaning thereby every- 
thing which can be done in any 
proper way to encourage proper 
mating and the birth of children 
who begin well. By negative eu- 
genics we mean everything which 
can be done in any proper way to 
prevent improper mating and the birth of children . 

who do not begin well. GDtO 

We are hearing more just now about negative cn/p/e 

eugenics. That side lends itself most readily to 
scientific and statistical study. By reason of the 
preponderance of literature and legislation on the 
side of negative eugenics it has been proposed to 
rename the science and call it dysgenics. 

It was Galton's science and his right to name it 
should not be disputed. Besides, by the time you 
would get the new name accepted positive eugenics 
would be well developed and the onesidedness of the Fig 
name now complained of would again prevail, the 
shoe being on the other foot. The science is well 
named. Let it alone. 

Dr. Goddard has recently issued a most interesting eugenics study of 
rr— i , a family whose identity 

Oj© [d] he hides under the name 

of the Kallikak family. 
In his institution 
for the feeble-minded 
he had a girl whose de- 
generacy bore the ear- 
marks of inheritance. 
He found that her 



A \ I unAnonrn 

© 

ff$3> 

ane/rcepk 
. 404. — Pedigree of 
Family Showing De- 
generation. ("Hered- 
ity and Eugenics.") 



O 



rr~T 

N N 

</>,tetrrn or $■ 



a 



^tatoHM^ » 



N ? 



N: 



N 



* £|'0T(S)'0T(S) J n * 0T© <&<&<&& feat-grandfather had 

had improper relations 
with a feeble-minded, 
loose female character, 
the girl's great-grand- 
mother, and that to 
them was born the 
girl's grandfather. 
The great-grandfather had married a woman of good stock and they 

had had children. 



Fig. 405. — Pedigree of a Family with Deaf Mutes (D) in a 
Large Proportion of the Later Generations. ("Her- 
edity and Eugenics.") 



CW rO ft) 




o 
« 
S 

ft 02 

5 % 



02 









3 < 

o 
O 3 



991 



992 



EUGENICS 



These two parallel streams were started from one male head, one stream 
flowing into jails, insane asylums, and poorhouses, the other into the walks 
of highly respectable society. 

The men and women of the first group are largely criminals, paupers, 
and insane; of the second, sturdy, high grade, good citizens. A study of the 
first comes within the realm of negative eugenics; of the second within that 
of positive eugenics. 

The first is more easily studied and the facts disclosed are most dra- 
matic. We shall hear much, as we should, of the millions of dollars that these 
degenerates have cost the state. 

Martin Kallikak, the first, deserted his illegitimate offspring, but the 
community has been holding the bag. The taxpayers, including the legiti- 

L-TW T_JTW[-L_]T^' 



d) 5 m ®5® ®J5 Eho 6-d i T o i T o 



01® u d) 6 5 Ori D r 6-D 6 



timSTTSoS 



fJO attempt A?<? fff 
tub *o fAoot 



cra6&d 



•□ 



bb-n6 



6Gb 



Fig. 407. — Pedigree of a Feeble-Minded Family in Which Criminalistic (C) and Licen- 
tious (Sx) Traits Also Appear. ("Heredity and Eugenics.") 



mate descendants of Martin Kallikak, have been carrying the load that Martin 
thought he had dumped off the face of his earth. Martin was near-sighted. 

As compared with the tragedy of the illegitimate line the story of the 
legitimate line is free from thrills. In consequence the study has been put 
on the illegitimate line, and the lessons drawn are widely circulated. There 
are some lessons to be learned from the legitimate line and a way should 
be found to spread the information gained from such study. 

Someone has said that society takes care of positive eugenics in an 
intuitive way and that there is no need for teaching, to say nothing of 
research and study. The' saying is that the admiration for, and the selection 
of, the strong, muscular, courageous male by the female and the fondness 
of the male for beauty in the female acting by natural selection constitute 
all the positive eugenics we need. 

To this Havelock Ellis replies that under our prec^nt social demands 
the female seeks as her source of information Bradstreet or Dun and not 
the war record or the gymnasium showing of her prospective lord. When a 
female becomes infatuated with a prize fighter pity is the mildest emotion 
that her fellows bestow upon her. When on the other hand a female bestows 
her hand on some whiskey-soaked, disease-filled, lame and halt rake who has 
ample means her fellows are apt to approve. 



FOR RACE BETTERMENT 993 

It is also stated that the male has discovered the difference between 
apparent and real beauty in the female ; that the apparently beautiful woman 
of the present day is largely dependent upon harness for her beauty and 
that this harness is destructive of native beauty and is also eugenicallv 
bad. 

According to the view of these gentlemen whatever power making for 
positive eugenics lay in the customs of primitive society has been lost in the 
complications of modern society and at the present time we are worshiping 
at the shrine of a god that is mud and which has been since the days of the 
cave dwellers. 

As right thinking men should, however, they do not propose to be 
destructive and there stop. They have a positive offering. 

We are growing fond of the study of genealogy. Great numbers of 
books are written on the subject. With such writings great sections of 
libraries are filled. Family trees are worked out as the result of great study 
and these are conspicuously displayed. 

The proposal of these gentlemen is that use be made of this demand 
and that some machinery be created to supply the demand. 

First, that each individual keep his personal history embodying therein 
each fact that would or could have any eugenical bearing. Such a record 
should contain height, weight and some tests of muscular ability, a properly 
abbreviated medical history and an educational history. 

For the purpose of this record mothers are to carry forward the inter- 
esting baby records now so frequently kept and to make them show similar 
facts as to childhood. 

The baby record now referred to is that which commonly contains such 
items as date of birth, weight and length at birth, date of first tooth, date 
of sitting alone, walking alone, first word, date of different child diseases 
and disorders. 

The proposal is that the record further show date of entering school, 
dates of making the different grades, weight and height at different ages and 
some estimate of physical and mental gains and losses. So much for the 
mother's record. 

Out of these records, some accurate and some less so (as is the case 
with the data on which the genealogist now bases his findings) there will 
be built up family trees with eugenical value. 

A necessity is that such trees should record the bad as well as the good. 
It must especially show the outcroppings of feeble-mindedness, insanity, 
epilepsy, drug addiction and certain types of criminality. 

Galton has shown that there is a tendency to return to mediocrity. The 
children of a genius, of a man of great money-getting ability, of a statesman, 
exhibit tendencies to return to average capacities and average accomplish- 
ments. 

The daring, the unconquerable courage that makes generals of finance 
and generals of war practically always gives way to safe and sane mediocrity 
in the succeeding generation. 

Why then deify courage in a family tree since everybody knows that it 
peters out in the span of one life? Nobody is fooled. 

On the other hand Goddard has shown that feeble-mindedness sticks. 




994 




995 



996 EUGEMCS 

No change of environment will make any material difference. When it 
gets into the blood it stays and the proportion of actives and latents in a 
given generation can be determined pretty accurately according to Men- 
delian law. 

These are two illustrations toward each end of the line. In between are 
a lot of items that are not so well worked out. 

Scientists have not worked out the degree of disadvantage in having 
insanity in the blood, for instance. 

Man is a mongrel. Follow up any man's family stream far enough 

h/BOCWOOO 0/3/? WM C ALTON 

*t9 9 T*T 9 ^T 9 

l — — ' itjJ~17~"« nri* 

cr 9-pi* © ir r 



I 



E — L — I L ~L — i 
cf •* «r «r •* © 



~1 rH — I 

ef © © cf © 

^ show* t «ttn of scientific ability ; £ shows a man of scientific ability, woo is also a 
Fellow of the Royal Society ; (s) shows five other children, and so oa. 

Fig. 410. — History (Condensed and Incomplete) of Three Markedly Able Families 

(After Whentham) (Kellicott). 



and you will be certain to find some muddy ditches flowing in. How could 
it be otherwise? 

The solution of the problems of eugenics, though, is dependent upon 
facts and we have the consolation that every stream tends automatically to 
purify itself, some faster, some slower. 

The practical problem of eugenics is to keep the purification ahead of 
the pollution, and that can be done by working along two lines — by increasing 
the things that make for purification and by decreasing those that make for 
pollution. 

It seems to me that Ellis' plan of a family tree is better than the old 
one. It does not frame so well or look so well on the library wall but it 
would be more serviceable. 

In time a standard will be worked out and a normal line will be estab- 
lished; then those whose inheritance is above the average will have charts 



COLLECTING EUGENIC DATA 997 

made, framed, and hung in their libraries. Those below will keep their 
trees locked up; but they will strive hard to purify their blood stream. 



COLLECTING EUGENIC DATA 

"How momentous for the nations are the betrothals that are taking 
place this year !" Davenport exclaimed. Momentous for this nation are the 
weddings that are taking place this June and October. About 2,500,000 
babies are born each year. About 2,000,000 survive the hazards of infancy. 
The additions to the population from immigration are large but the babies 
born far outnumber them. 

The marrying couples are worth thinking about and enough is now 
known about the questions of inheritance to make that subject worth while 
for marrying couples to think about. Nor should thinking about the subject 
be limited to marrying couples. The marrying fever is liable to break out 
in the most unexpected places. 

Davenport tells us in "Eugenics: Twelve University Lectures/' that in 
the middle of the eighteenth century John Lowell, as he was being graduated 
from Harvard, vowed he would never marry. . No doubt John Lowell meant 
what he said but in spite of that John Lowell married three times and from 
him descended the present president of Harvard; James Eussell Lowell, 
the poet; Gen. Charles Eussell Lowell, the soldier; the founder of Lowell, 
Massachusetts, and its cotton mills; a director of an astronomical observa- 
tory ; the founder of the Massachusetts General Hospital ; and many other dis- 
tinguished public servants. 

Fortunately for society, the young graduate, John Lowell, had within 
him a cosmic urge that the plans for his life had overlooked. Marrying con- 
cerned him though he vowed to the contrary. 

Let us assume that marrying in our society is a matter of universal 
concern. 

The Eugenics Record Office at Cold Spring Harbor, New York, has pre- 
pared a schedule for recording family traits. These are sent out upon request. 
They are to be filled out and returned to the office. 

There are in that office about 10,000 family records. Not all or even 
a large part of these have been filled out by people asking advice about 
matrimony. Only about 2 per cent, or one in fifty, of the people who write 
in for these family trait blanks fill them out. 

In only two cases in which marrying was not advised have the parties 
agreed to accept the advice. This seems a discouragingly small proportion. 
For the small result several causes are responsible. 

1. Few people know of the Eugenics Eecord Office. It has never done 
anything dramatic enough to catch the attention of the general run of men. 

2. There has not been time enough since eugenics was launched as a 
constructive program to convince people of its importance. Only a small 
fraction of the people understand that the program is or can be made personal. 
It is not generally known that this constructive program contemplates the 
preservation of the family unit and the promotion of the most attractive 
features of romantic love. 



998 EUGENICS 

3. Even though the eugenic family tree as planned by this office only 
runs to the grandparents and their descendants the average person has not 
the information necessary to fill it out and will not take the trouble to get 
it. Many of the points inquired about do not stand out in the family mind 
as did such items as money, prominence and the like. 

4. Some of the information asked for one hesitates to put on record 
anywhere. The Eugenics Eecord Office has always been careful not to 
expose anyone. The published reports designate families by such names as 
the Nam family, the Hill folk, and the like, to prevent unpleasant notoriety. 
Nevertheless, many people are conservative and therefore are unwilling to 
disclose information until such time as the continued trustworthiness of the 
record office shall have reassured them. 

The record of 2 per cent of returns to the central office is by no means 
a measure of the results from sending out the family trait books. The person 
receiving blanks and instructions as to the information of importance at a 
time when his mind is concretely on the subject of matrimony will never 
forget what he reads in that book. He may not write to Cold Spring 
Harbor but that does not mean that he will not heed what he has read 
in the book. 

5. Some trouble is required. A great many people who think themselves 
interested have only a psychological interest. If effort, change in habits or 
plans or customs is required they drop the matter. To them the prospective 
gain does not offset the trouble. 

6. The rules for guidance which the eugenist can now lay down are too 
few to make a broad appeal. The subject is a new one. On some points 
it is possible to speak positively. In a few instances it is possible to say 
"Thou shalt do" or "Thou shalt not do." But on most of the points that 
people are interested in it is not possible to say anything one way or the 
other. This the eugenist knows better than anybody else. 

It is to correct these defects that the office has been created, that ten 
thousand family records have been gathered and are being studied, that a 
corps of field workers are investigating, that the proposition to advise as to 
matrimony has been made. 

Davenport is much more definite in his teachings than any of his 
associates. As to many qualities he speaks with the positiveness of a" teacher, 
More than anyone he follows the plan of a great teacher of obstetrics of 
twenty years ago, Dr. W. W. Jaggard. Dr. Jaggard was accustomed to say : 

"Gentlemen, I tell you this dogmatically to be accepted, not tentatively 
to be argued." 

Davenport, though, after enumerating some fifty or more qualities con- 
cerning which eugenics speaks dogmatically finally said: 

"The great work of the future in eugenics is to determine as accurately 
as possible the law of heredity of each human trait." 

It is to this end that these thousands of family trees are being gath- 
ered. When eugenics has developed its doctrine it will find the people ready 
to accept it. In fact the people will be ready before the doctrine is ready. 

I believe it was Sir Francis Galton who suggested the eugenics family 
tree and the development of a regenerated romantic love around the central 
idea of family trees. Immediately following his suggestion individuals began 



COLLECTING EUGENIC DATA 999 

keeping life albums in which there would be entered the intimate personal 
history of individuals, and families began constructing family trees along the 
Lines laid down by Sir Francis. 

The Family History Book, issued by the Eugenics Eecord Office as 
Bulletin No. 7, gives detailed instruction as to how to construct such a family 
tree. In the record there is a place for an analysis of the capacities, likes, 
dislikes, peculiarities, and other qualities of the individual. 

Some day the plan will be modified so as to enter certain desirable 
qualities with the ease of entry now provided for certain bad qualities. A 
glance at the plan as now outlined shows that the work has been done by men 
whose chief interest has been in the abnormal. 

We find a key in which fifteen inheritable undesirable attributes are 
to be noted by a single letter: A, alcoholic, decidedly intemperate; B, blind; 
C, criminalistic; D, deaf; E, epileptic; F. feeble-minded; G, gonorrheal; 
I, insane; M, migrainous; N, neurotic; P, paralytic; S, syphilitic; Sx, 
sexual, immoral; T, tuberculous; V, vagrant, tramp, confirmed runaway. 

In this list there is one symbol for the desirable — X, normal — and one 
to designate an infection that is not inheritable — G, gonorrheal. 

Further analysis is necessary in many of these entries and therefore 
such suggestions are made as that the capital I for insanity should be 
modified to make, for instance, Is, senile dementia ; Ig, general paresis ; 
Ip, paranoia. All these differ in their importance from the inheritance 
standpoint. 

Davenport tells us that in this country there are aristocratic families, 
such as the Harrisons, statesmen; the Morgans, financiers; the Edwards and 
Dwights, scholars; the Wilkinsons, inventors; the Lees, soldiers; the Hulls 
and Footes, sailors; the Jeffersons, actors. 

There are cacogenic families such as the Jukes, Ishmaelites, Nams, Hill 
folk and Kallikaks, a large portion of whose descendants manifest crimi- 
nality or some other evidence of subnormality. 

If one marries into the one group the majority of the offspring will 
be a source of happiness to the family. If one marries into the other group 
a majority of the offspring will be a source of misery to the family. 

Some of the inheritance relations of the above have been well worked 
out. Some have not. 

The blood will clear itself of any inheritance in four generations. This 
statement requires some modification. There are a few qualities that can- 
not be bred out. Those are pretty well understood. They conform to de- 
veloped principles of Mendel's law. 

Occasionally a quality will appear that has not appeared elsewhere in 
the family tree which goes back three generations — to the great grandparent. 
In such case the Family History Book tells us that the searcher delving 
farther back will find some forerunner. 

These are the exceptions; the rule is that four generations is enough. 
In some instances it is more than enough. For instance, gonococcal infec- 
tions are usually included. This infection produces sterility, causes blind- 
ness in the newly born child and in other ways is related, but in no proper 
sense has it inheritance features. Two generations clears the stock of both 
the infection and the effects of the infection, 



1000 EUGENICS 

Syphilis, on the other hand, extends "even unto the third generation" — 
bnt not beyond that. Alcoholism, epilepsy, insanity, migraine, wanderlust, 
tuberculosis, neurasthenia, are qualities from which the stock clears itself by 
the fourth generation if given any chance. 

The tendency to normal mind, normal stamina, normal resistance, to 
epileptic convulsions, to a certain color of skin and eyes is marked. It is 

M 



F F 



I I 

F F 

I I 



M 



M M 



I I I I 

F F F F F F 

I I 1 _L 1 l_ 

II I I I I I I I I I I I I I I 

M M M FMMFFMMMFFMFF 



1 



Fig. 411. — Pedigree Showing Hereditary Persistence of Color-Blindness. M, male; 
F, female; Bold-faced type- color-blind subjects. ("Heredity and Eugenics.") 

called a dominant. Even though an abnormality in any one of these qualities 
should be introduced in the next generation it would be half gone and in the 
third generation it would have disappeared for all practical purposes. 

In hereditary ataxia, astigmatism, otosclerosis (a form of deafness), 
Thomsen's disease and non-resistance to consumption the normal is the 
dominant, and the abnormal does not last beyond the Biblical teaching that 







1 
M 

1 










1 
F 

1 




1 

M 
1 


1 
M 

1 

1 1 
F F 


1 
F 

1 






1 1 
F M 

1 


1 1 
F F 

1 

1 ! 

M M 

1 
1 1 


1 
M 


1 1 
M M 

1 


1 1 
M F 


1 1 1 
M F F 


1 


1 
F 


1 1 1 
M F F 


I 
M 


Mil 

M M M F 



M M 

Fig. 412. — Pedigree of a Family Containing Color-Blind Members. 
("Heredity and Eugenics.") 

"the sins of the fathers shall be visited upon the children even unto the third 
and fourth generations." 

Certain abnormal conditions are dominants. For them three or four 
generations will not clean the blood. Among these are Huntington's chorea, 
cataract, ptosis of the eyelid, night blindness and extra toes and fingers. 

Sex-limited traits tend to disappear spontaneously if certain rules of 
mating are observed. They tend to be indefinitely perpetuated if the rules 



THE OPTIMISM OF EUGENICS 1001 

are not observed. Among the self -limited traits are color blindness, atrophy 
of the optic nerve, hemophilia, muscular atrophy, multiple sclerosis, nystag- 
mus and myopia. 

This is only a beginning. The Eugenics Eecord Office will not succeed 
until it offers a program with a broader appeal. In order that it may do 
so it is piling up studies. 



THE OPTIMISM OF EUGENICS 

Some of the opponents of eugenics have ridiculed and maligned it 
because, they said, every man's family tree goes back to the beginning and 
it is therefore a reasonable certainty that among any man's ancestors were 
some who had inheritable defects, physical, mental or moral. 

Had these critics taken the trouble to inquire they would have learned 
that the blood has a tendency to clean itself and that the great teaching of 
eugenics is in the laws of cleaning. 

Irving Fisher in Good Health says: "Thus it is possible to apply the 
laws of heredity as laid down by Mendel in a thoroughly practical way and 
to get results in one short generation. It seems, and it is, a colossal task 
to change average human nature one iota. Yet in the light of modern 
eugenics, we could make a new human race in 100 years if only people 
in positions of power and influence would wake up to the paramount impor- 
tance of what eugenics means." 

Professor Fisher quotes David Starr Jordan's report on the lessening 
of cretinism in Aosta, the result of a ten-year effort. 

Most of the bad qualities are recessive. That means that the blood 
clears itself of them if it has any chance to do so. This power of the blood 
to clean itself is so strong that the human race holds its own well in spite 
of the haphazard lines along which it has been run. 

The eugenists propose that in the case of those bad conditions that are 
dominant (the blood not having much power to clean itself of them) 
propagation shall be prevented but — and this is the part that they especially 
insist upon — that study shall be made of the natural laws by which the blood 
clears itself of the recessive defects and that the people shall be educated 
to make use of the information gained. 

When Galton launched the eugenics movement he called it a eugenics 
education movement. There has never been any killing of babies or infan- 
ticide or breed-'em-like-hogs proposals even from the followers of the move- 
ment and certainly none from the leaders of the movement. 

The influence of heredity does not go back indefinitely. To consider 
the parents is the main necessity. 

However, that is not quite enough. A little thought should be given 
to the four grandparents and all who have descended from them. Some 
thought must be given to the eight great-grandparents and their descendants. 
That is about all. 

A man need be interested only in about one-half the defects found among 
his first cousins and one-quarter of those among his second cousins. 

The most important part of eugenics is its teaching as to what are 



1002 EUGENICS 

good limbs and what are bad limbs on a family tree. Of importance is 
the teaching that a family tree need not go back into more than three 
generations. 

Of great importance is it that the young person live cleanly not only 
because it is the proper preparation for parenthood but because he is the 
temporary custodian of the seed of the race. 



PROBLEM OF THE FEEBLE-MINDED 

Kecently, when I was in Momence, Illinois, two most intelligent gentle- 
men told me of the large number of feeble-minded along the Kankakee valley. 
There is much intermarriage amongst the families in which the strain runs, 
and in consequence the condition is on the increase. 

The people of the district referred to do not change location often. They 
show a disposition to stay in the neighborhood wherein they were born, to 
marry neighborhood girls, to rear their families among old friends and 
(their lives coming to the end) to be buried in the neighborhood burying 
ground — the wisest and best of plans if there is combined with it efficient 
supervision of the stock to keep feeble-mindedness out; the worst of plans 
once a transmissible condition like feeble-mindedness gets into the stock. 

In his address before the state charities commission Dr. Henry Goddard, 
who knows more about this subject than anyone else, estimated that there 
are 20,000 feeble-minded in Illinois. 

What the feeble-minded cost the state there is no way of telling but 
the sum must be enormous. No accurate compilation has been made of 
the crime which may justly be laid to the mental inferiority of its perpetrator. 
The mental defective is a positively aggressive enemy of society whether it 
be through a large progeny or criminal activities, or both. 

Based upon views of this character Dr. Goddard advises that legisla- 
tion be passed. Just what this legislation is to be is a difficult question to 
decide. 

The best authorities are of the opinion that some of the states have gone 
forward too rapidly in their negative eugenic laws. Such opinion is strongly 
put in the last bulletin from the eugenics laboratory, that on the marriage 
laws of the United States. 

The English have been worried about the problem of the feeble-minded. 
Their people stay even more closely in their neighborhoods than the people 
of the Kankakee valley. When feeble-mindedness gets into a family inter- 
marriage and marriage among neighbors tends to increase it. 

The British parliament appointed a committee to investigate the sub- 
ject. Dr. Goddard tells us that no subject before that body has had more 
earnest consideration than the mental deficiency bill and that when it finally 
becomes law it will probably be a fit example for other countries to follow. 

David Lloyd-George has succeeded in turning the thought of English 
statesmen to problems of this character. Perhaps he could not have suc- 
ceeded had not the Boer War made the English introspective. 

If, as a result, solution is found for some of the ills of society the world 
will be the beneficiary of that unfortunate contest. 



EUGENICS CONCLUSIONS 1003 



EUGENICS CONCLUSIONS 



Salaman, studying the facial expression of English Jews, found in 136 
families where the father was a Jew and the mother was a Gentile that there 
were 336 children with Gentile faces and 21 with Jewish. In five families 
where one parent was a Gentile and the other half-Jew and half-Gentile 
there were 11 Gentile faces and none Jewish. 

Jews are supposed to have about as fixed a facial type as is to be found. 
That was the reason for the study. Therefore Jews marrying out of their 
race will have children with Gentile faces in nearly all instances. Those 
children, marrying an out strain, will have no children, with Jewish facial 
characteristics. 

Ewart, studying the 105,000 inhabitants of XLiddlesborough, England, 
came to these among other conclusions: 

"1. The children of the better working classes are above the average 
standard of those of the professional classes. 

"2. A mother produces her best girl before her twenty-fifth year, and 
her best boy in the twenty-six to thirty year period. Add five years to each 
group and the figures apply to fathers. 

"3. Children born in the first half of the year are larger than those born 
in the second. 

"4. Xo pregnant woman can nurse her child at the breast without hav- 
ing the unborn or the born child suffer. When children come far enough 
apart (three years), so that the woman is not nourishing a born and an 
unborn babe at the same time, the majority of mothers improve as child 
bearers as their families increase. The third averages better than the first 
or even the second. When children come at a shorter interval than two years, 
the later children are not so strong mentally and physically as the first." 

The quotations from recent writings on eugenics have been given with 
a view to stimulating interest in a greatly neglected subject. 

In Davenport's book nearly every physical, mental and moral trait is 
given some consideration. However, it is all so new that neither Pearson, 
presiding over the Galton Laboratory in England, nor Davenport, presiding 
over the Eugenics Laboratory in this country, has facts enough for final con- 
clusions. But the subject is so important that it must not be neglected longer. 

Statistics show that men and women of bad stock have twenty-five per 
cent more children than normal. The flowers must have a chance to outgrow 
the weeds. Xock says England's mournful lesson is that you cannot have 
national greatness bottomed on unsound men and women. Unsound men and 
women result from bad environment and bad heredity. The first is the more 
important; but the second deserves more thought than it has had. 

Mental Defects. — "Two mentally defective parents will produce only 
mentally defective offspring." — Goddard. 

If a person belonging to a strain in which a mental defect is present 
marry a cousin the chance of some defective children is very great. When 
two persons of strong minds but with mental defects in their blood strain 
marry, one-fourth of the offspring may be expected to be mentally defective. 

Mongolians. — (Feeble-minded children, looking somewhat like the 



1004 EUGENICS 

Chinese type.) "A Mongolian is usually the youngest or oldest child, the 
last or the first born. Such a child is born to a mother (or occasionally a 
father) who is too young or too old, or who, for other reasons, is in a bad 
condition of nutrition/' — Davenport. 

There is a eugenic relation between genius and feeble-mindedness. Says 
Havelock Ellis: "It is no paradox to say that the real affinity of genius is 
with congenital imbecility rather than insanity/' He notes that eminent men 
are more apt to be eldest or youngest sons. 

Memory. — "When both parents, having poor memories, are from fam- 
ilies so characterized, few of the children have excellent memories. When 
one parent has a fair memory and the other has a poor memory, all children 
have poor memories." — Davenport. 

Criminality. — Davenport, from whose book these illustrations have been 

M F 



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MF FMMMFMMF F MMMFM FMMFMM 

I I III III I 



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II I I I I I I Mill III II 

MF MFMFMF FMFMF FMF MF 



Fig. 413. — Pedigree Showing Hereditary Transmission of Hemophilia. Bold-faced type 
indicatesbleeders. ("Heredity and Eugenics.") 

drawn, says : "It is just as sensible to imprison persons for feeble-mindedness 
or insanity as to imprison criminals who are of a criminal strain. The ques- 
tion whether a given person is a case for the penitentiary or the hospital 
is not primarily a legal question, but one for a physician with the aid of a 
student of heredity and family histories." 

Hemophilia. — A disease characterized by frequent, almost uncontrollable 
nose bleed; the afflicted are known as "bleeders." 

Eugenic teaching — Sisters of bleeders should not have children. Males, 
whether bleeders or not, may marry and reproduce with impunity. Their 
descendants will not be bleeders. 

Cancer. — "This disease is much more frequent in some families than in 
others. Children born to old parents are more liable to have it than children 
born to young parents or parents in the middle of the reproduction age." — 
Ewart. 

TENDENCY OF BLOODS 

In a certain "Village consisting of 1,000 Souls" (Gesell tells us), there 
are 220 families. He studied the life history of these people from 1880 on 
and classified them according to eight conditions : Feeble-mindedness, insanity, 
suicidal impulse (successful accomplishment), alcoholism, epilepsy, criminal- 
ity, eccentricity and tuberculosis. 

In thirty-three years no member of 111 of these families has shown any 



THE SURVIVAL OF THE FITTEST 1005 

manifestation of any one of these conditions. In 109 families the stock was 
found tainted by one or more. 

Numerically the two worst family records were one in which there were 
three cases of tuberculosis, one of insanity and one of alcoholism, and another 
in which there were two insane, one suicide and two eccentrics. 

Xine of the families had four subnormals each. In one of these families 
there were four feeble-minded; in another there were two insane, one feeble- 
minded and one alcoholic. Out of the thirty-six members nine were insane, 
five were feeble-minded and seven were tuberculous. 

Ten of the families had three subnormals each. In two there were two 
feeble-minded in each and in one there was one. Two had two insane each 
and two had one each. 

Twenty of the families had two subnormals. Two of the families had 
two feeble-minded each and ten had one. Two families had two insane each. 
Forty-one of the families had two or more abnormal members. In the 220 
families there were 187 subnormal individuals. Two per cent, one out of 
fifty, of the pupils in the public school were feeble-minded. 

Gesell found it difficult to classify two eccentric druggists, a hard-hearted 
stepmother, the local banker who lost the savings of most of the people, one 
bigamist who used the money secured from the second wife to provide com- 
forts for the first wife and her children, and three young men who became 
vagrants. 

A point indicating decadence that I have never seen noted before is 
the tendency of men and women in this village to come to a standstill at about 
thirty-five. A good stock grows in intellect and power to a later life period. 
So much for one side. 

As for the other side nine of the families produced fourteen quite supe- 
rior individuals. Several ball players in the Xational League came out of 
this town. 

Of greater significance is the mediocre stock of this village — just the 
ordinary, everyday people, the common run of people, the people who go 
through life raising their families, carrying on the everyday work of the 
town, neighborly, helpful, practicing the homely virtues. 

In this village this group makes a good showing. There is that tend- 
ency to stop growing in capacity at an early day but almost every other 
observation indicates that the mediocrity of the village is getting on quite 
well. 

As Gesell says, "Feeble-mindedness tends to be transmissible, but so does 
normality." The proof is conclusive that bloods tend to cleanse themselves. 
With a little study and planning the stock can be protected against the 
subnormals. But help is needed. It is needed in the quiet, peaceful, happy 
villages as well as in the city slums. 

THE SURVIVAL OF THE FITTEST 

When the movement for the conservation of health began to attract the 
attention of the indifferent there were those who lent it no aid, and even 
at times opposed it because they believed in Herbert Spencer s doctrine of 
"the survival of the fittest/' 



1006 EUGENICS 

Before the Chicago City Club Mr. Bridges of London called attention 
to the difference between the ordinary idea of what this doctrine meant and 
Herbert Spencer's idea. The survival of the fittest means the survival of 
those fittest to survive and that is all. The best of a race are not necessarily 
the fittest to survive. The advancements are always made by those who are 
a little out of joint with the times. "When the average has been adapted 
to advanced standards the force for advancement becomes the fittest to 
survive but when it does it is no longer a force for advancement. 

A judge who in his decisions sticks close to precedents will have few 
reversals — an offshoot of the idea of the survival of the fittest. But on the 
other hand he will petrify the law. Justice is carried forward by men with 
a sense of social justice directed by judgment. Such men are often reversed. 
As Mr. Bridges put it, if a polar bear and a Lincoln were set down on an 
arctic island the bear would survive because he was fittest. 

Galton uses the term "worthy 7 ' as meaning those who should survive 
and who can do so when society is so organized as to make for race betterment. 

Another influential group has opposed the entire health conservation 
movement both in its hygiene and in its environment features because, they 
have argued, the policy served to keep alive many who (for the benefit of 
the race) should not live; that in the long run the race would be better off if 
the weaklings were allowed to die. 

When in a state of savagery man has acted upon this conception with 
brutal directness. The lame, the halt, the weaklings, the excess of females — 
any who in the judgment of the masters were thought to be, or liable to 
become a burden were killed and custom and law held the murderers justi- 
fied. As civilization came on a bit outright murder stopped but murder by 
neglect was countenanced. 

The next step in the evolution was neglect, but neglect short of murder. 
The successive steps following were poorhouse care, asylum care, humane 
care, curative care which brings us to where we now are, preventive care; 
at least, we are at the dawn of this era. 

If the idea of those opposed to the policy of human conservation because 
of their belief in the survival of the fittest was correct why is it that society 
has been evolving away from the old habits? 

Mans tendency is always upward. The constant trend from savagery 
(even when it be justice to humanity) must be right because it is the trend. 

Again, the death rates are getting low, invalidism less, the average of 
efficiency higher — the newer ideas must be right, the older ideas must be 
wrong. 

Scientists find ample demonstration of the truth of this logic. Care of 
environment and thought for inheritance mean lowered death rates ; they also 
mean heightened health rates. 

Havelock Ellis says: "In a policy of the survival of the fittest the fit 
survive, but though the relatively strongest have survived, their relative 
strength has been impaired by the very influences which have proved alto- 
gether fatal to their weaker relatives." 

"Furthermore," he elsewhere adds, "not only must an undue struggle 
with unfavorable conditions enfeeble the strong as well as the weak; it also 
imposes an intolerable burden upon these enfeebled survivors. It involves 



"UNTO THE THIED AXD FOURTH GEXERATIOX" 1007 

the multiplication of the diseased, the maimed, the feeble-minded, of paupers, 
lunatics, and criminals." To which might be added neurasthenics. 

A convincing demonstration of the truth of this conclusion is given by 
a comparative study of the death rates of the countries where the infant 
mortality is high and those where the infant mortality is low. Without 
exception those countries where the infant mortality is high have an adult 
mortality rate which shows that sickness in childhood undermines resistance 
for the rest of life. 

For instance, Eussia where the infant mortality a few years ago was 
more than 300 and still is over 250 has much more sickness and a much 
higher adult death rate than Norway which has a low baby death rate. 

As Carpenter puts it, "A high infantile mortality means a far higher 
infantile deterioration rate," or as someone quoted by Ellis puts it, "A 
dead baby is next of kin to a diseased baby." 

From no standpoint is a nation justified in neglecting its people. Or 
to quote Goldscheid: "The protection of the weak is the protection of the 
strong against degeneration." 



''UNTO THE THIRD AND FOURTH GENERATION" 

The above was selected as the title for a paper to be read before the 
Canadian Medical Association by Professor Adami of McGill University, 
Toronto. 

Many years ago "Weismann of Freiburg University, Germany, wrote that 
environment was of no importance and inheritance was all important in shap- 
ing the destinies of men. His teaching was that the cells of the body fell into 
two groups — the somatic cells (including all cells except those of generation) 
and the generation cells which in the developing child were the progenitors 
of all the cells but that thereafter originated only cells of generation. 

Somatic cells sprung from generation cells but the chain having started, 
they were thereafter produced only by somatic cells. Generation cells origi- 
nated from generation cells always and could never originate otherwise. 
Somatic cells inevitably died bu t>e germ plasm acting through generation 
cells was perpetual. 

The practical effecv of the teaching of "Weismann is that the germ cells 
are wholly protected from the influence of environment — for instance, that 
whatever may be the experiences of a woman her children will not be affected. 
Parents are born with all their germ cells complete and finished. 

There is, of course, much truth in the dogma of Weismann. though 
even the last modification of his views is not thought to be the whole truth. 
Studies have shown that the gTandchildren of people who have consumption 
are highly susceptible to the disease. Susceptibility may even skip the first 
generation and appear in the second — the sins of the fathers visited upon 
the children even unto the second generation. 

In Adami's opinion, the results of one's living a^e manifest even unto 
the third and fourth generation and he sets forth in this paper his reasons 
for that belief. 

Of course his is not a one-sided belief. Those who live right impart the 



1008 EUGENICS 

good gained to their descendants just as those who live wrong impart the 
harm done to theirs. 

The term "sin" is used entirely with a scientific and not with a moral 
meaning. 

He quotes experiences that show that lead, mercury, and alcohol effects are 
carried over into succeeding generations. He also makes use of observations 
on poisoning with the toxins of tuberculosis and certain other diseases where 
proof is somewhat easy to make. 

Adami says that when Weismann cut off the tails of mice and from these 
bobtails bred long-tailed mice he proved that a race of bobtailed mice could 
not be bred in that way but that was all that he proved. 

The action of the important organs of the body and the resistance to deli- 
cate chemicals is much too subtle to conform to the same laws as regulate the 
tail of a mouse. 

There is proof that subtle changes do result from change in environment. 
Besides, it is common sense. Individual man is influenced by his surround- 
ings and in time the race comes to feel the influence though the cells 
charged with carrying on the race are better protected against outside influ- 
ences than are the cells that do the day's work. 



THE BABY SCIENCE 

We have been so busy with environment that we have forgotten team 
work. Eace betterment is loaded in a two-horse wagon, to which are hitched 
improved environment and eugenics. The horses wear blinders. Improved 
environment (including the workers for its improvement) has been so busy 
pulling on its end of the doubletree that it has forgotten the fellow on the 
other side of the pole. 

Sir Francis Galton calls eugenics "the science which deals with all in- 
fluences that improve the inborn qualities of the race"; which Davenport 
further clears by saying: 

"The eugenical standpoint is that of the agriculturist who, while recog- 
nizing the value of culture, believes that permanent advance is to be made 
only by securing the best blood. Man is an organism — an animal — and the 
laws of improvement of corn and of racehorses hold true of him also. The suc- 
cess of a marriage from the standpoint of eugenics is measured by the 
number of disease resistant, cultivable offspring that come from it." 

Davenport in his "Heredity in Relation to Eugenics" has set forth many 
eugenical principles. That the science of Mendelism has proceeded far enough 
in the human subject to permit of eugenical formulae covering so many fields 
will come as a surprise to many. 

Mendel, the Austrian monk, wrote the story of the breeding of the sweet 
pea a quarter of a century after the railroad was invented. He made his 
experiments, recorded his results, wrote his book — and died — his life a failure 
so far as he could see. When William McKinley was president, Devries 
happened to read this little book and seeing the seed of a science in it found 
for it a hearing. 

Most of Galton's writings were during the presidency of Cleveland, Mc- 



THE BABY SCIENCE 1009 

Kinley, and Eoosevelt. It was in 1911 that he died leaving his estate as an 
endowment for this work. The bulk of the literature on the subject has been 
written since Taft became president. 

Not much senility about a science which runs back only to the last 
Roosevelt administration! A baby science immature in years will certainly 
be immature in its conclusions and error will creep in. Some of its pres- 
ent principles will be abandoned in the light of broader information and 
others will be modified. But the methods and the general outlines will 
stand. 

Davenport says: "As we may now predict with precision the characters 
of the offspring of a particular pair of pedigreed poultry, so may it some 
time be with man." 

We will all agree with Nock that man made laws will never supplant the 
laws of nature. Even the laws of custom and society will yield slowly where 
they yield at all. The students of eugenics as a general rule think the re- 
generation of the race will come about more through intelligence and informa- 
tion than through legal enactments. 

Medical examination and certification as a basis for a marriage license is 
not advocated by Havelock Ellis, Newsholme, Saleeby, Davenport and Hut- 
chinson. They think that some of our state laws have gone too far or rather 
too fast having been enacted without enough preliminary study. Asexualiza- 
tion of the very lowest strata of society is about as much as they are ready to 
advocate. They propose to state the known facts and the principles de- 
ducible from them and then to leave the results to the wisdom of men. 

While the majority of men will drift along as heedless as ever a fair 
number will give some thought to the subject, knowing that unwisdom will 
be "visited upon their children and their children's children even unto the 
third and fourth generation." 

Now let me set down a few selections, principally from Davenport's work, 
illustrating what eugenics is teaching: 

Deaf-Mutes. — The first eugenic recommendation is that two deaf-mutes 
should not have children especially if they come from the same long settled 
community or are known to be blood relatives. Bell, in a special census 
report to the United States government in 1906, showed that intermarriage 
was a very important cause of deafmutism. Where a deaf person has inherited 
his deafness about 25 per cent of his children will inherit deafness. Where 
a deaf person has acquired deafness through neglected tonsils, and such causes, 
2 per cent of his children will be deaf. 

In a marriage where one partner is congenitally deaf and the other 
has no deafness in the family 7 per cent of the children will be deaf. If 
the partner with good hearing has deafness amongst his relatives 35 per 
cent of the children will be deaf. If one or both partners are deaf as the 
result of neglected tonsils, ears, or other defects, and have no deaf relatives 
only one-quarter of 1 per cent of the children will be deaf. 

Becoming Hard of Hearing with Age. — Two persons with this as a 
family tendency should not marry as probably all their children will be 
"hard of hearing" as they grow older. But a person with such a family 
tendency could marry into a family with no such tendency and the children 
would have no such tendency. 



1010 EUGENICS 

Blue Eyes. — When both parents have pure blue eyes all the children will 
have pure blue eyes. 

When one parent has brown eyes, while the other has blue, either the 
fraternity of children will show no blue eyes or half of them will be blue eyed 
— more accurately, 48 per cent and 52 per cent. 

When both parents are brown eyed, 75 to 100 per cent of the children 
will be brown eyed and no per cent to 25 per cent blue eyed. 

Color Blindness. — The eugenical conclusion is that while color blind 
males will have no color blind sons and (typically) no color blind offspring 
of either sex yet their daughters married to men of normal stock will have 
color blind sons. 

Cataract. — The eugenical rule is that if either parent has cataract at 
least half the offspring will have it also. 

Cretins. — Absence of the thyroid gland, the opposite condition to goiter, 
appears especially in families which have intermarried for several generations. 
There is a large cretin colony in Switzerland. For some time these have not 
been allowed to intermarry and Jordan, in the Eugenics Review for 1910, 
says that cretinism has about disappeared from the village. 

Exophthalmic Goiter. — This is clearly inherited, as certainly as epilepsy. 
The laws of inheritance have not been worked out. 

Neurotics. — In a certain case where a nervous person married a neuro- 
path of eleven known offspring six are normal and five neuropathic. Where 
two neurotics married two out of six children are normal and one insane. 
Where an insane and a normal married of thirteen children four are normal 
and two insane. Where a neurotic and a normal married of twenty-eight 
children sixteen are normal, nine nervous, one feeble-minded and two insane. 

Multiple Sclerosis of the Nervous System.- — This disease is transmitted 
through unaffected females. The eugenical conclusion is that unaffected 
females who have affected brothers should not have children. Neurotic 
parents will have about 50 per cent of neurotic children. 

St. Vitus' Dance. — Occurs in families of a neuropathic make-up. 

Insanity, Alcoholism, Drug Addiction. — Says Davenport : "Probably an 
hereditary predisposition lies at the basis of most cases of insanity, and this 
predisposition behaves in heredity like a defect." Alcoholism and drug 
addiction as modified insanities belong in this group. 

Cancer.— a There is a family liability to cancer, but along what lines this 
liability is transmitted and what plan shall be pursued to prevent its trans- 
mission has not been worked out." — Davenport. 

Consumption. — Coolidge says that old New England families show a rela- 
tively high resistance to consumption as compared with recent immigrants. 
The opinion is quite generally held that the mortality from this disease 
among negroes and Indians is due in part to bad hygiene but in greatest part 
to the fact that the disease is to them a new one. They have an inherited 
susceptibility to it. 

Davenport's study of the family histories in his eugenics files shows 
some with no consumption, others with little and some with a consumption 
death rate of 75 to 80 per cent. He concludes that children of families with 
a tubercular history should not intermarry. 

The above illustrations have been drawn in miscellaneous fashion from 



THE HILL FOLK 1011 

"Heredity in Eelation to Eugenics." The principles are based on data 
which in most cases are abundant enough to prevent errors due to individual 
variations. In some instances there are enough data to meet the requirements 
laid down by Pearson for the law of probabilities; in most instances, far 
from it. 

THE HILL FOLK 

The man who lives in the country reads of the unworthy citizen and 
the slums of the city in a detached way thinking of them and all such 
much as he thinks of aborigines in Australia or pygmies in Africa. As a 
matter of fact the only studies of bad family inheritance ever made in this 
country have been of rural families. 

The Eugenics Eecord Office has recently published another of these family 
studies under the title "The Hill Folk/' It is the story of the descendants 
of two men who came into a small Massachusetts town in 1800. The town, 
now with 2,000 inhabitants, lies in a fertile valley surrounded by less fertile 
hills. The population in the main consists of industrious, intelligent farmers. 

Through this placid mass of good citizens the progeny of these two bad 
citizens has sifted making desolate, alcoholic homes and furnishing wards to 
the state for over fifty years. 

The taxpaying, law abiding citizens have lived beside these troublesome 
paupers so long that they are too disgusted with them and also too accustomed 
to them to do anything. 

About every so often one of the Hill folk goes to jail or to some other 
institution and the people temporarily threaten to do something about the 
whole worthless stock. But it stops at that. 

The cost to the taxpayers for caring for these Hill folk has been a little 
short of $500,000. 

The first generation or two cost little or nothing thus limiting the years 
on which the cost has fallen to about the last fifty. The average cost has thus 
been about $9,000 a year, a pretty good price for a community of law abiding, 
frugal farmers to pay for the luxury of paupers, drunkards and criminals by 
inheritance. 

In the last ten years the cost has increased fourfold so the promise is that 
Mr. Farmer Xeighbor will have to dig down into his jeans a good deal deeper 
within the next ten years. 

About every so often the good people have been so aroused at boys getting 
drunk and girls going wrong that some officer has gone among the Hill folk 
and taken the children to some public or philanthropic institution. Where- 
upon the drunken parents, relieved of the need of finding bread for their brood, 
have proceeded to raise another brood. 

The neighbors having never studied the problem the Eugenics Eecord 
Office has become intent upon digging right down to the roots. What has been 
found out about this family may not be of service to this Massachusetts village 
that has suffered the nuisance for a century but it may be of service to 
communities that are just beginning to get a "katzenjammer." 

For instance, they find that half the school children of this family 
show evidence of mental deficiency. As their mental weakness shows a 



1012 EUGENICS 

tendency to make habitual drunkards of them one might say that communities 
which pass prohibition laws are striking at the root of the difficulty, are not 
idly drifting in the face of a menace. But are they striking at the tap root or 
only at a surface root? 

I was struck with this: "Old Neill," the father of one of the lines, lived 
to be 110 years old. He was a chronic drunkard and shiftless but was 
described by old men as a "harmless fellow and rather decent." 

Had he burned a few houses or killed a few men and been hanged therefor 
he would have been less harmful and more decent than his progeny has 
proved him. 

THE NAM FAMILY 

The second memoir issued by the Eugenics Record Office gives the results 
of a family of ne'er-do-wells that originated, so far as the study showed, in 
Massachusetts about 1750. Soon after 1800 this family began to inhabit 
the jails, asylums and poorhouses in a certain rural district in New York. 
The farmers of this neighborhood have had to bear the expense of caring 
for the defectives in this large family since about 1830. 

A certain portion of them migrated to Minnesota and the investigators 
followed up those branches with a view to discovering whether the new en- 
vironment would bring the stock up to standard. 

The report quotes an old history as saying of the Nam who started the 
strain : 

"He is one of a set of vagabonds by the name of Nam who lived in the 
mountains." One of the sons is described as "ignorant, alcoholic, irascible, 
and indolent." 

"One son emigrated to New York, bought 160 acres of land, and there, 
in 1810, built a log cabin which was occupied until 1880 and is still standing. 
This log cabin may justly be called 'the Cradle of Nam Hollow/ for every- 
one born in this cabin has been socially inadequate and has helped to swell 
the number of degenerates who give this place its character." 

The conclusions quoted below are based upon a study of 1,795 individuals 
of whom 852 were descended from the original Nam. The cost of this family 
is estimated at $1,411,000. 

The non-social traits in this family are indolence, alcoholism and licen- 
tiousness. 

The eugenic principles of laziness are as follows : 

"When both parents are industrious, 90 per cent of the children are 
industrious; when both parents are indolent, 76.5 per cent of the children 
are indolent. 

"Two lazy parents may become the founders of industrious strains, but 
indolent strains arise chiefly, if not exclusively, by marriage with indolent 
persons." 

Alcoholism is extraordinarily high — 88 per cent, of the females and 90 
per cent of the males. "Where both parents were alcoholics every child became 
alcoholic. Where one parent was alcoholic and the other possessed self-control 
the offspring who were alcoholics ranged from 50 to 75 per cent." 

A study of the cousin marriages in this strain (where the bad predomi- 



EUGENICS AND ASYLUMS 1013 

nated) showed consequences of infant mortality, imbecility, feeble-mindedness 
and other defects fearful to contemplate. 

On the possibilty of improving the strain by improving the environ- 
ment the authors say: 

"Placing out in better families and asylum life give a veneer of culture 
and tend to strengthen the sex impulses, but that effect is uncertain and fre- 
quently discouragingly slight." 

As to the effects of the migration to Minnesota one report says : 

"The Nams were of the inefficient, worthless sort, not lazy and not 
criminal. None of them was ever arrested except for drunkenness." 

Another report says of the second Minnesota generation: 

"They are inefficient and alcoholic." 

The general conclusion as to the emigrants is that they have the same 
mental traits as those that remained in New York State. 

Another general conclusion is that it is three times as expensive to main- 
tain the offspring of a degenerate couple as it is to segregate the original pair 
and maintain them in idleness. 



EUGENICS AND ASYLUMS 

The insane committed to institutions make up about three-tenths to five- 
tenths of 1 per cent of the population. Every town having a thousand inhab- 
itants has about four insane who are being cared for by the government. The 
percentage is increasing continuously. 

It is doubtful, however, that there is any increase in insanity. As some- 
one puts it, our standards of sanity are increasing, which means that many 
people are now regarded as insane who a generation ago would have been 
regarded as merely peculiar. 

Another reason is that the standards of custodial care have advanced 
until now persons are willingly released to asylums where a generation 
ago they were kept at home by reason of the inhumanity of many of the 
provisions for custody. 

Asylums were of the first eugenics agencies. By segregating the insane 
they have always protected the stock, not perfectly but fairly well, as the 
results show. 

The insane m a rough way fall into three groups: The paretic, the 
dementia precox, and the maniac depressive. As a eugenic measure asylums 
are quite effective in relation to the first two groups but not as to the third. 

Mott in his paper showed that of the children born to insane parents, 
8 per cent were born after the first attack of insanity. This maniac depressive 
group includes the emotional insane — the people who get worse and better, 
those who come and go in asylums, sometimes being held sane about half 
the time and insane the other half. 

It is from another standpoint that asylums as eugenic agents fail. 
The border line between sanity and insanity is hazy. Insanity is not in- 
herited. A certain mental instability is inherited and environment pushes 
those of that group into sanity or insanity. Mott quotes Morel as follows : 

"Nervous, irritable weakness, the neurotic temperament, neurasthenic 



1014 EUGENICS 

predisposition may be the first evidence of degeneration of a stock. The 
signs of degeneracy which may be exhibited are self -centered, narrow minded- 
ness in religious beliefs, fanaticism, mysticism, spiritism, an unwholesome 
contempt for traditional custom, social usages, and morality, a vain spirit of 
spurious art and culture, a false self-loving vanity in the pursuit of a sen- 
timental altruism, or by eccentricities of all kinds. 

"Such signs of degeneracy are often combined with talent and even 
genius, but the brilliant intellectual qualities of a degenerate are invariably as- 
sociated with either a lack of moral sense or of sound judgment and the 
highest control." 

As showing the relation of inheritance to insanity as demonstrated by a 
study of the provable insane Mott studied the family relationships of the 
insane in London asylums. 

He found 750 closely related persons, about 3.5 per cent of the whole. 
He is certain that not 3.5 per cent of all the people in London are so closely 
kin. 

He argues that the strains with a large infusion of mental twists produce 
an undue proportion of the insane. 



THE IMMIGRANT'S CHILD 

In 1910 the National Immigration Commission issued a study entitled 
"Changes in the Bodily Form of Descendants of Immigrants." It was issued 
as Senate Document No. 208. 

Are we amalgamating the people who come to us? Is this the "melting 
pot" ? We think we are taking people from all parts of the world and making 
them Americans. Are we doing this socially, politically, mentally, physically? 

The question as to the physical amalgamation was that which this com- 
mission set out to solve. It compared children born abroad with children 
born in this country to immigrant parents. It compared children from 
mothers who had recently come over and from those who had been over one 
year, five years, ten years. These different groups were compared with one 
another and with children born before the mothers emigrated. 

Jews principally from Poland and Eussia and Italians principally from 
Sicily and Calabria were studied. Some of the commission's conclusions 
follow : 

The Sicilian type of head is long and narrow. Sicilian babies born in 
New York within five years after the mother landed have a shorter, broader 
head and those born later have a still shorter, broader brain box. 

The East-European Jew has a round head. Babies born to Jewish mothers 
in this country have longer, narrower heads than those born abroad. 

Comparing the different groups of children — mothers here ten years, five 
years and two years — it was found that the change of type from children born 
abroad to the two-year type was rapid ; from the two- to five- to ten-year type 
that the change was slower. 

It is the first few years in this country which contrast most with what 
the mother has been accustomed to and her children show it in their make-up. 

The other parts of the body are changing even more strikingly. The 



SMALL FAMILIES 1015 

head changes are noted here because the head shape is supposed to be fixed 
and hard to change. 

Thus we see that while inheritance counts environment gradually makes 
us even — regardless of race, religion or region of origin. 

Another interesting conclusion was that while the Jewish child born 
in this country shows an improved physique as compared with the Jewish 
child born abroad the physique of American-born Sicilians and Calabrians 
shows a downward tendency. American city life is helping the children of 
Jews from eastern Europe. It is harming those of Sicilians and Calabrians. 



SMALL FAMILIES 

The baby death rate in large families is high. The prospective mother is 
nearly always run down and frequently is ill nourished. The duty of caring 
for her child already born, the nourishment which she furnishes it from her 
own body, the broken rest — when these are added to the strain of childbearing 
at short intervals — lower the nourishing power of the mother so that the form- 
ing baby does not get nourishment enough. 

The baby starts out poorly. If to this is added bad environment a high 
death rate can be expected. The rule is that in families where there are many 
children the nursing is done by young children, the bedrooms are crowded, 
cheap milk and inexpensive food other than milk is used, the family income 
is small — and in many instances the parents know neither the language nor 
the customs of the country. 

The argument of the thinkers and investigators is practically unanimous 
for small families as against large. This plea is the very backbone of the 
booklets on race regeneration written by Ellis, Xewsholme and Saleeby. Sup- 
porting this view are some conclusions of Boas in the report of the Immigra- 
tion Commission. They say that first born children exceed later born children 
in stature and weight. Investigations made of the school children of Toronto, 
Canada, and Oakland, California, showed a decided decrease in development 
of the individual according to the increasing size of the family. 

Havelock Ellis in writing about the decreasing size of families says tha 
decrease starts in the more advanced nations and works down — as it starts 
in the most intelligent families and gradually invades all levels. It began in 
highly enlightened, thrifty France, extended to Germany, thence to England, 
and within a generation or two will reach the nations of eastern Europe. 

The immigration commission finds support for this view. For example, 
those from rural Poland where community life is simple have large families 
in the first generation; in the second generation their families are nearer the 
American average and in the third the American level is practically reached. 

On the other hand small families are not an unmixed blessing. The 
Galton laboratory files show a higher tuberculosis, insanity and criminality 
rate among first bonis than among later children. However, these an 
conditions which develop in adult life and are due to social and economi 
causes rather than to inheritance. 

When a baby's chance of living is small a part of it is due to bad heredity. 
a part to bad environment, and a part of it is due to the bad condition during 



1016 EUGENICS 

these borderline nine months between the beginning of the child and its 
birth. 

THE ONLY CHILD 

In presenting the arguments for small families I would not have you over- 
look the disadvantages of the only child. 

Pearson found that first children, the normal consumption rate being 
66, had a rate of 112. The normal criminality rate being 56 they had a rate 
of 120. They had a lunacy rate which is above the normal. Where the first 
child is the only child these rates are the family rates. 

The only child is usually well shielded against summer complaint, 
measles, scarlet fever, diphtheria and smallpox. It has more of the mother's 
care than the child who is one of several and there is some advantage in 
this but there is more than enough disadvantage to offset. 

The limitation of the family to one child, as a rule, is voluntary. This 
means also, as a rule, that the parents are self-indulgent and weak-spirited 
— a bad inheritance. The child is indulged, coddled and pampered. He is 
overhoused, overdressed and of low resistance. He is spindle-legged, thin- 
chested, anemic and flabby. He is a poor player, is self -centered, nervous, out 
of sympathy, anti-social. He is neurotic, neurasthenic, "whiny." 

There are "only children" to whom none of these criticisms applies. But 
averaging 1,000 such children these qualities will be found more frequently 
than among 1,000 children of three-children families. 

The hardest problem of life is to find one's self — to get a line on one's self 
as compared with one's fellows. This the only child finds very difficult. He 
has been talking with adults instead of having cooperative and competitive 
play with other children and he has not had a fair chance to find himself. 

Grinker, in his paper on "Race Breeding/' emphasizes the difficulties of 
rewards and punishments, of control of emotions and nervous impulses. 
These are doubly difficult where the child is an only child. To be an only 
child is awfully hard on the child. If the records show that the child of a 
large family stands a poor chance I am sure that the only child also stands 
a poor chance. 

Small families are wise — but they should not be too small. A French 
authority says that the good of the state demands that a family should con- 
sist of at least three children. The best family, from the standpoint of the 
state contains four healthy sound children. 

Prenatal Marking. — Anxious writes: "1. At what time during preg- 
nancy is a fright or scare to the mother liable to affect the child? 2. Is it 
natural for the breasts to be very sore? S. Do they remain so the entire 
period?" 

Reply. — 1. At no time. A fright or scare cannot mark an unborn 
child. When development starts the child is from under the influence 
of the mother except as to its nutrition. If she is being starved or poisoned 
the baby will follow suit. If she is well nourished the babe will be. The 
developing child is liable to be hurt and thus deformity may be brought 
about. This, however, is due to other developmental principles. Gen- 



EUGENICS 1017 

erally speaking, everything relating to inheritance from mother or father 
has laid out its work when the child begins to form. 

2. Yes, with some women. 

3. Somewhat so, but proper care of them reduces the soreness greatly. 

No Cause for Worry. — Mrs. A. writes: "I expect to give birth to a 
little one in January and have become frightened several times. A great 
many people tell me I probably have marked my child. I have been 
brought up to believe that there is nothing in this, that it is an old-fash- 
ioned idea, and that it is impossible to mark a baby, as the unborn child 
is so well protected. I find it impossible to argue with these women, as 
I am not certain myself. Your kind advice on this subject will be greatly 
appreciated. Also will you tell me whether an 8-month baby lives?" 

Eeply. — Birthmarks, harelips and other deformities do not result 
from frights, scares or other violent mental shocks to the mother. This 
fantastic idea has never had any foundation in fact. Whenever instances 
have been investigated it has been found that there was no reason for 
believing that the deformity was due to anything which the mother had 
seen or heard. 

The mental state of mothers, some of the diseases which affect them 
and their nutrition may affect the growth and nutrition of the child but 
they cannot cause organs to develop wrongly. 

At some time I shall go further into the subject of the influence of the 
parent on the unborn child. 

An eight-month baby has a good chance to live; nearly as good as a 
nine-month baby. 

Cretinism. — 0. B. D. writes: "What is the cause of cretinism? How 

does it differ from idiocy?" 

Reply. — Cretins have poorly developed thyroid glands. They are gen- 
erally feeble-minded; occasionally they are idiotic. Idiots may be such 
because of insufficient thyroid or by reason of other deficiencies. Not all 
idiots have poorly developed thyroid glands. In fact, some idiots have a 
good muscular, bony, and thyroid development. Idiocy is a condition of 
mind. Cretinism is a condition of the thyroid gland. 

Exceptions Not Convincing. — C. L. R. writes: "The argument as to 
small families versus large families has another side to it which does not 
mean precisely what the argument would, at first sight, seem to indicate. 
I shall first give the argument, or, rather, a few facts, and then point to 
the real meaning, as distinguished from the apparent meaning. In a sur- 
prising number of cases the eminent man has been the youngest, or almost 
the youngest, child of a large family. Franklin was the fifteenth child; 
Josiah Wedgwood was the eleventh child; Thomas Young, the tenth child; 
John Hunter and many others were the ends of large families. If these 
families had been curtailed to make small families, these eminent men 
would not have been born; and the list, when extended, includes many 
hundreds of men who have been of the most use to the world and have 
contributed most to its progress. Apparently this means that the large 
family is desirable, but when investigated further it is found that there 
is something else than mere largeness of family which is desirable. The 
really eminent persons are nearly all born when their parents are of more 
than mature age; in fact, when their fathers are comparatively old. But 



1018 EUGENICS 

on investigating still further it is found that age of itself is not the teal 
thing, any more than mere largeness of family is the real thing. Both are 
incidental to the production of the real thing, and that real thing is 
energy accumulated by work performed before reproduction takes place. 
Age in parents is time, which is always a factor of energy, and the large 
family is simply the commonest means by which children are produced late 
in the lives of their parents. An analysis of the few exceptional cases in 
which eminent men have come from comparatively young parents shows 
that the process of accumulating energy is one which extends back through 
generations. As a collateral on this investigation it is found that as long 
as parents retain their health and strength, the older they are when their 
children are born, the longer is the normal life of those children. This 
has a direct bearing on what you are teaching/' 

Reply. — Some studies made in Chicago show that the children of 
immature parents are not healthy and strong. Studies of children born to 
old parents show them not to be strong. The strongest children are those 
born to parents in the years of strength. The citation of seeming excep- 
tions is not convincing, because we must stand by averages and also be- 
cause, as Havelock Ellis has shown, great genius is closely related to 
mental defects. 

Have Effect on Child. — L. D. P. writes: "A woman at the age of 26 
becomes a mother. She has taken laudanum as a preventive against child- 
birth and is also quite a heavy drinker of whisky. Do these have any effect 
on the child?" 

Reply. — Yes. 

Marriage of Cousins. — L. writes: "What do you think about cousins 
marrying? I am about to take such a step, as I believe there is no harm 
in it. The family is opposed to it, asserting that such a marriage is hurt- 
ful to the next generation. I have among my friends some married 
cousins and one couple still closer related. All have children, and every- 
thing seems all right. Why do royal families intermarry, and such families 
as the Rothschilds? My father objects most because he and his brother 
are so much alike in temperament and that I am so much like him, also 
that I am so nearsighted." 

Reply. — The marriage of cousins is advisable or not according to the 
family history. The mental and physical strength of the European aris- 
tocracies including royalties can scarcely be held to be a proof of the 
advantage of intermarrying. All improvements in breeds of domestic 
animals has been brought about in part by judicious inbreeding. That it 
has done more good than harm with animals where mating is under the 
control of dominating minds working with no regard for any consideration 
except a given end does not argue that it would do more good with the 
human race whose mating is not thus dominated. Experience shows 
that with men inbreeding has done more harm than good. If in the blood 
strains there are dominant good traits those traits will be strengthened in 
the progeny by the marriage of cousins. If there are bad traits such as 
insanity, epilepsy, feeble-mindedness, nearsightedness, and the like, those 
will be made worse. Finally there is a slight deterioration in cousin- 
mating which is like the gambler's 15 per cent — though it may be over- 
come temporarily, if persisted in, it finally comes to the front. 



EUGENICS 1019 

Law Forbids Marriage. — P. L. writes: "If you will kindly write a 
paragraph or more on the inadvisability of the marriage of first cousins, 
it will be greatly appreciated. A young friend — male — is corresponding 
with a first cousin, and I wish some authoritative statements to put before 
them." 

Eeply. — The marriage of first cousins is prohibited by the laws of 
Illinois and some other states. Except in selected cases, the marriage of 
first cousins is bad for the offspring. Any defect in the stock is especially 
apt to crop out in the children of such marriages. 

If a careful search shows the stock exceptionally free from inheritable 
defects marriage of first cousins is not bad for the stock. 

The rule, then, should be that first cousins should not marry. But 
those passed by some such authority as the staff of Eugenics Laboratory 
should be allowed to marry. 

Size of Family. — S. A. B. writes: "I had hoped that your article on 
'Small Families' would state what all writers on this subject seem to have 
overlooked or ignored: That there is a distinction between death rate and 
death percentage. It is no scientific discovery that the death rate in big 
families is greater than the death rate in small families. It could not be 
otherwise. Where a larger number of children are born and consequently 
exposed to sickness and death, there are bound to be more deaths. But it 
does not necessarily follow that the percentage of deaths in the big family 
is greater than in the small family. If the large family is given decent 
social and industrial conditions under which to live and grow — a natural 
right that society is now denying them — it is my opinion that there will 
be among the children of large families a greater percentage of survivals 
than among the children of small families, a conclusion justified by statis- 
tics, which seem to indicate that the physical condition of 50 per cent of 
the male portion of the population of marriageable age is not comme il 
faut; and this approximately 50 per cent includes, I believe, only a small 
portion of the so-called poorer class, saved from inclusion not on account 
of any superior sense of morality but rather by virtue of proneness to 
early marriage and their conspicuous fecundity. Is it not a fact that, 
for the big death rate among the children of the poor, society,, and not the 
existence of a large family, is to blame? The large family cannot be con- 
sidered an evil per se. Society, however, is at fault, when it makes the 
raising of a large family a hardship to worthy parents, and almost an 
impossibility to the poor. The remedy, if remedy is needed, lies not in the 
reduction of the size of a family but in the increase in the earnings of the 
members of the family." 

Reply. — Conclusions as to the advantage and disadvantage of families 
of different sizes are based on : 

A. Mortality among the children. 

B. The prevalence of different diseases among children of small and 
large families. 

C. Measurements of children at a given age. 

D. The percentage of abnormally dull children in the different groups. 
Conclusions drawn from infant mortality alone, as you show, would be 

misleading. The conclusions generally favor three or four children, or 
more, if the intervals between them are long. If you will look into the 
matter you will find that infant mortality is generally figured on the basis 
of total infant population. 



1020 EUGENICS 

Eugenics. — J. W. B. writes: "I have heard mentioned several times 
lately a new science coming into vogue called eugenics. What is it and 
where can I read up on it?" 

Keply. — Eugenics is the science having to do with the improvement 
of the race through heredity. By negative eugenics is meant measures for 
the prevention of reproduction by those whose children would certainly be 
burdens on the community. By positive eugenics is meant all of those 
measures that make for improvement in inheritance. Go to any library 
or to any book store and ask to see the catalog of books and magazines 
on eugenics. 

Birthmarks. — L. H. P. writes: "If you do not believe a mother can 
mark her child, how do you account for these cases, which I know to be 
true? A neighbor s boy in leading a cow with a rope had one of his fingers 
cut off between the rope and a tree. His mother saw the accident, and 
when her baby was born it was minus the same finger on the same hand. 

"My wife's aunt in going by some currant bushes reached through the 
fence and picked some. A woman came out and shouted at her to stop. 
In trying to get her hand out it caught between the pickets and she was 
obliged to drop the currants. When her baby was born it had a perfect 
bunch of currants on its arm in the same place where the mother s arm was 
caught in the fence. This birthmark turns a bright red when currants 
are ripe. At other times it is faint. 

"My mother had a servant with red hair that made her a lot of trouble. 
When my mother s baby was born he had red hair, and during his life was 
a constant worry to my mother. No other red hair in the family that I 
ever heard of. My mothers hair was black and my father s a dark brown. 
I know of similar cases." 

Reply. — You have not set forth all of the facts although you probably 
stated all known to you. For example : How much red was there in your 
father's dark brown hair? How about your grandparents? Your great- 
grandparents? No one of the phenomena related could possibly be the 
result of maternal impression. 

Question of Physical Condition. — J. P. writes: "In a recent discussion 
on the feasibility of first cousins marrying I found that it was considered 
impracticable by most people present. Would the offspring be affected if 
the physical condition of the parents was perfect? Under what conditions 
could cousins marry without ill effect upon their children? Perhaps you 
would rather refer me to some eugenics society or literature published on 
the subject. I should like full information." 

Reply. — 1. In order to decide whether first cousins should marry it is 
necessary to find out, first, if the individuals are free from inheritable 
conditions and, second, if the stock as far back as the great-grandparents 
is free. If so, there is no reason why they should not marry if they live in a 
state where the marriage of first cousins is allowed. 

2. Write the Eugenics Laboratory, Cold Spring Harbor, L. I., New 
York, for their blanks. Fill them out and return them with a request for 
counsel. 

No Bar to Marriage. — G. G. A. writes to ask about a marriage to be. 
The young man is of average height, slender, healthy color, lives a clean, 
temperate life, is full of energy and ambition and has a great love for 



EUGENICS 1021 

work. He is 30 years of age. The woman is about 5 feet 7, well de- 
veloped, has never been seriously ill in her life but is not the husky type. 
She is eighteen months older than the man in question. Of late she has 
heard a great deal about the kind of people one should marry to insure 
healthy children. She is imbued with the idea because of something she 
has read that she has no right to marry a man so entirely her opposite 
physically and eighteen months younger than she. Also the fact that she 
is of German parentage and he of a mixture of Welsh and Irish troubles 
her. 

Reply. — There is no reason why they should not marry. The difference 
in age, the difference in nationality and what yon write of the difference in 
their physiques are in no sense a bar. 

Marriage of Cousins. — D. L. D. writes that she is engaged to marry her 
cousin. He seems fond of her and she of him but she is doubtful and 
wants to know what she shall do about it. 

Reply. — I cannot answer your question without knowing more of the 
facts. There are certain blood strains that are made stronger by inter- 
marriage of members of the strain. There are certain conditions and 
diseases which appear with more frequency and in worse forms in the 
strain as a result of intermarriage. In addition to these last there are 
a few conditions which tend to develop in the children of intermarriages, 
even though there is no taint in the stock. I should suggest that you 
write to Professor Davenport, Eugenics Laboratory, Cold Spring Harbor, 
New York, giving your family history and that of your affianced, what 
diseases they have had, what they have died of, the family traits — and 
ask his advice. 

Second Cousins May Marry. — J. G. writes: "Is there any danger in 
the marriage of second cousins? Would their children be all right?" 

Reply. — No. There are some families where the stock is so bad that 
not even second cousins belonging to them should marry but such families 
are few. 

Intermarriage. — W. B. writes: "Is it a fact that intermarriage is 
detrimental to the offspring?" 

Reply. — Intermarriage may or may not be detrimental to the off- 
spring. Every improved breed of stock has been inbred. Individuals with 
points desirable in the offspring are inbred until those qualities are fixed. 
A time comes, however, when outbreeding is necessary to save the stock. 
On the other hand it has been proved that intermarriage brings about 
imbecility, nervous instability, and a long train of undesirable conditions. 
Mendelism teaches under what circumstances intermarriage is helpful and 
under what detrimental to the offspring. Even when it is gainful it be- 
comes harmful if persisted in for more than two or three generations. If 
a stock has strength in it, intermarriage fixes it in the strain. If it has 
insane or epileptics or cretins or a number of other undesirables in it 
intermarriage fixes those qualities in the strain. 

Blindness Not Inheritable. — Mrs. 0. B. writes: "A few days ago a lady 
wrote the Tribune opposing the bill now before the legislature for a 
colony for the blind. In this letter the lady said children bom to the 
blind will be blind. Is this correct?" 



1022 EUGENICS 

Reply. — No. The children of the blind are not especially liable to be 
blind. The most frequent cause of blindness is infection of the eyes. An- 
other group of causes is the general or systemic infections which affect the 
eyes secondarily. The next most important cause is accidents and injuries. 
Into these three groups fall nearly all cases of blindness. Such are not 
inherited and not inheritable. 

Weismann tried out this question thoroughly. He cut off the tails of 
mice and bred the tailless individuals. He kept this up for thirty genera- 
tions and found that no mouse was born tailless. 

Blindness, the result of infection or accident, is on a par, from the 
inheritance standpoint, with the Weismann bobtailed mice. The idea that 
blindness is inherited is due to the number of blind babies. The infection 
of the eyes which results in blindness is very apt to take place during birth 
or shortly thereafter. 



Such Marriage Forbidden. — J. H. W. writes: "1. Is it lawful for a 
to marry her uncle? 2. What do you think of a marriage of this kind?" 

Eeply. — 1. No. 

2. Such a marriage should not be allowed. If there is insanity, feeble- 
mindedness or viciousness in the stock it is apt to crop out in the progeny 
of such a union. As in times past no particular effort has been made to 
keep stocks pure or even to know what stocks are pure there is no way of 
telling when such unions would be safe. In fact, such unions are practically 
never safe. 

Marriage of Double Relations. — H. writes: "Would you kindly tell me 
whether there is any danger of weakness in the children horn of a couple 
who are cousins? The girl I wish to marry is doubly related to me. She 
is a cousin to me on my father s side and a second cousin on my mother s 
side. Both her health and mine have been nothing but the best since our 
birth. We have never been subject to any sickness, except the measles. I 
am strong. Our morals are of the highest standard. Our ancestors, as far 
as we can trace them, over 200 years, have been people of strong and healthy 
mind and body and have been long lived. As far as- we know, none of our 
ancestors ever died of any disease, but succumbed to old age, most of them 
having attained 65 to 90 years. Do you think that there is danger that 
the children who may be born to us will be weak mentally or physically 
in any way?" 

Reply. — There are states in which you could marry. In the family his- 
tory submitted there is nothing noted that should prevent your marrying. 
You are so closely kin that you had better search your family history for 
inheritable bad traits and conditions. It is not enough that you and your 
intended are free. Go back three generations. Write to the Eugenics 
Laboratory, Cold Spring Harbor, New York, for blanks. Eill these out 
and return to the laboratory. 

Should Cousins Wed? — G. A. writes that he is anxious to marry his 
first cousin. So far as can be learned her ancestors have never inter- 
married. Good health is the rule. In fact, both cousins are of sturdy 
stock. 

Reply. — Irving Fisher says that by prohibiting improper marriages an- 
cient Sparta raised its vitality to a high point of physical excellence. In 
twenty states marriage of first cousins is illegal. Arner's "Consanguineous 



EUGENICS 1023 

Marriage in the United States" discusses the subject excellently, according 
to Fisher. 

In a family tree there can be a few intermarriages without deteriorating 
the stock. In fact, experimenters in Mendelism and expert breeders of 
stock and plants habitually cause inbreeding as a means of fixing a type. 
Where a prospective parent has an especially good point it can be em- 
phasized by inbreeding in the offspring. But scientific breeders recognize 
that while they are strengthening one quality they are weakening the sub- 
stratum, and inbreeding, persisted in, undermines the whole structure. 

The conclusion, which we believe justified, is that while inbreeding in 
beasts controlled as it is by practical scientists is justified, inbreeding in 
the human species where mating is the result of sentiment and impulse is 
subjecting posterity to risks which are not justified. 

Mendel Theory of Eugenics. — A. W. S. writes: "1. Please explain the 
Mendel theory of eugenics. 2. What countries or states, if any, have passed 
or are seriously agitating a eugenics law?" 

Reply. — 1. The Mendel theory of inheritance relates both to good breed- 
ing or eugenics, and to bad breeding. The Mendel theory is too long to be 
given as an answer. To understand it get Castle's book or Drinkwater's 
booklet. 

2. In one way or another the subject is covered. 

Eugenics Literature. — C. 0. J. writes: "Please give me a list of the 
hooks and pamphlets mentioned in your first lectures on eugenics at the 
Y. M. C. A. Any other important literature on hygiene and eugenics you 
would like to recommend will be appreciated" 

Eeply. — "Heredity in Relation to Eugenics," Davenport; "Studies 
from the Eugenics Laboratory, Cold Spring Harbor, N. Y." ; "Problems in 
Eugenics," from the Eugenics Laboratory, Cold Spring Harbor, N. Y. ; 
"Heredity and Eugenics," Castle and others; "Race Regexieration" series; 
"Heredity," Castle; "Eugenics Review," Eugenics Education Society; "The 
Super Race," Nearing ; "The Task of Social Hygiene," Ellis. 

Risk Four Cents. — A. B. writes: "In a recent answer to questioners you 
said: 'Write to the Eugenics Laboratory, Cold Spring Harbor, N. Y ., for 
blanks. Fill these out and return to the laboratory.' Am I to understand 
from this that anyone can thus secure aid in looking up ancestors? Is it 
done free of charge for anyone?" 

Reply. — In looking up ancestors, no. In safeguarding descendants, 
yes within reasonable limits. Risk 4 cents in postage in finding out just 
what they will do for you. 

Advice on Eugenics. — K. K. writes: "At what institution can one find 
out as to whether he or she is fitted mentally to marry?" 

Reply. — Eugenics Laboratory, Cold Spring Harbor, Long Island, N. Y. 

Book on Eugenics. — Inquirer writes: "What book would you recommend 
on eugenics (from a physical standpoint)? Where can it be procured? 
Can Slemons' 'Prospective Mother be bought in any large book store?" 

Reply. — Davenport's "Heredity in Relation to Eugenics." Your book- 
seller probably will not have Slemons in stock. He can call up his jobber 
by telephone and get Slemons and Davenport. 



1024 EUGENICS 

Mentality of Twins. — R. A. B. writes: "I read an article some time since 
on the effect the heaVth or the mind of one twin has on the other twin. 
For example, if one were happy, the other, though miles away, would be 
likewise, or vice versa. If this is true, what effect would the mind of a 
twin who has been made feeble-minded by an overdose of a drug have 
upon the other twin? Or is the article I read all nonsense?" 

Reply. — It is nonsense. Twins are liable to be of the same general type 
of mind, and, therefore, are disposed to be alike in taking things seriously 
or lightly or in some other general quality. However, there are many ex- 
ceptions. Two ova from the same mother stimulated by two cells from the 
same father, the two cells resulting in two children developing simultane- 
ously, are liable to result in children much alike mentally. According to 
Mendel's teaching the children may be very dissimilar mentally. Why 
not get a copy of the report on the "Heredity of Feeble-mindedness" from 
the Eugenics Laboratory, Cold Spring Harbor, Long Island, N. Y. ? It 
sells for 4 cents. 

Reason for Birthmarks. — 8. K. writes: "1. If birthmarks are not 
caused by impressions of the mother, what is the cause? 2. Why is ergot 
given in postpartum cases to prevent hemorrhage? I cannot understand 
how the same drug is used in almost opposite ways. 3. Are there any par- 
ticular reasons why a person who has nightmare should not marry? Could 
such a thing be hereditary?" 

Reply. — 1. Birthmarks are of so many different kinds that it would take 
a good many columns to refer to each. Each has its reason for being. I 
can discuss but one in the limits of this reply — strawberry marks. The 
area just below the skin is rich in blood vessels. When, in a given patch, 
the blood vessels are larger than in the surrounding skin, the area shows as 
a strawberry mark. As the child develops the size of the vessels in the skin 
is large as compared with their size after the skin upbuilding has come to 
a rest. The need for blood in the skin, the size of the blood vessels, lessens 
relatively. In a strawberry area this diminution does not take place. Na- 
ture leaves a bit of scaffold behind. The reason may be a local injury or 
hurt or infection. The mind of the mother is not hooked up in any way 
with the capillaries in the skin of the baby. 

2. Ergot contracts smooth or involuntary muscle fibers. The blood 
vessels contain such fibers — therefore ergot contracts them, makes them 
smaller, stops hemorrhage. The uterus is composed of smooth or invol- 
untary muscle. Ergot stimulates this muscle to contract. The contracting 
muscle squeezes the blood vessels and collapses them. This action is of 
importance in stopping uterine hemorrhage. It is pretty well agreed that 
ergot is just about powerless to bring about abortion. 

3. No, but if the supposed nightmare is really epilepsy the person 
should not marry. 

Fright and Birthmarks. — L. writes : "I must take issue with you on the 
question of birthmarks. I know of a young wife who was called on by a 
one-armed fish peddler. Without thought he thrust the stump of his arm 
almost into her face. It gave her a shock.' A few months later she gave 
birth to a fine girl baby with no hand on one of the arms. It was as if the 
hand had been amputated. I have imagined that your positive stand re- 
garding birthmarks might be taken in order to free expectant mothers 



EUGENICS 1025 

from apprehension. I did not think it could represent your actual opinion 
in the matter." 

Eeply. — After the first third of pregnancy is passed the arm of the de- 
veloping child is just as definitely developed as it is in an adult. It would 
be just as easy for a woman to think her own hand off as to think off the 
hand of her baby. The cord got caught around the hand and strangled it off 
or the child was injured in the arm region while carried by the mother. 
Why go snooping around looking for mystery in connection with a case 
like this since when the facts are known the explanation of them is as 
simple as the ringing of a bell when the button is pushed? 

Deafmutism Inheritable. — B. L. D. writes: "Kindly enlighten me as 
to why, as a rule, as far as my observations have been, the children of 
married first cousins are bom deaf and dumb? Is it due to some physical 
cause through the mating of first cousins?" 

Reply. — Deafmutism is inheritable. Intermarriage where there is 
mutism in the stock is liable to result in a certain proportion of the chil- 
dren being deaf-mutes. By "in the stock" is meant all the descendants of 
one's great-grandparents. Back of that is not of much consequence. 
Deafness coming on after middle life is in a smaller degree an inheritable 
quality. 

The Yolta Bureau, Thirty-fifth and Volta Place, Washington, D. C., 
would be glad to have an accurate statement of the inheritance phenomena 
of deafmutism noted by you. Davenport's book gives the laws of in- 
heritance of deafmutism. 

Eugenics No Fad. — I. writes: "Is this talk of eugenics merely a fad, 
or is it something which is really sane, serious, and necessary? Where 
does one secure the certificates for a eugenic marriage?" 

Reply. — No, eugenics is not a fad. It is sane, serious and necessary. 
The marriage laws differ in different states. The Wisconsin law, commonly 
referred to as a eugenics law, has just been upheld by the Supreme Court 
of that state. 

It will be some time before it will be certain just what should be the 
requirements of a eugenic marriage. Let me suggest that you get a copy 
of the blank required in Wisconsin and have any reputable physician ex- 
amine you as required by that blank. 

Books on Eugenics. — N. A. W. writes: "Where can I secure a copy of 
Davenports 'Eugenics, Twelve University Lectures/ or other writings 
relating to marriage? Can a person obtain any information by addressing 
the Eugenics Record, Cold Spring Harbor, N. Y .? What is meant by 
gonococcal infection?" 

Reply. — 1. Your bookseller will get them for you. "Twelve University 
Lectures" is published by Dodd, Mead & Co.; "Heredity in Relation to 
Eugenics," by Davenport, is published by Henry Holt & Co. 

2. Yes. If you want to know about marriage it will send you blanks 
to fill in. 

3. Infection with gonococcus, the germ which ordinarily causes gonor- 
rhea. 



CHAPTEE LV 

Massage 



MASSAGE A CURATIVE AID 

Hospitals and dispensaries usually stop when they do as much as 
medical care and nursing can accomplish. The rule is to carry the patient 
to the point where convalescence is established and then to dump him out 
of his bed to make room for another case. Incidentally he must work his 
way back to a condition to earn his living the best he can. 

Usually he succeeds admirably and 
then everybody is happy. Sometimes there 
is nowhere any reserve to carry him back 
to strength and then he drifts back to the 
hospital or to something worse. 

A few years ago a New Englander, a 
crusader born and bred, Cabot by name, 
began to preach the gospel of a broader care 
of the sick. According to his doctrine to 
care for a man sick of disease was not 
enough. The man must be taken into ac- 
count before the disease and then the man 
left by the disease must be cared for and 
trained back into efficiency. The cure was 
not completed until the man's muscles 
were hard, his wind good and his physical 
machine pulling together. This required 
the services of physicians, nurses, social 
workers, masseurs and physical trainers. 
He succeeded in getting the Massachusetts 
General Hospital to put most of the plan 
in operation. Since then most of the better 
regulated hospitals have felt the influence 
of Cabot. 
About three years ago a Jewish hospital in New York City fitted its dis- 
pensary to give massage, mechanotherapy and muscle exercise to patients 
referred to it from other departments of the hospital. One of the fields 
which it has worked on especially is to cure up fracture cases so that they 
could work efficiently. 

In the old days it was the custom to amputate badly broken, badly 
torn or badly infected limbs. One-limbed people were plentiful. 

The practice was bad but treatment was so poor that it was better to 
lose one's limb than to lose one's life. 

1026 




Fig. 414. — Exercise Bars to be At- 
tached to Window. 



MASSAGE A CUEATIVE AID 



1027 



Now treatment is so much better that in spite of the greatly increased 
hazards of our heavy machinery one-limbed people among the younger men 
are rarely seen. Every year will see the number grow less. 

A few years ago our methods 



of handling fractures were so crude 
that if we could get the bones to 
knit together everybody was satis- 
fied. If the limb was somewhat 
crooked or if the adjacent joints 
were a little stiff it was thought to 
be inevitable. Ofttimes we had to 
be satisfied with a false joint — the 
bones would not knit. 

Now a failure to knit is inex- 
cusable except where the fracture 
is of the hip within the capsule. 

The next step will be for the 
surgeons to operate promptly on 
those hip fractures (intra-capsu- 
lar), nailing the fragments to- 
gether. When such' fractures are 
treated by operation the day of old 
ununited intracapsular fractures 
will be over. 

So far as the other fractures 
are concerned they are now expected to heal in such a way as to leave the 
limb strong and the joints just as pliable as before. 

To bring about this last result several procedures have contributed. The 
first is the use of the X-ray. When a bone is thought to be broken the X-rays 




Fig. 415. — Door Exercising Bar. 




Fig. 416. — Exercise for all Muscles, Especially for Leg and Shoulder Muscles. 

show the location and the nature of the break. When the fracture is reduced 
so that everything is in the right place and no tendons or nerves are caught 
between the fractured ends are not guessed at but are demonstrated with 
X-rays. Then, when, during the course of the recovery, it is thought neces- 
sary the X-rays show just how things are. 

The next procedure that is contributing to the better result is the use 
of massage and exercise of the limb. Mr. Eumely tells us of two men with 
broken legs whom he saw treated in a German hospital. One, a professional 



1028 MASSAGE 

man, was told that he could have his leg put up in an ambulatory splint and 
that he could come and go as he pleased. He could get the advantage of 
sun, air and exercise. 

The other was insured under the government insurance. He would have 
none of the ambulatory splint. He was entitled to his month of rest in 
bed and he would have it. He never had heard of a man with a broken 
leg walking around the street. The man who had more care and what he 
regarded as better treatment got the worse result. 

Thirty years ago a Frenchman, Champonniere, said he thought broken 
bones should be massaged from the beginning but the idea was too radical 
for that day and, besides, it was quite risky before the days of X-rays. 

One department of the Mount Sinai Hospital gives massage just as soon 
as it seems good judgment. The nearer the fracture is to a joint the quicker it 
must be begun, because a stiff joint following a fracture is no longer held 
allowable. Those stiff jointed people are always at a disadvantage and must 
not be tolerated among this race so near to the super-race. 

A frequent fracture is Colics' fracture, a fracture of both bones of the 
forearm just above the wrist, the fracture one gets in cranking an automobile 
or falling on the ice. 

When these fractures were put up in splints and massage started in the 
first week it was found that the arm was cured in twelve to twenty days. 
When massage was begun in the second week cure took three or four weeks. 

When massage was begun in the third and fourth week cure took six 
weeks. When the massage was postponed longer than four weeks the cure took 
six to twelve weeks and longer. 

In fractures through the elbow the same general results held true. If 
the massage was begun before the week was out the cure was effected in 
three to four weeks. 

In the case of fracture of a long bone as, for instance, the thigh bone, 
inches away from a joint, it is safe to hold the bone steady for two weeks 
before beginning massage. 

The massage indicated is a gentle rubbing pressure. The part to be 
massaged is to be well greased with vaselin, steadied with one hand and the 
pressure gently applied with the other. 

Wolf in his report advises us to be guided by pain. Do not cause pain; 
for if you cause no pain you can be certain that no harm is being done. 

Not only should the effort be to prevent the joint from becoming stiff 
but the muscles must not be allowed to shrink. 

Therefore, toward the end of the treatment, say after the third week, the 
massage may be of the kind ordinarily called massage. Instead of a gentle 
rubbing of the skin it may be the usual pinching and digging effort to 
stimulate nutrition in the muscles. 

However fractures cause but a small part of the crippling one sees. 
There are joints stiffened and gnarled by rheumatism, gout, rheumatoid 
arthritis, and by gonococcal infections. 

There are also flabby and weakened muscles. They may result from 
infantile paralysis, locomotor ataxia and other forms of paralysis and disuse. 
These conditions distort the human machinery, getting it out of balance. 

"I am all crippled up with rheumatism/' is an expression as familiar as 



MASSAGE A CURATIVE AID 



1029 



a household word. Why are you so? The reason is to be found usually in 
the fact that you have not completed the treatment. 

A man comes down with rheumatism: he sends for a physician; the 
physician prescribes for him and he gets better. His pain subsides and he 
goes back to work. 

That is not enough. The use of the salicylates will relieve the pain all 
right; they make work more bearable: they may limit the damage which the 
infection otherwise would have done but they do not effect a cure. 







V 



Fig. 417. — Exercise for All Muscles, Especially for Muscles of Abdominal Wall. 



In acute rheumatism the joint is infected. The germ which causes the 
rheumatism gets into the blood stream through some part of the body such 
as the tonsils. 

In the treatment of the disease, then, regard should be had not only 
for the relief of pain but for rinding the port of entry of the germ which 
causes it and putting and keeping it in order. 

Rheumatism, though, does more than cause pain. Being an infection 
it may be of sufficient degree to cause the bones of the joint to grow together 
resulting in stiffness. If it does not reach this degree of damage it causes 
injury to delicate and important structures of the joint. 

As the result of the injury there may be a creaking, popping sound 
besides more or less pain when using the joint in after years. 

Treatment of rheumatism then should have in view not only relief of 
pai?i and the control of the gateway of infection but the correction of damage 
done to structures that have suffered from the rheumatic attack. 

This can be done in two ways : by treatment directed to the care of the 
joints proper and by treatment having regard for the care and protection of 
the soft parts involved such as muscles and the various organs of the body — 
heart, kidneys, and the like. 

For the relief of the pain of rheumatism the salicylates and vaccine 



1030 



MASSAGE 



are our chief remedies. Vaccines have approached perfection so closely that 
they are being used quite generally at the present time* 

A much more important phase of the treatment of rheumatism consists 
of efforts looking to the prevention of stiffness of the joints, or, if stiffness 
has occurred, looking to the correction of it. This can be largely done by 
massage and exercise. 

People who have stiff joints resulting from rheumatism and arthritis 
should be encouraged to practice passive use until they can be brought into 




Fig. 418. — Mild Exercise for Trunk and Leg Muscles. 



active service. Massage greatly helps to restore functions and hasten absorp- 
tion and elimination of diseased products which have been left in the wake 
of rheumatism. It not only does this but it gives tone to the muscles, thereby 
creating a more normal balance between the joints and muscles and insuring 
a more harmonious working of the human machine. 

Where it is desired to employ exercise for the restoration of the function 
of an arm, a hand or a limb a well defined plan of exercise procedure should 
be followed. The exercise treatment of one extremity or joint does not mate- 
rially differ from that to be employed in treating another. 

For this reason when a plan or system of exercises has been worked 
out and carefully followed for a short time it becomes less irksome to execute 
each succeeding time. 

When doing exercise one should do his test to accomplish something. 
Each succeeding attempt should have in view the accomplishment of just a 
little more good. 

Where a hand or wrist, for instance, is crippled as the result of arthritis 
effort should be made each day to make it a little more useful. Try to move 
each finger just a trifle more each day. Use gripping exercises and note 
the increased strength and mobility. 

In the beginning these* efforts will present many discouragements but 
by persistent application and effort better use of the part affected will be your 
ultimate reward. 

Since the germ theory of the cause of rheumatism and arthritis has been 



MASSAGE A CUKATIVE AID 1031 

advanced many people have got the notion that mineral springs have lost their 
usefulness in the treatment of this disease. 

This is not so. Mineral springs are most valuable auxiliaries in the treat- 
ment, especially in the chronic stage. Nothing more greatly assists in ridding 
the body of poisons and increasing its resistance. 

In locomotor ataxia, where the muscles have become flabby and weakened 
from lack of nourishment and disuse, much good has resulted from the sys- 
tematic employment of massage and scientifically planned exercise in efforts 
to restore muscular function. 

By this means muscles that have been wasting away have been made strong 
and brought under such control of the mind that it is difficult to identify 
those afflicted with this disease. 

In other words where formerly the sufferer acted automatically he now 
acts mechanically but on account of his persistent training he has been able 
to establish a walking gait and such control over his arm movements that it 
is difficult to distinguish him from the normal. 

What has been done for a man suffering from locomotor ataxia can also 
be done for those suffering from rheumatism and a tendency to arthritis if 
the treatment is begun early enough. Even where the deformities are pro- 
nounced and no efforts at correction have been made for a period of years, 
one is not justified in a lack of effort at correction along the lines outlined. 



CHAPTER LVI 

Exercise 

Professor Schock of Munich tells us that we must exercise on all fours. 
We are descended from four-footed animals. Our veins, our stomachs, and 
various other organs have not fully adjusted themselves to the upright posture. 
Therefore, back to the four-footed at least for an hour or two each day. Be it 
curvature of the spine or stomach trouble or biliousness — back to the four- 
footed. 



breast bone 




cervical vertebrae 
clavicle or collar bone 



elbow 

innominate or hip bone 

ulna 

radius 

pelvis 



femur 



knee cap 



tibia 
fibula 



bones of metatarsus^! 
phalanges of toes J 00 



Fig. 419. — The Skeleton. 
1032 



EXERCISE 



1033 




Fig. 420. — Upper Surface of Left Clavicle or Collar Bone. 



The advice may be good under rare circumstances. Some lazy, lolling 
folks will be improved by anything that takes them out of easy chairs. Gen- 
erally speaking, the plan will do more harm than good. Why? 

Much the most bendable part of the spinal column, except the neck, is 
that in the small of the back — the lumbar region. The little cartilages 
between the vertebrae permit of a good deal of sway. Whenever the lumbar 
part of the column 
sways forward the dor- 
sal or chest part of the 
column arches back. In- 
crease the forward curve 
of the abdomen and 
there always follows 
some increase in the 

backward curve of the chest. When this is bad it is called humpback. 
But the trouble does not stop with the back. As the chest column arches 
back the ribs shape the chest narrow and deep. Whereupon the shoulders slide 
forward — the condition is stoop shoulders. The shoulder blades flare out — 
winged scapula. The forward gliding shoulders make the chest cave in in 
front — hollow chest. These conditions make for consumption, anemia, and 
low vitality. 

Dr. Wiener of Chicago pursues a plan just the oppo- 
site of that of Schock. He makes his subjects lie on their 
abdomens on a hard surface. He then makes violent trac- 
tion on the head backward and on the shoulders back- 
ward, at the same time pressing hard on the back of the 
spinal column in the chest region. Thus he lessens the 
chest curve and at the same time indirectly he straightens 
the lumbar curve. The ribs flatten out. 

Woods Hutchinson and M. G. McHugh found out a 
long time ago that consumptives had narrow chests. These 
Wiener movements broaden the chest, throw the shoulder 
blades back, move the shoulders around back of the vertical 
line and banish the hollows above and below the collar 
bone. In time the chest takes on a shape midway between 
the hollow chest and the bantam type. 

Other exercises consist in lying on the back and 
bending the head back over the edge of the table and 
carrying the arms over the edge of the narrow table. 
The idea is to throw the chest up by dragging the arms 
down. 

Another exercise consists in having the patient lie 
with the face down on the table but with all the upper 
part of the body projecting over the end of the table. 
The operator supports the patient by the arms. The arms are drawn up as 
far as possible and the head is bent as far as possible toward the floor. 

The purpose of these various exercises is to straighten the spinal curves, 
to slide the shoulders bach and to eliminate the hollows about the collar 
bone. 




Fig. 421.— Fibula, 
Lower Leg, Tied 
in a Knot, After 
Maceration in a 
Dilute Acid. 
From a specimen 
preserved in spirit. 
(Dalton.) 



1034 EXERCISE 

The man who spends his days at sedentary work accumulates fat in some 
inconvenient localities, converts his muscles into structures of low efficiency 
and loses his wind. While he is better oif for the day's work with poor 
muscles than with good ones he should keep them as high as a certain base 
line. 

There is no reason in having a big-muscled man do brain work or in a 




Fig. 422. — Left Scapula, or Shoulder Blade. 

brain working man having monster muscles. Such a combination is a waste, 
and eventually harms the person in whom the combination exists. 

On the other hand a man who keeps himself physically fit gains in effi- 
ciency and in his ability to fight disease. 

A walk for a mile or more in the morning and again in the evening, 
kept up for a few weeks, will put the average person in pretty good shape. 
Begin the exercise with a small dose and gradually increase it. The 
exercise should be active enough to fill the skin vessels with blood and to 
bring about a profuse perspiration. The perspiration of itself does no 
good. 

Sweat carries off practically none of the body waste. It is composed of 



LEAEX HOW TO WALK 



1035 



water and salt and little besides. The common idea about sweating out poisons 
has very little of truth in it. But to fill the vessels of the skin with blood 
does wash the waste out of the tissues back to those internal organs capable of 
burning them up. That's where the good 
comes in. 

The amount of exercise taken should be so 
gradually increased that no stiffness and soreness 
is produced. Bear this in mind : stiffness and 
soreness are signs that mean the thing has been 
overdosed. In time an ordinary dose of overdoing 
will be recovered from, at least so far as the pain 
and soreness is concerned, but a record of it is 
made on the arteries. 

If overdoing is persisted in. it may finally end 
up in arteriosclerosis, high blood pressure or some 
other disease of the worn out group. Some people 
will find it better to train for the vacation by 
swimming once or- twice each day, others by climb- 
ing stairs. 

If one's office is on the fourteenth floor let 
him get off at the tenth floor and walk up. In 
the afternoon let him walk down to the tenth 
floor and take the elevator there. Two days later 
let him make the eighth floor the end of his ride 
and so on until he climbs the fourteen flights with- 
out panting or soreness coming after. Whatever 
method is the most convenient let him follow it 
until he has some wind. When he lands at the 
resort chosen the impulse will be to try every 
stunt the first day. 

The gypsy in him is calling. The memories 
of his youth in the woods and fields, the recollec- 
tions of the old swimming hole, of fishing in the 
creek, of hunting with the old muzzle loader; all 
these are calling. Besentment at days spent cooped 
up, jailed — this is driving. The man feels an 
almost irresistible impulse to do it all at once. 
He overdoes. In consequence he is again cooped 

up with stiff -joints, sore muscles, aching feet, or 

r , x i t i ix Fig. 423.— Right Femur, 

sunburnt back — days are lost. Thigh Bone 




LEARN HOW TO WALK 



Physiological laboratories and even the well organized boards of educa- 
tion equip themselves with an instrument called an ergograph. This little 
instrument accurately records the power and rhythm of muscle movements. 
Making use of it, we have learned many things about muscles that the ath- 



1036 EXEECISE 

letes had suggested in a crude, dogmatic way as the result of their ex- 
periences. 

We know much about fatigue, its causes, its effects, the differences in the 
rate of its development according as muscles work within easy limits or under 
some stress. I have never seen any ergograph testing of the leg and foot muscles 
to discover the extra strain of "walking wrong" as compared with "walking 
right." But there is a lot of curbstone opinion that the man who "walks 
wrong" may "get there just the same" but he is more tired than the other 
fellow when he does. I am sure the ergograph would confirm this curbstone 
opinion. 

The ankle joint can only move backwards and forwards. The little lateral 
play in the foot is between the bones of the foot itself. The muscles of the leg, 
upper and lower, are so placed as to move the foot forward or back — toward 
the toes or toward the heels. When in walking the foot is carried forward, 
slewed out, the muscles waste some of their power pulling against their tendon 
sheaths. From the mechanical standpoint, the toes should point straight 
forward or a little in — a very little pigeon toe is a good arrangement. 

When the body is still plastic it is good judgment to. spend some effort 
in learning how to walk rightly. Why should the mother stop her teaching 
when the baby learns to walk? Most children under the school age point 
their feet about right. The turning to one side or the other is noticeable 
in the mid-school years. 

Possibly the knee breeches age shows up a degree of deformity which 
may pass unnoticed when the clothes are worn longer. If this is true the 
trouble may be progressive from shoe time on. At any rate, in those years 
the body is changing so much that with proper care a tendency to toe out or 
toe in can be corrected. 

Under efforts made to correct the bones will shape themselves just a wee 
bit differently, the tendon sheaths will move a fraction of an inch forward 
or back, the muscles will change their location a bit, the body will readjust its 
automatic balancing apparatus a little differently; whereupon the leg muscles 
will be able to work at higher efficiency and with less tire. 

The first step in the training to cure toeing out will be to teach the child 
to stand with the heels apart. When standing in this way the toes are natur- 
ally disposed to turn conversely. When the child is pigeon-toed, to stand 
with the heels together will throw the toes out. 



ATHLETIC GAMES 

From the physical standpoint, handball is the kingpin. In it the eye must 
see, the brain must judge, and the muscles must move with lightning rapidity. 
In fact, as Congressman MacKenzie of Kentucky once said: "In comparison, 
the lightning is a puling paralytic." 

Handball is the exercise of the fit. When a man is fit enough to play 
handball he is in such good physical condition that he does not need to play it. 

Tennis is an expurgated handball. It is also a game for the fit but 
the same degree of fitness is not required. By beginning with a slow com- 
petitor, a man or woman with a soft heart muscle, in fact one who is generally 



ATHLETIC GAMES 



1037 



soft, can stand the pace. In tennis, the eye, the brain, the muscles are not 
compelled to act with the lightning rapidity of handball; nevertheless they 
must move much faster than in golf. It is the best of all exercises for men 



Articulated with radius 
forming wrist joint. 



Carpus 



Metacarpus 




Fig. 424. — Bones of the Left Hand Palmar Surface. 



and women with low blood pressures, no thickening of the arteries, good heart 
muscles and no special superfluity of fat. 

Why baseball should have such a grip on boys does not appear at first 
glance. It comes pretty near being a game for men of an age in between that 
of tennis and golf. What spoils it for older men is that 90-foot top speed 
run — a run occasionally stretching to 360 feet. That run takes wind and, 
therefore, baseball is a game for boys. 



1038 EXERCISE 

Of all games it has the center of the American stage. It takes hundreds 
of thousands of people out of doors and gives them an afternoon of fresh 
air and sunlight; but more than that, it makes millions of boys exercise in 
the open air during all the months of the late spring and early summer. 
It is a great health department. 

What has made it so is the fact that it is our great spectacle. The 
spectator who goes wild over the game, the hero worshiper who pedestals the 
players, the sporting extras, and the pink sheets — these are factors which fill 
every vacant lot with "kids" playing baseball. 

And, in that it makes every boy want to play, want to own a mask 
and "mitt," the game is worth all that it costs. In fact, it is cheap at the price. 

PLAYING GOLF 

Golf brings out of doors exercise within the reach of men whose hearts 
are enveloped in a good deal of fat and whose artery walls are pretty thick. On 
the one hand, this group of people could not play tennis, handball, or lacrosse. 
The exercise is too intense. On the other, they will not botanize because 
it has no competitive features — is not intense enough. They need fresh, clean 
air and the smell of grass. They need long walks. 

They need just that momentary allover muscle tension of driving, the 
unrestrained muscle action of putting, and the community muscle action of 
holing. They need to tighten the play strings that they may loosen the 
business strings — for all the strings cannot be slack at the same time. They 
are not built that way — the keyboard would fall to pieces. 

When a man has reached forty years of age without having educated 
certain groups of muscles to work together for a drive or putt he can never 
teach them the tricks so well as a young man can train his. But let us not 
miss the spirit of it. Golf is a means to an end and competition is incidental. 
As a means of keeping men and women able to yoork at a high degree of effi- 
ciency during the forties, fifties, sixties and sometimes the seventies it has 
no equal. 

PLAYING BILLIARDS 

A cable is made up of wire through which the electric current passes, 
insulation to prevent the current from leaking out and wrapping to give 
strength and protection to the parts within. 

When a baby starts to kick its foot it kicks with the whole works from 
"stem to gudgeon." When a baby starts to wiggle its toe it makes it 
unanimous — it wiggles all over. 

The reason — a baby's nerves have no insulation. When its brain cell 
sends out word to move a toe the impulse spreads over everything, like 
water over a levee. The impulse not only moves the toe but it moves a score 
of muscles uselessly. 

As time goes on its nerves are wrapped in insulation and as they be- 
come so wasted motion is decreased. After a while the brain can send out 
an impulse to move a single joint, the impulse travels straight to its appointed 
place and no energy is lost. 



PLAYING BILLIARDS 



1039 



All this is education — education for efficiency. 

The billiard player has developed to its highest degree this capacity to 
move just the right muscles and no others. His eye sizes up a situation, its 
mathematics, its physics. His judgment weighs one stroke against another. 
A line of procedure is determined upon. 



:^"Tfr> ; 




Trochlea 
Fig. 425. — Left Humerus. 




Artie, with semilunar and 
Radial head scaphoid of carpus. 

Fig. 426. — Left Radius and Ulna, or Bones of the Forearm. 



The telegrams are sent out from his brain to the different muscles. Each 
is given just its work to do — no more, no less; each is told just when to do 
its work — no sooner, no later. The action is loosed. 

Upon the judgment the muscle sense, the touch sense, the cooperation, 
the coordination, the insulation, the work together, the control depend 
whether the shot wins or loses. 



1040 



EXERCISE 



Some have said the measure of civilization is control— that society 
succeeds if government controls and if men have self-control. Assuming this 
to be true, governmental control, self-control, brain control, muscle control, 
are a part of the same scheme. 

It is a very poor view of health work that does not include work for a good 
physical development, a well controlled mind and body. In this broader view 
billiard playing has its health relations. 

Billiard halls are usually badly ventilated. Many prominent billiard 
players have died of consumption. There could be no better monument to 
Schaefer and Ives than a solution of the problem of ventilation of billiard 
halls. 

ARCHERY 



Women write to me: "How shall I get rid of pimples?" The answer 
is to "get fit." A prize fighter who is pimply never wins. Women write to 




3 2 




Fig. 427. — Thorax, Anterior 
(Sappey.) 



View. 



Fig. 428. — Thorax, Posterior View. 
(Sappey.) 



me : "How shall I prevent wrinkles f The answer is to develop the muscles. 
The muscles of the skin are a part of the same muscle system as those of 
the arms. 

Women can play any games except football. They should swim and row, 
play tennis and golf — but none of these gives them any better field than 
archery. 

The training gained in archery is similar to billiards, with the added 
advantage of being an out-of-doors diversion. In archery the eye must be 
trained to find a point of aim, which is often a small leaf on a tree sixty 
yards away. The muscles must be under such control that the arrow is not 
loosed too soon or too late and, if the arrow is to go right, muscle sense, 
muscle control and muscle cooperation are all made use of. 

Says Miss Leigh in Badminton: "Nevertheless, archery has advantages 



SWIMMING 1041 

over many amusements which renders it specially suitable for ladies. No 
hurried movements or violent exertion, no ungraceful attitudes or contortions 
are necessary; it need never be anything but quiet, graceful, and ladylike. 
And also, there is no restriction as to age — young, middle-aged, and old can all 
shoot in some form or other if they have bows suited to their strength. For 
delicate or growing girls it is a most healthy exercise, taking them out into 
the fresh air; they must hold themselves upright, and their chests are ex- 
panded in drawing up. It is a gentle and elegant amusement for young 
ladies, and most suitable for the matron who feels it undignified to take 
part in some outdoor games and yet is quite young enough to enjoy them." 

Archery develops and strengthens the muscles of the arms and wrists as 
well as those of the abdomen. Walking to and from the target and bending 
to pick up the arrows that fall on the ground all bring into play other muscles, 
especially those of the legs. 

SWIMMING 

The human animal is somewhat up against it for exercise in hot weather. 
He knows every muscular contraction means more heat and already getting 
rid of heat is a question. Furthermore, the more muscle work the more 
tissue used up and, therefore, the more food required. But the more food 
eaten, the more heat made. What can be done about it ? 

Theoretically, he knows he should exercise in the cold but how is that 
to be done? Why, swimming of course. The answer is plain and there is no 
other this side of the line of perpetual snow. 

^Yhen swimming the muscles are working hard, squeezing out waste, 
pumping in new nourishment — processes good for the muscles, for every other 
life process within the body — therefore highly desirable. 

But these muscle movements make a great excess of heat. If they are 
made in hot air it is difficult to get rid of this heat. On the other hand, 
when made by swimming the excess heat is easily got rid of. The temperature 
of water is 50° to 70°. Water is a better conductor than air; bathing suits 
are lightweight ; swimming fills the bill. 

Swimming teaches proficiency in an art which may be a life-saver. It 
gives an opportunity for plenty of muscle exercise without danger of over- 
heating. It gives opportunity for the stimulus of cold applied to the skin — 
good in summer as well as winter. Therefore, every community should 
see that its people have ample swimming facilities, for such facilities are just 
as necessary to high grade health and first class physical efficiency as garbage 
disposal, and much more necessary than an excess of paving. 

And yet what town pays any attention to its swimming hole ? If a village 
boy wants to go in the creek he must undress and dress on a muddy bank, 
swim in sewage pollution and then go home to take his chance of a licking. 

One of the men rescued from the Titanic who was in the water for several 
hours gave it as his opinion that any man who could have kept a level head 
should have been able to keep afloat until the rescuers arrived. This man's 
opinion was right in part, although he apparently overlooked the fact that the 
average man cannot make heat enough to keep alive when submerged up to his 
chin for several hours in freezing water. 



1042 EXEKCISE 



EXERCISES FOR CONVALESCENTS 

Around any hospital one can see men and women feebly walking along 
the street. Many of them are convalescents leaving the hospitals for their 
homes and boarding-houses. In a certain sense they are well. Their dis- 
ease is cured, their operation wounds have healed and they have been 
asked to surrender their places to others who need to have their diseases 
cured, who need operations. 

Though cured of their former afflictions they are not ready to take up 
their former tasks. Some are fortunate enough to have good homes to 
convalesce in. Others can go to the convalescents' hospital at Algonquin or 
elsewhere. Many must fight for strength under circumstances that do not 
make for strength. 

In the Journal of the American Medical Association, April 19, 1913, a 
New York surgeon, Dr. Pool, tells how he teaches his patients to harden their 
muscles while they are still in bed. Following this plan, the convalescent can 
go forth from the hospital with muscles strong and enduring enough to get 
him home with ease and after a little while he will be equal to a day's work 
at carpenter's bench or anvil. 

The exercises are twelve in number : 

1. Bending the feet up and down. 

2. While lying flat in bed roll the right foot out and then in. Eepeat 
with the left foot. 

3. Lying flat on the back raise the right leg to the vertical position; 
carry it back. Repeat with the left leg. 

4. Draw the knees up one at a time; straighten them. 

(After appendicitis operations, hernia operations, and abdominal op- 
erations these exercises should be done with caution.) 

5. Fist closed and opened. 

6. Hands bent forward and back. 

7. Hands turned palm down and then palm up. 

8. Elbows bent and straightened. 

9. Arms carried forward and back. 

10. Head raised and lowered. 

11. Head moved from side to side. 

12. Breathing — very deep. 

To get the most good from exercises 1 to 9 Dr. Pool says, "All move- 
ments should be performed with voluntary muscular resistance." By this 
is meant, all of the muscles of a part are held tense while the movement 
advised is carried out. 

To begin with, each movement is done five times each period and there 
should be three periods a day. The number may be gradually carried up from 
five to thirty. 

The result of this plan is that the patients feel better and get well faster. 
They leave the hospital with muscles that have some strength in them. Instead 
of having to learn to walk over again they are able to make their muscles 
do team work from the start. 

One would think that the danger of sudden death would be increased 



EXERCISES FOR CHILDREN 1043 

by these exercises but Dr. Pool says no. Rather, he asserts, will the better 
circulation and better muscle tone of these patients prevent them from the 
thrombi and emboli which sometimes cause sudden death in convalescents. 



EXERCISES FOR CHILDREN 

Professor Sudor in charge of physical training in the Chicago schools 
recently sent out a book of instructions to principals from which the following 
is extracted: 

"Practically no attention has been paid to posture, and this .is only 
brought about by thorough drill in calisthenics and apparatus work. These 
movements will tend to develop the chest and trunk muscles, and guard 
against possible spinal deformities." 

The instructions for open-air centers are as follows : 

1. Inhale and exhale several times. 

Raise arms sideward and inhale; lower arms and exhale. 

Rise on toes and inhale; lower heels and exhale. 

Bend head backward and inhale; raise head and exhale. 

Raise arms sideward, rise on toes, and inhale; lower arms and heels 
and exhale. 

Raise arms sideward and twist, bending head backward, and inhale; 
lower arms, raise head, and exhale. 

2. 1 — Hands behind neck, and sit erect — place ! Hands on lap — place ! 
2 — Hands behind neck, and lean back — place ! Sit erect, and hands on 

lap — place ! 

3 — Head backward — lower ! Raise head, and sit — erect ! 

4 — Head backward, and lean back — lower ! Raise head, and sit — erect ! 

5 — Lower head backward, raise chest and inhale deeply — lower ! Raise 
"head and exhale — raise! 

6 — Raise left arm sideward and turn head left — raise ! Lower arm, 
and head to the front — turn ! 

7 — Like exercise 6, but right. 

8 — Place right hand behind neck and turn head left — place ! Lower arm, 
and head to the front — turn ! 

9 — Like exercise 8, but vice versa. 

10 — Lower head backward, raise chest, inhale deeply, and lean back. 
Raise head, exhale, and sit — erect ! 

The above exercises to be conducted by command. Practice each exercise 
several times. 

Recreation exercises. 

Exercises in sitting position. 

From the erect position, forearms toward chest, finger tips touching, 
elbows sideward. 

1 — Move arms slowly sideward as far as possible, and twist the arms, 
knuckles down. Return to starting position. Practice several times. 

2 — Like 1, but inhale at first movement, and exhale at second. 

3 — Like 1, but lower head backward at first movement and raise head 
at second. 



1044 EXEECISE 

4 — Like 3, but with inhaling and exhaling. 

5 — Like 1, but with leaning backward, arms over desk in rear. 

6 — Same, with inhaling and exhaling. 

7 — Like 6, but with lowering head backward and raising. 

8 — Like 7, but with inhaling and exhaling. 

Exercise in standing position: 

From the erect position, forearms toward chest, finger tips touching 
elbows sideward : 

1 — Move arms slowly sideward as far as possible; twist arms, knuckles 
downward, and rise on toes. Return to starting position and lower heels. 
Practice several times. 

2 — Like exercise 1, but at first movement inhale; exhale at 
second. 

3 — Step position forward left (right) like exercise 1, but with first 
movement bend left (right) knee, and with second movement straighten the 
knee. 

4 — Like exercise 3, but with first movement inhale ; at second, exhale. 

5 — Like exercise 3, but with bending of knee bend head backward, 
and raise head with straightening of knee. 

6 — Like exercise 5, but with inhaling and exhaling. 

7 — Like exercise 3, but with bending of rear leg. 

8 — Like exercise 7, but with bending head backward, raising head, and 
with these movements, inhaling and exhaling. 

Note: All exercises in sitting as well as standing, especially with 
breathing, must be practiced slowly. 



THE PLAY CURE 

It may sound strange, but the play months are the healthy months and 
the play people are the healthy people. 

In May the general death rate drops, pneumonia lessens and contagion 
declines. Nothing is bad evcept spring fever and spring fever is nothing 
more than energy trying to find itself. It is a yearning of the spirit to stop 
the doing of winter things or to stop doing anything in a winter way. The 
desire to do is strong but it is a different "do" that is wanted. 

Play is educational. It makes for mental and physical training. It 
makes for judgment. It trains, it breeds bravery, decision and courage; 
and finally it makes for health, both of itself and through the environment 
in which it places one. The brain is composed of cells and fibers which 
bind them together. No cell is separate and isolated. When the brain cells 
send impulses back and forth cooperating to do a certain thing they train 
themselves for other kinds of brain work. 

Quoting Maria Montessori: "These exercises are truly intellectual gym- 
nastics; such gymnastics reasonably directed aid in the formation of the 
intellect just as physical exercises fortify the general health and quicken the 
growth of the body. . . . True rest for muscles intended by nature for action 
is in orderly action just as true rest for the lungs in the normal rhythm 
of respiration taken in pure air. ... To act in obedience to the hidden 



THE PLAY CUEE 1045 

precepts of nature, that is rest. . . . The child wishes to coordinate his volun- 
tary actions — to exercise his muscles by lifting, to train his eyes to estimate 
distances, to exercise his intelligence in the reasoning connected with his play, 
to stimulate his will power by deciding his own actions." 

The keynote to her entire method: Self-development is almost the only 
pleasure of children. 

It is a good thing to have good muscles.' They make up 65 per cent 
of the body weight after leaving out the weight of the passive bones. They 
do their work. They have no diseases, or rather they have so few that muscle 
diseases can be forgotten. They protect us against enemies, they take us 
where the air is good and they establish our breathing requirements; for, as 
Woods Hutchinson says, "We breathe with our legs." 

As the working muscles burn tissue into waste, they use and pollute air — 
and to renew the supply is the purpose of breathing. The gases flow in the 
air tubes as far as they go and then they get into the blood cells and are 
carried the balance of their journey. 

Commonly, we say the heart circulates the blood (and it does furnish 
a part of the drive) but contracting, moving muscles squeezing out tissue 
juices furnish an important part of it. 

The muscles are the servants of the commonwealth. They stand and 
serve. They have a right to use the motto of the English royal family, "Ich 
dien." 

But development of muscle, while important, is not the most important 
aim of exercise. More important is the use of muscles in groups, each 
muscle doing exactly its work, no more, no less, and each doing its work at 
just the right time, not too early, not too late. That is the work of nerve cell 
control. 

Moving the muscles in groups cooperating each with the other is good 
mental training. Xo mind is educated or trained until it has taught its cells 
cooperation and control. Did you ever see an overeducated, bespectacled, 
learned man who could do nothing with his hands ? You haven't quit laugh- 
ing at him yet, have you? Or had you pity? 

A brain gains in abstract power when it gains the power to control 
muscles, particularly the muscles of the hands — what Hetherington terms the 
fine muscles — the muscles which are exercised in the arts, crafts and most 
of the manipulations of skilled labor. 

The first point is — it makes for health to build up the muscles and 
keep them in good condition. The next is — it makes for general well-being 
to train the muscles to control and cooperation. But cooperation is the 
basis of society. Cooperation is society. Where there is cooperation things 
are social. When there is no cooperation things are anti-social. 

It is only an easy step to pass from a group of muscles playing together 
to accomplish an end and a group of boys working together on a base- 
ball nine. And proper play combines all these good things in one. It 
gives growth of muscles, good muscle tone, proper burning up of waste, 
good open air brain exercise, mental training, control, spirit, courage, coopera- 
tion, community spirit, the social point of view — the whole flavored with zest. 

That there is a difference between muscular development and health 
is attested by Eustace Mills : "I do not consider a mere athlete to be a really 



1046 EXERCISE 

healthy man. He has no more right to be called a really healthy man than 
the foundation or scaffolding of a house have a right to be called a house." 
At that, an athlete in that he has mental control over his muscles, is a 
grade better than the muscular monstrosity whose muscles stand up like 
Pikes Peak and, like Pikes Peak, are mighty, massive, immovable, useless — 
a mere knot on the landscape. 

Athletics in that they furnish a spectacle have served a most useful 
purpose. It is easy to see how the spectacle stimulates a desire for better 
physical development which in turn fills every vacant lot with small boys play- 
ing baseball and football and occasionally makes the spectator do a few ele- 
phantine stunts. There is no doubt but going to baseball games stimulates 
many a man to play golf or to swim. 

The objection urged against athletics is that it serves to overdevelop the 
fit and to neglect those who need physical development most — the soft- 
muscled, the short-winded, those lacking coordination, those who cannot do 
things with their hands. But that need not worry us. Competition between 
social units will find a way to become more social. It is only a step from a 
jumping contest between the best jumpers in your high school or college and 
those in a neighboring institution to a contest between the average jumper of 
the senior class of the one against the senior class of the other. When this 
time comes the jumpers who know how will put in some of their time helping 
those who do not know how. 

The nearest approach to community in athletics is the methods of the 
Turngemeinden. 

From development of a muscle to muscle control was a step, from muscle 
control to athletics another, from athletics to play is even more a gain, for 
play combines the social, the muscular and the mental to an exceptional 
degree. 

For a child "the play's the thing," or still further paraphrasing Shake- 
speare, "All the world's a play and all the men and women merely players." 
That was not what Shakespeare meant but it is true enough to belong with 
the myriad of true things said by Shakespeare. 

Developing muscles may pall, exercising may become irksome, athletics 
may lose its relish but the appetite for play abides. In the language of Mon- 
tague Glass, "Business is business, Mawruss, and sometimes pleasure." 

Children need play to get them into the open air, to get them into the 
sunlight, to make them breathe deep, to grow red faced and excited, to tingle. 
As Luther Burbank puts it, "Every child should have mud pies, grasshoppers 
and tadpoles, wild strawberries, acorns and pine cones, trees to climb and brooks 
to wade in, sand and snakes, huckleberries and hornets, and any child who 
has been deprived of these has been deprived of the best part of his educa- 
tion." 

There is no place where a child learns things so readily as in play. Wirt 
with his Gary school system is wise beyond his generation in making the 
playground the place to teach geography, arithmetic, and other didactic 
branches. But better than geography, play teaches self-control, social sense, 
honor, enthusiasm, determination, the never-say-die. As Gulick says, "Play 
is the spontaneous enlistment of the entire personality. We do not have to 
pursue the goal; we wish to — it is our main desire. The people who accom- 



"OUTSIDE OF A HORSE IS GOOD FOE INSIDE OF A MAN" 1047 

plish things are the people who play the game. They let themselves go; 
they are not afraid. Play up, play up, play the game." 

Says Allen in "Civics and Health": "Hygiene and play teachers would 
have an incalculable effect on the reduction of tuberculosis not only in making 
healthier physiques but by inculcating habits of outdoor life and love of fresh 
air. The danger of those contagious diseases which ravish childhood would 
be greatly reduced. An ambition for physical integrity would make unnatural 
living unpopular. Competition in games with children of the same physical 
class develops accuracy, concentration, dispatch, resourcefulness, as much as 
does instruction in arithmetic. Smoking can easily be discredited among boys 
trying to hit the bull's eye. A boy would sooner give up a glass of beer 
than the championship in rifle shooting or a home run." 

Encourage your boy to play marbles, your girl to skate; show your pride 
in his jumping or in her game of tennis. Plan organized play for your 
children and do not forget the value of what Colonel Roosevelt terms "un- 
bossed play" — play for the sake of play — spontaneous play — just play. 



"THE OUTSIDE OF A HORSE IS GOOD FOR THE INSIDE OF A 

MAN" 

The truth of the above proverb men have always known. The man of 
the stone age made a close companion of his servant, the horse. Whenever the 
archeologist uncovering relics of the neolithic age finds the remains of man, 
he always finds those of a horse near. In the fifth book of the Yonkug we 
are told that 2,637 years before Christ the Chinese cavalry were placed on 
the wings of the army. 

When the Lord speaking out of the wilderness rebuked Job as recorded 
in the thirty-ninth chapter of the Book of Job the following reference to 
the horse appears: 

"She scorneth the horse and his rider. Hast thou given the horse 
strength? Hast thou clothed his neck with thunder? Canst thou make him 
afraid as a grasshopper? The glory of his nostrils is terrible. He paweth 
in the valley and rejoiceth in his strength; he goeth on to meet the armed 
men." 

Plutarch tells us that the Greeks at first did not make use of horses. 
When they saw cavalry in the armies of the barbarians they thought them 
superhuman and called them centaurs. In their mythology centaurs were 
descended from the son of Ixion and the cloud and some Magnesian mares. 
In mythological literature they are taken to signify the rays of the sun, the 
children of Apollo. 

There is precedent for horseback riding. Its bitterest enemy would not 
charge that there was anything of the fly-by-night about it. Any opinions 
about its advantages have had time for a tryout. The motto, "The outside 
of a horse is good for the inside of a man" has stood long enough to have 
had fair trial. The fact that it still stands is proof that it is true. 

Why is horseback riding good for the internal organs? It is exercise in 
the open air. It fills the lungs full of the freshest and cleanest of air and 
it gives the sun a fair chance to get in its beneficent work. It massages the 





Wff -wE in 


m m I 


jft, nn 


Bn i 1 





No. 2 



No. 3 



No. 1 

1 — Correct chest position: Head up, chin in, chest expanded front, shoulders 
"back and down, neck pressing collar at back. Assume this position, slowly draw 
in long breath through nostrils and slowly exhale. Repeat until tired. 

2 — Deep breathing: Assume position shown, fill the lungs, exhale breath 
slowly through nostrils, pushing the arms forward, bending the body at the same 
time. Return slowly to upright position, drawing the air slowly into the lungs. 

3— Slowly raise the arms from side forward and upward in line with the body, 
drawing in a deep breath through the nostrils, hold the breath while the arms 
are swung around (backward) to the side, completing a circle. 





"No. 4 No. 5 

4 — Exercise to prevent stoop in shoulders: Slowly inhale a deep breath 
through the nostrils while assuming the position shown, exhale breath in return- 
ing to upright position. 

5— -Extend arms to position shown and walk into a corner of a room, then 
inhale' ami exhale through the nostrils from four to ten deep breaths. 

Fig. 429. — Exercises to Develop the Chest. (Johnson & Johnson, New Brunswick, 

Contagious Disease Bulletin, 1910.) 



1048 



"OUTSIDE OF A HOESE IS GOOD FOR INSIDE OF A MAN" 1049 

abdominal organs, especially the liver. As the body comes down with a jolt 
into the saddle the liver is caught between the diaphragm and the structures 
below it and out of it are squeezed all stagnating liquids. The abdominal 
organs are likewise shaken up. 

The great good of riding is in the shaking up. It strengthens the ab- 
dominal muscles. The impact of the jolt drives toward the abdominal muscles 
and these grow strong by resisting. 

It develops the leg muscles. It trains the muscles to work together. 
It stimulates the spirit of mastery. It invigorates and it stimulates. As 
a measure of personal hygiene it appeals to reason and it is backed by ages of 
precedent. 

Expanding the Chest. — H. V. K. writes: "Can a man SO years old, who 
is 'chicken or 'pigeon breasted, as it is called, broaden his chest by breath- 
ing exercises, or is the bony structure hardened too much at that age? 
What is the proper method of exercising for permanent expansion of the 
chest walls?" 

Reply. — He may accomplish a little, but not much. Climbing exercises 
are better than breathing" exercises. Ladder work, chinning, ring work — 
these are types of climbing exercises. 

Exercise Rests Tire. — J. S. D. writes: "Is a two-mile walk beneficial 
after working in an office eight hours, said eight hours being spent mostly 
on the feet? Am generally pretty tired by the time I reach home. Will 
the good gained from the oxygen eventually offset the tired feeling?" 

Reply. — Yes, one kind of exercise rests the tire produced by another. 

Play in Open Air. — M. W. writes: "I am £4 years old, and 5 feet 6 
inches in height, but I weigh only 117 pounds. I am troubled with a pain 
in my back below the waist and sharp pains around my heart, and I feel 
tired nearly all the time. I sleep and eat well. Do you think I ought to 
see a physician, as I am losing weight steadily." 

Reply. — You are underweight and are losing weight, but that seems to 
be about the only trouble with you. Suppose you have a careful physical 
examination. If nothing is found out of the way do enough work in the 
open air to get up an appetite and to get your nutritive apparatus going 
right. People who feel tired all the time do not work enough. If you can 
do it, play in the open air — that would be better still. 

Not Injurious to Health. — N. M. W. writes: "Do you consider motor- 
cycle riding liable to injure in any way the health of the average person? 
I hear motorcycles called kidney destroyers, producers of floating kidney. 
What is your opinion?" 

Reply. — 1. No. 

2. Nothing to it. 

Exercise for Muscle. — Subscriber writes : "Will you kindly inform as to 
what foods I should eat to gain weight? I am 19 years old, and I weigh 
only about 115 to 120 pounds." 

Reply. — A 19-year-old boy weighing 120 pounds should not eat to gain 
weight, regardless of his height. "Subscriber" does not state his height. 
Let him exercise for muscle and let eating take care of itself. 



1050 EXERCISE 

Too Much Exercise. — L. M. H. writes: "Do you approve of gymnasium 
exercise in the evening for a woman who works during the day as a cleric? 
I have been going to a gymnasium class twice a week for about an hour 
each evening, being of the impression that the exercise would benefit my 
health generally. I find that the next day I am fatigued generally, that is, 
my muscles are sore, my back aches, my head aches, and all together I feel 
miserable. This lasts for two or three days. I am a clerk in a department 
store and, of course, am on my feet and get quite a bit of exercise during 
the day. I am thirty years of age. I am told that this condition will last 
only for the first few weeks, but I have been going to gymnasium for 
six weeks, and my condition does not improve; that is, I don't seem to be 
getting used to the exercises at all. Do you think it wise for me to keep 
onf 

Reply. — Clearly the exercises you are taking are too strenuous for you. 
An excellent method of resting is to exercise the groups of muscles not ex- 
ercised by the day's work. To plan such exercises requires thought. 

Whenever one is sore after exercising it is proof that too much exercise 
has been taken. 

Needs Outdoor Exercise. — B. S. B. writes: "Do cold morning baths 
make one nervous? I have been told they are good for a person, but a 
few days ago someone said they made people nervous. I know I am terribly 
nervous, and don't know the cause. I eat and sleep well, but my head and 
eyes ache all the time. I went to an oculist and got glasses, but they do 
not seem to help much. I am a stenographer, so my work is naturally 
hard on the nerves. The cords in the back of my neck get stiff often. I 
seem to be on a strain all the time and catch myself holding portions of 
the body stiff, and cannot seem to relax. Any little thing upsets me. I 
am in an office where there are a good many and it is noisy. I think 
sometimes I cannot stand it. I do not think going to a doctor and taking 
medicine would do me any good." 

Reply. — One cold bath may increase nervousness temporarily. Syste- 
matic cold baths are a tonic. You need exercise in the open air. You 
also need to learn to control your nerves. See if studying "Physiology of 
Faith and Fear," by Sadler, or "Conquest of Nerves," by Courteney, is not 
what you want. 

Physical Exercise. — Blank writes: "I am 19 and studying pretty hard 
at school. Do you think it advisable for me to go through certain physical 
exercises in my room just before going to bed? Also is it a good plan to 
take a run around the block before breakfast in the morning?" 

Reply. — Yes, as to each question. 

Horseback Riding. — H. L. W. writes: "What do you think of horseback 
riding as an exercise? I am tied down to my office a good deal, not active 
enough for baseball, and too young for golf (they tell me it's an old man's 
game); tennis bores me." 

Reply. — Go to it. If you want to know how many muscles it exercises, 
ride six hours and then try to find a muscle that is not sore. Golf is an 
old man's game in the sense that an old man can play it. It is a young 
man's game as well. 



EXEECISE 1051 

Riding Astride. — Constant Reader writes: "1. Is riding horseback 
astride injurious to girls? 2. Can this be carried to excess without injury 
to the girl's general health? 3. Will horseback riding moderately, astride, 
be likely to affect the girl's health later in life? In other words, is it a 
menace to the race?" 

Eeply. — 1. No. 

2. No. 

3. No. 

Perhaps the answer to question 2 requires modification. Anything can 
be done to excess but I interpret your question to mean : Is there anything 
in the anatomy or physiology of girls that makes horseback riding more 
dangerous or more harmful (when it is dangerous or harmful) for them 
than for men? 

Skating Fine Exercise. — B. H. writes: "Is skating more unhealthy than 
visiting saloons and moving picture theaters? If not, why do the South 
Park commissioners refuse us our usual skating in Jackson Park tliis 
winter?" 

Reply. — Skating is about the healthiest exercise that has been devised. 
It keeps you out of doors at a time when house air is hot and infectious. 
We cannot understand why they do not allow skating on the South Park 
ponds in winter and swimming in them in the summer. We hope you are 
incorrectly informed as to skating not being on the program for the 
winter. 

Advice on Tennis. — C. F. H. writes: "How about tennis for recreation 
for a fairly robust man of 36, engaged at desk work? Is a good hard 
'man's game' of one or two hours too strenuous? Would a heart examina- 
tion be advisable before commencing, presuming that the subject had not 
played for four or five years?" 

Reply. — 1. It is all right. 

2. To begin with, yes ; after the muscles have hardened up, no. 

3. Not unless you have reason to think your heart is off. 

Gymnastic Dancing. — B. P. writes: "Would it be injurious for a woman 
of 46 to take gymnastic dancing if her general health is good?" 

Reply. — No. 

Enter a Gymnasium. — L. J. S. writes: "What would you advise me to 
do to develop my arms? When I was Ik years old I worked in a factory 
where I had to swing a heavy hammer. I had to reach far up over my 
head and pound hard. I remember having lumps as large as pigeon eggs 
under the arms. Do you think this incident had anything to do with my 
arms not being developed? They measure only seven and one-half inches. 
I am 32 years old, weigh 165 pounds, and am 5 feet 11 inches tall. My 
chest measure is 31 inches. I am not strong." 

Reply. — The part of your arm referred to is the first four inches meas- 
uring downward from the tip of your shoulder. That part of your arm is 
largely made up of muscles which run from your body to the upper part 
of the arm. In doing the work described you would use just those muscles. 
Probably you overused them and thereby injured them. The lumps under 
your arms were enlarged lymph glands. These enlarged glands meant 



1052 EXERCISE 

that you were suffering from some infection about that time. The two 
acted together to harm you. Carefully regulated exercise should build you 
up and increase the size of your arm muscles. If you can, join the Y. M. 
C. A. and have the physical director lay out an exercising plan for you. 

Needs More Exercise. — J. M. writes: "What is the cause of that eter- 
nally tired feeling in the case of a woman of JfO? She sleeps fairly well and 
has a good appetite. Often she rises in the morning as tired as when she 
went to ted the night before. After dinner she is ready for bed and scarcely 
has enough strength to undress. She weighs about 120 pounds and is under 
average height." 

Reply. — She is neurasthenic. She does not exercise enough. Pusey 
says, in "Care of the Skin and Hair" : "The average person who is tired 
all the time, who, after a day of ease, finds himself worn out at night, is, as 
a rule, not a victim of overwork or nervous fatigue but of too much food 
and too little exercise." 

Should Take Exercise. — S. T. B. writes : "I am a young man, 21 years 
of age and 5 feet 2 inches tall, and weigh only ninety-five pounds. Please 
advise me what to do. I do not use liquor or tobacco." 

Reply. — You are nearly twenty pounds underweight and are undersized 
as well. If you will trace back your ancestry you will find some inherited 
reason, either in your parents or a little further back. You ought to exer- 
cise as systematically as you eat. That is, you should give a part of each 
day to exercise, preferably in the open air. You can increase your weight 
and stature fairly well in this way, although in the latter you will never 
get up to the average. 

Exercise After Operation. — N. writes: "Having had an abdominal op- 
eration, later a rupture and it also operated upon, is it safe to take swim- 
ming exercises, or to roll or lift the hands over the head and down to touch 
the floor? I fear another strain, maybe another rupture. I wish to exercise 
to keep from getting stouter." 

Reply. — Begin swimming and the bending exercise mildly and grad- 
ually increase them. Violent strain is liable to cause the weak places to 
give. On the other hand, if flabby muscles do not do their part of the 
holding up the weak places are threatened. The policy of gradually and 
slowly building up tone in the abdominal muscles incidentally strengthens 
the weak place. 

Exercise for Women. — A. X. writes: "I wish you would write upon the 
advisability of women returning to the bicycle. My patients are so fat 
and unwieldy it would be simply a new lease of life for them; but, alas, 
the bicycle is not fashionable. If clubs were formed it might be brought 
back, and your advice would help. The average well-to-do woman of today 
is a horror when undressed. I mean women between 30 and 50. They 
usually suffer from some disease; real or otherwise. No woman who rode 
five miles a day would ever get to be out of shape. I am a masseuse and 
trainer, and know all about fat and what it does. I wish you would help. 
If some power could make women exercise, eat less, cut out all alcohol 
etc., there would be fewer divorces." 

Reply. — I wish you success in your efforts to convince women that 
the figure is developed through exercise. One of the methods of positive 



EXERCISE 1053 

eugenics is to teach men the difference between a good female physique 
and one that appears so by reason of clothes and accouterments. 

Special Exercise Necessary. — M. L. M. writes: "Am a matron of 31, in 

apparently good health, hut since fall set in have been constantly troubled 
with cold feet, especially at night. After I go to bed I have a near chill, 
sometimes lasting all night. What is the trouble and what the remedy? 
I take plenty of outdoor exercise and eat simple, wholesome food." 

Reply. — You are a poor heat maker. Since you make so little heat 
your heat regulating apparatus economizes by sending as little as possible 
to your skin, ; especially to the skin of your hands and feet. First, you 
should know whether you are anemic or not. You may have to leave this 
to a blood test. If anemia is not the cause, you must decide whether you 
will make more heat by muscular work, heavier eating, cold baths, air and 
water, followed by a brisk rubbing or whether you will increase your 
comfort by heavier clothing, particularly stockings.- Old people must fol- 
low the latter plan. Young ones should follow the first. The young ones, 
if healthy, can train themselves to be good heat makers. Blood vessels 
in the feet and hands of old people cannot carry enough blood to keep the 
skin warm all the time. They must help out by using woolen clothes to 
retain the heat in the skin. 

S. C.'s Exercises. — Morning exercises which have kept S. C. and his 
son in prime condition: 

Lying Prone on Bed or Couch. — For the trunk: 

1. Hands clasped behind head, sit up. 

2. Raise legs perpendicularly, knee stiff. 

3. Arms folded, sit up. 

4. Draw up legs, knees bent. 

5. Hands extended above head, sit up, bend over, and touch toes. 
With a Chair. — For the arms: 

6. Right arm extended at side; lift chair, then rest. 

7. Left arm extended at side; lift chair, then rest. 

8. Both arms extended in front; lift chair, then rest. 
Standing in Doorway. — Additional for arms: 

9. Heels against back jamb, body thrown forward; push it with both 
arms to erect position and let it fall forward again. 

10. Toes against front jamb; grasp casing on either side of jamb with 
fingers ; let body go backward to extent of arms and pull forward as far as 
possible. 

For fingers: 

11. Grasp casing above door and raise body on fingers to tiptoe position. 
For toes : 

12. Rise on tiptoes and with hands against top of doorway push body 
down. 

Standing Free. — For neck and shoulders: 

13. Hands on hips, fingers pointing backwards; throw the head for- 
ward and then back as far as possible. 

For legs : 

14. Left foot forward, hands extended above head; bend over and 
touch toes. 

15. Right foot forward; same. 

16. Heels together, knees stiff, hands extended above head; bend, for- 



1054 EXERCISE 

ward and come as near touching toes as possible so as to stretch the back 
leg muscles. 

Take a full breath before each movement and let it out as the move- 
ment proceeds so as to get a rhythmic relaxation of entire body. 

Twelve to fifteen repetitions of each movement. Follow with a cold 
bath or rub with dry towel if possible. 

Benefit from Massage. — C. L. writes: "Would you kindly answer the 
following queries: 

"1. Is there any benefit derived from vibratory massage for weak 
muscles? 

"2. Is Faradic electricity good for the same, in conjunction with mas- 
sage? 

"3. Is the galvanic current also a benefit? 

'% Which is the best? 

"5. Should the massage be applied before or after electric treatments?" 

Reply. — 1. Yes. 

2. Yes. 

3. Yes. 

4. Faradic. 

5. Makes no difference. If exercise in the open air is possible, it is 
much better than either or all. 

Exercise to Prevent Cramps. — L. W. L. writes: "Please state the cause 
and prevention of cramps in the feet of elderly persons who lead more or 
less sedentary lives." 

Reply. — Cramps come from lack of use of the muscles. Muscular 
exercise systematically carried out is the way to prevent it. Cold air, 
cold baths and persistent exercising is the way to ward off attacks of 
cramps while swimming. 

Swimming Better Exercise. — H. C. L. writes: "Do you recommend 
running as a summer exercise? What is the longest distance a boy of 18 
may run each day with no bad effects? Is it advisable to run before 
breakfast? Is it better to swim?" 

Reply. — 1. Yes. 

2. Depends on the boy and the condition he is in. Run enough 
to keep your muscles in condition. If you are stiff or sore afterward 
you have overdone the exercise. 

3. Yes. 

4. Yes, swimming is better than any other exercise in hot weather. 

Effect of Swimming. — Mrs. S. C. H. writes: "I have been in bathing 
and swimming four times this season, and each time on leaving the water 
I notice my lips are blue and my finger tips numb. Will you please 
tell me if I should discontinue? I do not think I have heart trouble." 

Reply. — Probably you remain too long in the water. If a short plunge 
causes the same effects refrain entirely. 

Exercise Before Breakfast. — C. J. M. writes: "When I arise I have no 
appetite, but regain it later for dinner and supper. What is the cause of 
this? Will one-half a glass of warm water before breakfast help any?" 



EXEECISE 1055 

Reply. — It is all right to drink a glass of warm or cold water as one 
of your bathing stunts on arising. Ventilate your room better and get a 
little exercise before breakfast. 

Exercise Out of Doors. — Exliausteds write: "1. It is our understanding 
that you do not approve of blood purifiers, such as old-fashioned sulphur 
and molasses, etc. Do you advise some substitute 1 ? 2. Is there any way for 
business girls, confined in offices, to offset that tired feeling which is in- 
evitable in spring? We sleep with our windows wide open and eat as 
sensibly as we know how. We abstain from tea, coffee, and pastry/' 

Reply.— 1. No. 

2. Out-of-door exercise — walking, tennis or golf — will turn the trick. 

Do Gymnasium Work. — C. R. wishes to know what will help a woman 
who has a well-developed figure but is chicken-breasted and has a promi- 
nent right shoulder blade. 

Reply. — Take up gymnasium work persistently until you have de- 
veloped the muscles in your back. You will find that your right shoulder 
blade is prominent by reason of a lateral curvature of your spine. Gym- 
nasium work will lessen this though it may not wholly remove it. Gym- 
nasium work will do as much for chicken breast as anything you can do. 
Not much can be done for chicken breast in people over 15 years of age. 

Rowing Good Exercise. — Elmer writes : "I am desirous of knowing the 
best way to develop my arms, especially from the elbows down to the 
wrist. Am 35. Not ever having done any manual labor, they are under- 
sized/' 

Reply. — The muscles below the elbow bend the wrist joint and close 
and open the fist. Any stunts which call for gripping develop these mus- 
cles. The wrist work of rowing is helpful. Bob Fitzsimmons developed his 
forearm by blacksmithing. 

Stop the Exercise. — D. 8. L. writes: "Have a slight and intermittent 
pain in the heart, due to overexertion in a gymnasium. What is the danger 
and what would the trouble be known as?" 

Reply. — A pain in the heart due to overexertion in the gymnasium 
is cause enough for stopping the work. Have your heart examined when 
you are suffering from this pain and just after exertion. If you are right 
in concluding that the cause is exercise stop the exercise. 

Bathing Bracing Practice. — D. H. writes: "At what temperature of 
the water do you consider it dangerous to swim in Lake Michigan? I 
have been going into the lake since the middle of the summer, when the 
temperature of the water was about 70 degrees. It is now about 5Jf degrees 
and going down about 2 degrees each week. By continuing to go into the 
lake am I doing something dangerous, or is it a good thing for me? 
I have normal health and do not feel chilled after coming from the 
water/' 

Reply. — Daily bathing in the lake after rising by the young and 
robust is one of the most bracing practices and is of great assistance in 
warding off colds and catarrhs. 

The minimum temperature at which lake bathing is permissible de- 



1056 EXERCISE 

pends greatly on the constitution of the bather and the amount of 
"hardening" he has undergone. The exact minimum temperature will 
vary in different persons. One must rather depend on the physiological 
reaction. 

If the reaction — that is, the rush of blood back to the capillaries of the 
skin after emerging from the water — and a pleasant, glowing sensation 
accompanying it are present the bathing is not harmful. If the sensation 
of chilliness and blueness of the lips and finger nails are noticed, with the 
reaction delayed or absent, then the water is manifestly too cold. 

Massage and Exercise. — Mrs. L. H. G. writes: "Over eight weeks 
ago I fell on the stairs, hurting my left leg at the top of the shoe. A 
lump appeared immediately. The shin was broken. The leg from the knee 
to the foot swelled badly. Later both sides of the foot turned black and 
the discoloration extended to the top of the foot and over the ankle, but 
it was not so dark as on the sides of the foot. I have worn an elastic 
bandage with good results, but when it is removed and I walk much the 
swelling is extreme. My age is forty-seven. Is that significant? Am 
suffering with a little touch of rheumatism in my fingers, but the foot 
trouble appeared first, I think." 

Reply. — Your injury has stopped one of the channels by which fluid 
returns from your foot to your body. The condition will pass away in 
time if you do not neglect it. Other channels will enlarge to do the extra 
work. Massage and exercise that foot and leg systematically every day 
unless the soreness forces you to exercise at longer intervals. 

Walking Good for People. — M. O'N. writes: "What about walking for 
women? I am a stenographer employed in the city and vmlk to my home, 
or from my home to the office, a distance of seven miles, at least once a 
week and often twice a week. Two weeks ago Sunday I walked from 
Wilson Avenue to Fort Sheridan, a distance of twenty-three miles. Is 
this too much for a woman 25 years old in perfect health?" 

Reply. — No. I wish you could influence a few thousand people to 
walk more. 

Continue Swimming. — B. R. D. writes: "Will you please help me out 
of a difficulty? The last two times I have been out bathing my skin all 
over the body turned a dark purple, almost black. My health is good and 
I enjoy the water. What is the cause? Is there anything to do to avoid 
such occurrences, or would it be better to forego the pleasure entirely? 
If it is caused by the temperature of the water, why does it affect me that 
way and not others?" 

Reply. — Your skin circulation is more susceptible than that of your 
companions. Continue your swimming but exercise more actively. The 
purple color will pass away when you swim or splash hard enough to get 
in a glow. 

Roller Skating Example. — W. G. G. writes: "I like your article on 
swimming, etc., for the young of our city. The authorities could follow 
with profit one thing done in Kalamazoo, that of roping off two or three 
blocks in different sections of the city from traffic in the early evening 
hours for roller skating. It would do you good to see the crowds of 
youngsters enjoying themselves here each evening." 

Reply. — Cities everywhere should follow the lead of Kalamazoo. 



EXERCISE 1057 

Exercise in the Open. — C. A. H. writes: "I have been troubled for some 
time with a feeling of depression not due to a melancholy nature. I have 
a desire to yawn constantly and find it difficult to get a good, deep breath 
without a sigh or yawn. Thinking it might be due to indigestion, I have 
eliminated all pastry from my diet, and endeavor to eat nothing but 
healthy food. I have not drunk coffee for some time. I am taking an 
iron tonic. Do you think this could be heart disease? What more can I 
do to overcome it?" 

Reply. — I do not think it means heart disease. Get some vigorous 
exercise in the open air — swim, play tennis, golf, or something equally- 
violent. You need to have your heart beat fast, your face turn red, your 
lungs draw deep and your skin sweat. 

To Strengthen the Ankle. — Reader writes: "Can you tell me how to 
strengthen my foot? Some time ago I worked a foot press for about two 
years and have in the last year been troubled with my ankle. I cannot 
bend it outwards. It seems to have no give to it. Sometimes it bothers 
me much, then again I have no trouble with it." 

Reply. — The ankle proper should not bend out. There is a little in 
and out bending leeway in the foot below the ankle. The best way to 
strengthen the ankles and feet is to exercise regularly and habitually the 
muscles of the legs below the knees. If this is kept up the ankles get 
strong. There is no other remedy. But do not try to stretch the lateral 
ligaments of the ankles, for a foot which turns in and out is not worth 
much to walk on. 

Take More Exercise. — 8. F. M. writes: "Please tell me the cause of and 
cure for frequent and deep yawning in a man of 55 years of age. I am 
in good health, my work is light, working hours short, I sleep well, am not 
a heavy eater, not especially strong, although exceptionally active and 
energetic. I yawn heavily and long, perhaps twenty-five times a day, 
during my waking hours. Does this indicate anything constitutionally 
wrong with me, or a condition needing a physician s attention?" 

Reply. — You are not getting enough air to your tissues. It may be that 
the room is not ventilated, that you do not take enough air into your blood 
through your lungs, that your blood does not carry enough to your tissues, 
or several of these combined. There are two things to do — ventilate better 
and get more exercise. If you eat a heavy meal you especially need to 
exercise during the succeeding four hours. 

In Need of Exercise. — M. writes: "You have stated that the arteries 
age from wear and tear, which are causes of arteriosclerosis. Should a 
person, then, of middle age do as little physical work as practicable? 
Would not moderate gymnasium or other exercise be beneficial, even to 
one in the fifties, by giving tone to the muscles of the arteries, heart, and 
elsewhere?" 

Reply. — Enough exercise, either golf, gymnasium work or other work, 
to keep a man's muscles firm is advisable. The man of fifty needs it a 
little more than does the younger fellow. 

More Exercise Needed. — Miss L. J. writes: "Kindly inform me what 
causes blind spells and dizziness, also a fever every morning until about 
noon. I am about 5 feet 8 inches tall, weight 137 1-2 pounds. My appetite 



1058 EXERCISE 

is good and I sleep well, with the exception of a dry cough occasionally 
at night, but never during the day. I have also had pains coming from 
the heart. Would this indicate heart trouble?" 

Eeply. — Blind spells and dizziness in a young woman generally mean 
that she is eating too much and exercising too little. Fever every day and 
cough frequently mean consumption. If you are certain as to the fever 
by all means have your chest examined carefully, especially for con- 
sumption. 



CHAPTEE LVII 

Posture — H eight 

POSTURE 

MAN AND HIS POSTURE 




Fig. 430. — Bad Posture, Due to 
Desk Which Is Too High. 



Early in the game the animal man was having a hard time competing 

with the other inhabitants of the jungle. He was shrewder than they and 

he pitted his brains against their strength and 

endurance. To his mind the suggestion came 

to rise up on his hind legs and to release his 

forelegs from the duty of carrying him; it 

should be possible to change his center of 

gravity and two legs were enough to carry 

any animal around. 

Mowgli was right. The monkey tribe con- 
stituted the only people shrewd enough to see it 

in that early day and at that they tried to com- 
promise. Said they: 

"This walking on the hind legs is a good 

thing in some cases, but there is about half the 

time when the old way is the better way. 

We, the banderlog, have more wisdom than 

Mowgli. We will walk on two legs when that is best and on four when that 

way is best." 

The banderlog missed the essen- 
tial point. The reason for walking on 
the hind legs was to free the forelegs 
for other work. Work was more im- 
portant than walking. 

The upright posture is far from 
being a perfect posture for man. In 
the thousands of years that he has been 
walking that way he has not wholly 
rearranged himself on that basis. 
Many of his anatomical points are on 
the old basis. From an incomplete 
adjustment the appendix results and in 
its wake comes appendicitis. From it 
comes constipation and the list of ills 

that follow it. In many things in life we gain by following our animal instinct. 

When in doubt in many situations the way to trump is to follovj instinct. 

1059 




Fig. 431. — Bad Posture, Due to Desk 
Which Is Too Low. 



1060 



POSTURE— HEIGHT 



However, this is not true of posture. Man holds himself upright as the 
result of the call to higher things. His instinct would make him slouch 
and slump. 

The spirit in him calls on him to toe, to stand straight and square, to 
hold his head up and his chin in and to look straight to the front. 

The animal in him, the great instinct that has come down in his germ 
plasm through the ages, bids him slouch. 

When the best in him is dominating he 
stands four square. When he is worn by sick- 
ness or by age he stoops. 

One of the helpful chapters in Bancroft's 
"Posture of School Children" is entitled "Erect 
Carriage as an Expression of Intelligence and 
Character." He says : 

"That a person standing 
erect looks to be more intelli- 
gent and energetic than one 
in poor posture needs no ar- 
gument; it is self-evident. 
Under this appearance, giv- 
ing it reality, lies the bio- 
logic fact that the erect posi- 
tion has been coincident with 
the development of the brain 
as it exists in man." 

The way a man stands 
tells many stories of his life 
to those who have learned to 
read. Eugene Sue told us of 
men who worked in one po- 
sition until their bodies got 
set in that position. So some- 
times we can learn of a man's 
trade by the way he stands; 
we can learn of some of the 
ill health experiences through 
which the man has come; we can learn of the experiences of childhood. 
The character of the man, his occupation, his disease history and the 
experiences of his childhood — even though each of these stories is incompletely 
told it represents a good deal of talk to the person whose observation has 
been cultivated. 

During the years of childhood and youth there was no chance to learn how 
to stand, how to walk, and how to live and in consequence in early manhood 
pains and aches and inefficiencies have developed. 

There was no way of learning about the arches of the feet, the work of the 
toe and that of the heel. The sentiment about small feet and pretty feet was 
working at its trade. Before chance to know was at hand tight shoes had 
dwarfed the toes, twisted the bones of the feet around until nerves had got 
out of their grooves and blood vessels were pinched at every step. 




Fig. 432. — Faulty 
Posture Favor- 
ing Enteroptosis. 




Fig 433. — Faulty Posture. 

Enteroptosis. 



POSTURE 



1061 



The same is true, though in lesser measure, of the shoulder girdle. The 
nerves, bones, arteries and muscles do not fit so snugly as they do in the feet, 
but sagging shoulders do press at times on structures which resent the pressure 
by pains, aches, and tires. Much of the pains and aches called neuritis, rheu- 
matism, gout, and other names that signify disease are the result of such 
maladjustment. 

This factor is important enough to be the basis of at least two schools 
of healing. As a general proposition, however, those schools place emphasis 





Fig. 434. — Normal Broad Chest. Wide 
angle between rib margins, giving 
wide upper abdomen. 



Fig. 435. — Enteroptotic Build. Long, 
narrow chest and abdomen. Long, 
narrow angle between rib margins. 



upon the nerves which emerge from the spinal column in a position to be 
pinched. The degree of distortion of the spinal column is never so great as 
is frequently found in the feet, and the more general opinion is that exag- 
gerated curves or lack of curves in the spinal column do harm by disturbing 
the cubic capacity of cavities that contain vital organs rather than by pinching 
nerves. 

Dependent upon the curves of the spinal column are the chest, occupied 
by the heart and lungs, and the abdomen, occupied by the digestive apparatus. 

When man walked on all fours his heart had less work to do. Walking 
upright adds to the work of the heart and therefore when the heart is 
diseased the shoulders droop forward — an effort is unconsciously made to fall 
back into the position of ease. 

On the other hand, the lungs are better off in the present human chest 
than in the old-style arrangement. 

The hands are seldom used together. Almost everything done by the 



1062 



POSTURE— HEIGHT 



hands is done better by one hand. This makes it possible to do two things 
at a time, one with one hand and one with the other. 

Again, all down the line this release from the need of using the two hands 
together has made it possible for the chest to broaden out. 

Man is bom with a deep, narrow chest — a tendency to return to the old 
animal type. If the gain is to be held it must be fought for. The broad- 
shouldered type must be cultivated; it is not natural. 

The most important curve of the spine is that in the abdominal region. 
It is known as the lumbar curve. In young children there is no sway in 
the back. In grown people a sway is natural. 

If it is too great the abdomen will pouch out 
in front and the pouching may seriously interfere 
with the digestion and assimilation. About as 
many people of middle life are made inefficient 
by reason of large girth measure as from any 
other cause. 

As a further consideration, unless the lum- 
bar curve is as it ought to be the pelvis tilts and 
too much or too little pressure is exerted on the 
pelvic structure. 

Some of the people who limp around with 
sciatica and other leg pains get no relief from 
liniment and neuralgia medicine because the real 
basis of the trouble is in the way they stand. 
The spinal column has some twenty-five joints 
in it. If the column were straight every step 
would jar all the delicate machinery of the body. 
There must be curves in the column for the same 
reason that automobiles have pneumatic tires. 

A back curve is needed in the chest for the 
lungs and the heart. You cannot curve the 
column back in the chest region without curving 
it forward in other directions to make up for it. 
There must be compensation. 

There is a forward curve in the neck and 

one in the abdomen to make up for the backward 

curve in the chest. If any one of these bows 

curves too far in one direction there must be a 

compensating increase in the bows in the other 

directions. If the abdomen pouches out too far 

then the shoulders must rear back too far, which 

adds to the inefficiency. 

The human body is a machine. This machine does not move forward 

with the minimum expenditure of energy when it starts from a backward 

slant. It is easier to maintain a column in the straight line than it is to 

maintain a series of curves. 

All of these weights hung some on one side, some on the other, but 
so placed as to maintain the vertical in balance represent an artificial 
condition. 




Fig. 436. — Enteroptosis, Show- 
ing Head Forward, Shoul- 
der Blades and Lower 
Part of Belly Prominent. 



POSTUEE 



1063 



The broad-shouldered base of the pyramid high in the air five feet or 
more from the ground, tapering to the apex of the pyramid at the ankles — all 
this is artificial. 

The pitching forward of the body held rigid and the catch on the 
heel, the physics of walking which Goethe first showed — this, too, is artificial. 

When strength, virility, elasticity are gone the gait is a shambling 
amble. The enfeebled person drags, slops along. 

The upright posture has made it possible for the human race to develop 
a thumb and a prehensile hand ; to develop arms that work better when work- 
ing singly ; to develop a flat chest ; to develop a resistance to wind and storm ; 
to bacteria ; to artificial conditions of living unapproached by any other 
animal; to develop a brain that puts man in a class by himself. 

A proper posture gives one individual a great advantage in health and 
efficiency, in mental vigor and spirit, over another. But it is not a natural 
posture with man. 

Many of his anatomical structures are not adjusted to it. 

Its best can only be secured and held by training begun in youth and 
continued through life. 

STOOPING SHOULDERS 

I know of nothing more quarreled about than stooping shoulders and I 
know of nothing else about which quarreling accomplishes so little. There 
must be a reason. There is a reason. 

A person carries his shoulders stooped 
because that is the easiest way for him 
to carry them. To carry them in any 
other way means ache and fatigue. So 
long, therefore, as the boy is near his 
mother or the commandant he will carry 
his shoulders square. As soon as he for- 
gets it down they go, for down is the easy, 
comfortable position. It is the position 
in which he works most easily, because 
in that position the bones fit and in no 
other position do they. 

All athletics, all work, is done with 
the tones in their natural position. The 
ramrod, square shoulder is fit for dress 
parade and nothing else. 

Nevertheless, some girls and boys 
have bad shoulder positions. Caught 
early, the bones can be made to sit in a 
position which will improve with age. 
Stoops left to themselves will lead to bone 
positions in which the tendency of the 
slide in the years to come will lead to 
worse positions. 

Why is it that instructors meet with such poor success? Because they, 
parrotlike, ding-dong : "Throw your shoulders back !" 




Fig. 437. — Belt foe Enteroptosis. 
Straps between thighs hold it down. 



1064 



POSTUEE— HEIGHT 



The shoulders are not to blame. The shoulders are great, broad, flat 
bony plates working on the rounded ribs. If the chest is too barrel-shaped 
the shoulders naturally stoop. The instructor, to get results, must go back 
at least as far as the ribs. 

The chest gets progressively more flat from birth to adult life. During 
the first fifteen years the flattening is 21 per cent; during the remainder 
of life it is only 8 per cent. 

Therefore play, exercise and athletics are to be taught in childhood. Climb- 
ing trees for both boys and girls stands at the head of the list. But the in- 
structor must go even back of that. 

Hard teething, summer complaint, rickets, in fact any severe illness 
in the first two years of life, mark up the body more or less permanently. 
One of the methods of marking is some form of barrel chest over which 
the shoulders slide to cause stooping shoulders. 

Again, the error, as Mosher has shown, may not be in the shoulders or 

ribs. She finds a group, par- 
ticularly in girls, where the 
trouble is with the curves in 
the backbone. 

In order to take the 
stoop out of these girls she 
tells them to stand so that 
their dresses hang low in 
front. This pitches the lower 
spine curve forward and back 
goes the shoulder curve to 
hold the equilibrium. 

An idea prevails that 
stooping shoulders box in the 
lungs and thus predispose 
to consumption — which is 
wrong. Consumption causes 
stooping shoulders by using 
up the fat and weakening 
the muscles so that the 
shoulders slide forward — the 
winged scapulae. 
The most important point is that the narrow-chested folk who are espe- 
cially susceptible to consumption are built right for the shoulders to slide. 

If a man is long chested and well muscled let him leave his shoulders 
where they are. In that way he will get the greatest efficiency and work 
with the least fatigue. 

The army has abolished the ramrod attitude except on dress parade. 
Eamrod attitude and dress parade are both playthings. 




Fig. 438. — Faulty Posture Favoring Enteroptosis. 



NARROW CHESTS 



The chest of a baby who has never breathed is broader from side to 
side than it is from breastbone to back. Soon after it begins to breathe the 



POSTUKE 



1065 



chest is about as broad as it is deep — in other words, it is round. As time 
goes on it continues to get flatter until at puberty the depth from breast- 
bone to back, as compared with the width, is as 100 to 80. When adult life 
has been reached the proportions are 100 to 70 as compared with the youth 
and the infant. The adult chest is flatter. 

Now, averaging a large number of people, it has been found that con- 
sumptives have round chests and hatchet chests rather than flat chests. The 
disease develops more frequently in people with the puberty type of chest 
form than in the adult type. The teaching of these observations is that 
disease and deficiency are prone to develop in those whose chest development 
has stopped at the puberty type — has not gone on to the adult shape. 






Fig. 439. — Normal Chest 
and Abdomen. (Herb.) 



Fig. 440. — Flat Chest and 
Sagging Abdomen. (Herb.) 



Fig. 441. — Showing Differ- 
ence Between Fig. 439 
(heavy line) ; and Fig. 440 
(dotted line). (Herb.) 

The shoulders and the shoulder blades are hung on the bony frame 
of the body proper something as a coat is. To take out stoops and straighten 
shoulders the work must begin back of the injunctions to "throw the shoul- 
ders back/' to "stand square shouldered." To begin with, there should be 
systematic breathing exercises — not for any effect on the oxygen of the blood 
but to develop the muscles of the diaphragm, abdomen and chest wall and 
to change the shape of the chest box from narrow and deep to broad and 
shallow. To breathe in and breathe out violently using every helpful muscle 
everywhere, if begun early and persisted in, will cure stoop shoulders by 
giving the shoulder blades a flat surface to lie on. 

At the same time undue accentuated curves on the spinal column can 
be straightened out by developing the two sets of muscles which run up and 
down it. One set is just behind this column and bends it backward; an- 
other is just in front of it, or its processes, and bends it forward. Bending 



1066 



POSTUKE— HEIGHT 



forward, backward, and to the sides while all of the muscles are held rigid 
will straighten out some of the curve. 



VERTICAL LINE TEST 

Above the line of the hips the spinal column points in three directions. 
In the region of the abdomen the direction is forward; in the region of the 
chest it is backward; in the region of the neck it is again forward. This 
zigzag line crosses and recrosses the vertical line. 

When a person stands properly a line dropped vertically from just in» 
front of the ear will fall just behind the ball of the foot. 
It is the vertical line. This line passes in front of the 
shoulders, a little in front of the hip joint, just behind 
the kneecap, in front of the knee joint 
proper and in front of the ankles. 

Let one stand a curtain pole ver- 
tically on the floor and then take his 
position by the side of it. The outside 
of the shoe two inches back of the tip 
of the toe should be placed against 
the pole. When one is standing prop- 
erly the pole will run just in front of 
the ear. 

This is an easy way to establish 
the vertical line. The method is called 
by Bancroft the vertical line test. This 
is the gravity line. 

In a person who stands properly 
the abdomen will not pouch much in 
front of this line and the back will not 
push much behind it for if the spine 
curves much in one direction the bal- 
ance is maintained by overcurvatures 
in other regions and in other directions. 
The muscles holding the body in the 
upright position are on the back — on 
the back of the calf, on the back of the thigh, on the back of the trunk and 
on the back of the neck. These muscles are strong. They could hold the 
body up even though it were out of plumb, even though it projected forward. 
The head might be thrown forward and the chin might droop but the 
muscles of the back of the neck would be under constant strain and neck 
pains, aches and tires would develop early. 

The shoulders might droop forward unduly and the individual not fall 
but it would be because the muscles of the back were always pulling hard 
enough to offset and that means aches, pains, and tire. 

If, on the other hand, the poise is right mechanically the work of these 
back muscles is reduced to the minimum. 

Incorrect position spells inefficiency. It spells vague aches and pains. 
It spells exaggerated spinal curves with cramping of vital organs. 





Fig. 442. — Normal 
Chest with Ribs 
Running Normal- 
ly. (Herb.) 



Fig. 443.— Ribs Run- 
ning More Near- 
ly Perpendicu- 
lar in a Poorly 
Developed Chest 
and Sagging Ab- 
domen. (Herb.) 



POSTUKE 



1067 



Stoop-Shouldered Girl. — J. H. N. writes: "Our daughter, 16 years 
of age, is developing a had case of stooped shoulder and hollow chest. 
We have endeavored to correct this by calling her attention to the results 
that may be expected if she does not get over the stooping habit. Can 
you suggest some remedy for thisf 

Reply. — To chide her will do no good. To put braces on her will be 
just as useless. She is narrow chested and her shoulders slide forward 
on her strongly arched ribs. She probably sways the lower part of her 
back too far forward which makes her upper back arch backward too 
much. 

Some months ago I wrote of an orthopedic surgeon who, by a series of 
manipulations and exercises, developed the muscles necessary to pull the 





Fig. 444. — Normal Angle of 
Ribs in Front of Chest. 
Normal Well Developed 
Chest. (Herb.) 



Fig. 445. — Narrow Angle of 
Ribs in Front of Chest. 
Poorly Developed Chest. 
A Very Poor Sign. (Herb.) 



excess out of the spine curves and develop the back muscles needed to 
hold the shoulders in place. Or it can be done by exercise. 

If she takes up this work in a gymnasium she must keep it up until 
her back is straight and the back muscles are big and strong. 

Round Shoulders. — A. W. E. writes: "Can you recommend a shoulder 
brace for straightening round shoulders and advise me as to its costf" 

Reply. — Exercise is a better shoulder straightener than braces. Mosher 
says that the way to throw the shoulders back is to drop the front of 
the pelvis — in the case of a woman for her to stand so that the front 
of her dress hangs low. Mosher's observation has been that this neces- 
sarily takes the curve out of the back. Some cases of stoop shoulders 
are due to narrowness of the chest. In such a chest the flat shoulder 
blades pitch forward and their back edges stick out like wings. The 
point to all of this is that the shoulders naturally fall into the easiest 
position. Therefore to correct stoop shoulders it is necessary to correct 
the body curves or the narrow chest or the position at work, one of which 
is responsible for the stoop. Ordinary braces built on the suspenders 
principle cost but little more than suspenders and help some. The wise 
thing to do is to go to a gymnasium and find the underlying cause and 
work to remedy that. 



1068 POSTURE— HEIGHT 

Stoop Shoulders. — W. wants to know: 

1. What is the danger in allowing young people to become stoop- 
shouldered? 

2. How may the evil be corrected? 

3. Are the ordinary shoulder braces practical? 

Jf. Is a cold shower or a cold plunge, followed by a vigorous rub, good on 
a winter morning? 

Reply. — 1. There is not much danger. The type of chest most liable to 
develop consumption is the narrow chest which results from arrested 
development. Stoop shoulders are undesirable, decrease efficiency and 
do harm in some other ways. 

2. Gymnastics and exercise persisted in for a long time; avoidance 
of incorrect posture and occupations which cause it. 

3. They are of little service. The proper plan is to straighten the 
spinal column by properly developed muscles and by habitually keeping 
the position right. 

4. Yes. For those strong enough to react well. 



HEIGHT 

One's height is largely determined by inheritance. In regard to in- 
heritance one must remember that influence on the germ plasm extends "even 
unto the third and fourth generations." Possibly also children can be made 
to grow larger by the use of internal glandular secretions but that fact is not 
fully determined in the first place and in the second the substances are too 
powerful to use except under close medical control. 

Any number of experiments with school children have proved that good 
feeding in childhood will add somewhat to the height. In fact, the great 
school feeding movements in Germany and England were based on this 
principle. 

Examinations for the armies of those countries disclosed an awful per- 
centage of runts and misfits. Those nations flew into a panic, appointed 
investigating commissions and as one of the results began school feeding. 

We are pretty generally agreed with Bryant that "chronic underfeeding 
or incorrect feeding is shown in the child by constant failure to come up to 
the average of weight and height, lung capacity, grip, etc/' 

Something can be added to the stature by standing straight. Bancroft 
has measured pupils who showed a difference in total height of one to three 
inches brought about by change from bad to good posture. Goldthwaite, 
by regulating the sway in the back, increased the height from one-half to 
three-quarters of an inch. 

About the only curve in a baby's back is in the chest region. When the 
head is held up the neck curve starts. When the baby begins to sit up the back 
curve begins to show in a few positions. 

During kindergarten years the back is straight. Up to nine years of age 
the back of a standing child is straight. When the child has reached twelve 
to fifteen the hollow in the back is much more pronounced. 

It is about this period that more or less steady variations from the 
normal curves begin to show themselves. 



HEIGHT 1069 

During the grammar grades the heart more than doubles in weight, the 
lungs treble and the liver doubles. Bancroft says these heavy organs are 
growing most rapidly when the child is from twelve to fifteen years old, while 
Donaldson says the muscular system is not growing at its best for several years 
thereafter. Therefore, the heavy organs are liable to overcurve the spine 
in these years of muscular weakness. 

The suggestion is that children be encouraged to play and to exercise 
judiciously. The regulated exercises are advised from the eighth year on. 
Such exercises as develop proper curves and prevent the development of over- 
curves add to the height. 

INCREASING THE HEIGHT 

I receive a good many letters from people who want to grow taller. 
While a part of this interest has been stimulated by advertisements in the 
main these advertisements have merely served to convert a vague desire into 
a moving impulse. 

A man "by taking thought can add a cubit to his stature." At least he 
can add a fraction of an inch. 

Many years ago it was noted that when the thyroid gland was removed 
from a young animal its bony growth was stunted and that feeding thyroid 
to young animals stimulated their bony growth. From this it was con- 
cluded that when young animals (including the human) were fed thyroid 
they would grow taller than their inheritance would lead one to expect. But 
this drug is too powerful for general use and it is doubtful if it helps much 
anyhow. 

The real secret of gaining a fraction of an inch in height is to take the 
curves out of the backbone. Some of the backbone curves are caused by 
tuberculosis of the bone. These cannot be straightened much. But ewe 
neck, stoop shoulders, and occupation stoops can be straightened out — the kind 
you read about in Eugene Sue's "Mysteries of Paris" — the kind you see 
about you on every hand. By proper, persistent muscle training these can 
be straightened out and the subject will grow taller inconsequence. 

1. As Ritchie says — "Stand tall, thrusting up the top of the head as high 
as possible and drawing the abdomen and chin in is the best rule for position 
in standing and walking." 

2. Spend some time each day pulling hard on all those muscles which pull 
the backbone straight. (Never mind the names of them.) Experiment until 
you find just what pull straightens you. You can feel the muscles contract. 
Having found yourself, each day make a few good, hard, tense pulls with the 
"pullers" which you have discovered. In this the setting-up exercises of the 
soldier are excellent aids. A good one is to bend forward until the fingers 
touch the toes or knees and then to straighten up. This should be done with 
the opposing muscles resisting hard. 

Are we getting taller or shorter, larger or smaller? I have heard men 
bewail the rareness of the tall, broad, brawny men of the old rail-splitter type 
and the abundance of little runty fellows. As a matter of fact, these opinions 
are without basis. The element of immigration makes conclusion from 
observation almost impossible in this country. Where the increase in popu- 



1070 POSTURE— HEIGHT 

lation is mostly due to immigration, where over 9,000,000 immigrants (mostly 
adult males) come into a population of 90,000,000 in ten years their influence 
is felt. If a large part of them were Patagonian giants the onlooker might 
think the race was growing larger. On the other hand, a certain proportion 
from the African pigmy tribes might make one pessimistic. 

Hansen of Copenhagen gave the Eugenics Congress the results of com- 
parative measurements of certain peoples in Europe. Their populations being 
more stable than ours conclusions from measurements are much more de- 
pendable. 

By way of a general conclusion, he says : 

"In many European populations, the most obvious racial quality of all, 
the stature, has in the last fifty years or more, undergone a very sensible 
improvement, having increased by as much as two inches or more." 

A comparison of the boys fourteen to fifteen years old, at Marlborough 
college in England 1874-78, with those there at 1899-1902, showed an average 
increase of .56 inch. In the last fifty years the height of the average grown 
Dane increased 1.4 inches. Hansen says the Swedes and Norwegians have 
increased about as rapidly as the Danes. Certain measurements of the Dutch 
made in 1866, 1883 and 1899 showed a total gain of a little over an inch. 
Bolk says in fifty years the Netherlander increased their average height four 
inches. He thinks this gain is too great to have been wholly the result of 
improved conditions but that fifty years ago the Netherlander were passing 
through hard times and that they are now returning to their normal condition. 

Pearson gives the average weight in England of boy babies at birth as 
7.3 pounds, girls about a quarter-pound less. In twenty years the average 
weight of British boys at birth increased 1,262 grams, nearly three ounces; 
girls, 908 grams, nearly two ounces. In Denmark the increase in thirty- 
five years was 600 grams. Observations made on school children show that 
there is a gradual gain in weight, height and chest measure. 

Hansen says: "It is permissible to believe that the increase of stature 
during the school age is a great deal due to the progress of school hygiene. 
The development of all kinds of bodily exercise that has taken place in the 
last decade must have* had a considerable influence on the growth of the 
children/' 

LONG-BODIED PEOPLE 

The "folks" on the farm hold that it is bad policy to buy a horse that 
"shows too much daylight under the belly." It may be too long-legged, 
or if it stands spraddled out it will not be strong and active in proportion 
to its weight and muscle. 

If it is too long bodied it will be too hard to keep. It will require too 
much feed for the work it does. 

Men lose in efficiency and in effective use of food by being too long- 
legged and too long-bodied. 

Another horse sign is too much space from the last rib to the hip bone. 
This means that the animal will require much feed. 

The height of man is due to the length of leg plus the length of body plus 
the length of neck plus the depth of the head from crown to neck. From the 
standpoint of vitality what counts is the length of the trunk — the height of 



HEIGHT 1071 

the person when sitting. To be still more accurate, that which counts is the 
height of the collar line when the person is sitting. 

Length of legs is especially serviceable in the doing of a few things. 
Length of trunk is especially serviceable in the great majority of life 
functions. Tyler tells us that "during the first three years the legs grow 
one-third more than the trunk; from the third to the sixth year of age 
they grow almost half again as fast as the trunk; from the sixth to the ninth 
year the legs grow proportionately three-fourths more than the trunk; and 
from the twelfth to the fifteenth more than half as much. After the fifteenth 
year the trunk grows faster than the legs." 

A baby is long-bodied and short-legged. A grown person is long-legged 
and short-bodied. His legs are about as long as his body, neck and head 
combined. His center of gravity, as Eeynolds and Lovett show, is about 
his hips. His legs and feet weigh about as much as all the balance of his 
body combined. 

There is a disadvantage in a short trunk which, in the horse, is held 
to be an advantage. Short-bodied people are prone to lay on fat. As a 
horse is on an economic basis a tendency to lay on fat is an advantage. A 
short-bodied horse which will do a hard day's muscular work and keep in- 
prime condition on a small allowance of oats is a desirable animal to have 
in the barn. 

Man is not an economic basis. He does not do muscular work. His train 
has lifted him out of that class and each year finds for him still other means 
of escape. He wants to eat overmuch and not get overfat. 

If he is short-trunked he cannot do it. If he measures far from his last 
rib to his hips he is reasonably certain to fatten up as he passes from youth 
into middle life. 

The men with endurance and vitality are those with long trunks, those 
that "sit high." They are the men who can work hard and long and keep it 
up for successive days, months, and years — that is, assuming that there is 
breadth of shoulder along with length of trunk. 

They have chest room for well developed hearts and lungs. They have 
abdomen room for completing the processes of digestion and preparation of 
food for proper use by the tissues. Storing food as fat is not proper use by 
the tissues. 

"Wants to Increase Height. — M. E. W. writes: "Can you suggest any 
exercise that will tend to develop the height f 

Reply. — Height is much more a question of inheritance than exer- 
cise. The bones attain their growth early in life. Therefore, exercise 
and feeding, to influence stature, must be made use of in youth. 

Abundant feeding and good hygiene in childhood and in youth can lend 
a helping hand to heredity. A part of an inch can be gained by the use 
of such exercises as tend to straighten out sway backs, stoop shoulders, ewe 
necks, and similar faults in posture. A few years ago dried thyroid, per- 
sisted in for years in youth, was thought to have some value. 

Exercises to correct posture and thus increase stature are not of much 
service except under the guidance of a physical culture expert. 

Will Not Grow. — L. writes: "I am a woman of 21, and should like to 
add two inches to my height. Will thyroid tablets do this?" 



1072 POSTUEE— HEIGHT 

Reply. — If you are twenty-one you will not gain in height from using 
thyroid. Competently directed youths in their teens might be justified in 
trying it. 

Rules for Height. — J. 8. writes: "Is it possible for me to increase 
my height about two inches by means of stretching exercises, after I have 
reached the age of 23, without impairing my health? If so, what exer- 
cise would you recommend?" 

Reply. — Follow the exercises issued by Sudor for use in the Chicago 
public schools. By standing straight you can increase your height, but 
not so much as two inches. 

How to Grow Taller. — J. H. J. writes: "Could you tell me something 
to make me grow taller?" 

Reply. — There is nothing to do but to eat plenty of meat, bread, 
vegetables and fruit. Exercise a lot and stand straight. Some day physi- 
cians may be able to increase stature by using the ductless glands but the 
plan has not yet been worked out. 

To Increase Height. — F. S. M. 8. writes: "Can the stature of a per- 
son 19 years of age be increased by stretching the cartilage between the 
bones? If so, how much of an increase can be had? Are there any harm- 
ful effects caused by using this method?" 

Reply. — By standing straight and thus lessening the curves you can in- 
crease your height somewhere near an inch. It is not stretching the cartil- 
ages that brings about the result. The treatment is harmless ; in fact, it is 
beneficial. Do not waste money on expensively advertised systems. Work 
in a properly directed gymnasium will do as much for you. 



CHAPTEK LVIII 



The Muscles 



The tissues of the human body are divided into hard workers such as 
brain, kidney and muscle, and those which merely sland and serve such as 
bone and fat. 

Of the workers, the muscles comprise the largest part. Their weight is 
65 per cent of the body weight, after the bone weight has been subtracted. 
They do more than 65 per cent of the work. The brain sleeps but the heart 
and breathing muscles work on through the resting hours. 

The most important reason for eating is that the muscles may have food; 
for breathing, that they may have air. If the muscles are burning up food 
properly the stomach will take care of itself. 

The real reason of dyspepsia and indigestion is in the muscles. The place 
where food is burned into waste is not in the kidneys or the liver but in the 
muscles. The kidneys and 
the liver merely eliminate 
the ashes as the lungs elim- 
inate the smoke. 

Muscle movement 
squeezes juices rich in waste 
products out of the tissue 
spaces and into the blood 
vessels where circulation is 
more active. 

Flabby, soft muscles 
mean several things. In 

the first place, they mean that 65 per cent of the man is not much man — 
is in a poor state of vigor. Besides that they mean poor breathing, poor 
burning up of waste, clogged elimination all over his body, a certain amount 
of lowered resistance and premature senility. 

Every man needs muscular exercise. No mans work gives all his muscles 
the needed exercise. About nine-tenths of the men are engaged in work requir- 
ing physical labor yet these too require some form of play to exercise muscles 
unused in their work, to empty the dead ends of their sewers — for such are 
inactive muscles. 

Properly planned play after the day's work is done is restful to the 
mind and the body. As to housewives, brain workers, clerks and office work- 
ers, there is no need of arguing that their muscles are flabby, their circulation 
poor, their digestion troublesome, their biliousness frequent, and that these 
call for better muscular development. 

Every flabby person is willing to admit that he ought to take more 
exercise but systems take time and apparatus. Some of them would build up 

1073 




Fig. 446. — Biceps Muscle as It Appears When Arm 
Is Extended. 



1074 



THE MUSCLES 




Fig. 



447. — The Bones of the Upper Extrem- 
ity with Biceps Muscle. 



their muscles if it could be done without apparatus or without going to a 

gymnasium. 

Let them get busy for to build up muscles it is not necessary to have 

apparatus or to go to any gymnasium or to take lessons from any physical 

culture professor or to use up any 
particular time. One can be a 
home-made Sandow. 

The plan which has been pro- 
posed any number of times is that 
instead of lifting a weight or chin- 
ning a bar the lifting be done 
against opposing muscles. No- 
where in the body is there a group 
of muscles that works unopposed. 
Universally whenever there is a 
group of muscles that pull in one 
direction there is another group 
which pull opposite. The simplest 

and best plan to develop the muscles is to use the pull of one group against 

the other. 

The man who is exercising according to this plan should go over his body 

systematically at least once every day. 

Step one is to pick out in the mind a group of muscles to be exercised. 

Step two is to move the part selected by pulling on one group of muscles 

and pulling against that group with the 

opposing group. Eepeat this three times. 
For this it is not necessary to know 

the names of the muscles. The motion 

having been decided on experience teaches 

just what muscles are to be used to accom- 
plish it. 

Having gone over the face muscles 

next go over those of the neck. For in- 
stance, draw the head back pulling it vio- 
lently with the muscles of the back of the 

neck and pulling violently against these 

with the muscles of the front. Exercise 

all the muscles of the neck by pulling hard 

and slowly with each group opposed by a 

hard pull from each opposite. 

The hands, wrists, forearms and arms, legs, chest, back, and abdominal 

muscles are gone over in the same systematic way. 

Five minutes in the bathroom in the morning while one dresses, and 

five minutes as one undresses at night will be all that is needed for the home 

part of the plan. 

Following it, within a week one can pick out any muscle and exercise 

it and one can squeeze out as much waste from his biceps by bending his 

elbow with the triceps pulling opposite as he can by lifting a bag of 

shot. 




Fig. 448. — Biceps Muscle as It Ap- 
pears When Arm Is Bent. 



THE MUSCLES 



1075 



The best part of the plan, however, is that as soon as one gets going he 
does not have to bend his limbs to get the exercise or to do anything else that 
attracts attention. As one rides in the street car or automobile, sits at his 
desk or does anything else which does not occupy all his mental energy he 
can throw his muscles 
into tension without 
moving or giving any 
outward sign. 

Let the man who 
goes home from work 
in the afternoon loggy 
and heavy — - perhaps 
suffering from a head- 
ache — systematically 
pick out and contract 
all the muscles of his 
abdomen and back. 
He will not only gain 
for himself a muscle 
control that will keep 
his belly flat but he 
will flush out the 
waste of peripheral 
tissues, cause himself 
to breathe deeper, to 
think more clearly and 
to resist infection bet- 
ter. 

Following this 
very simple plan for 
ten minutes in the 
bathroom at home and 
from time to time 
during the day a man 
can build up muscle 
lumps that will com- 
pare favorably with 
the pictures in the 
street cars. 

If the advice were 
stopped at this point this article would do more harm than good. Muscle 
building is not enough. Muscle training is of importance. A muscle building 
system must be supplemented by a muscle training system and this last calls 
for play of some sort. 

The big-muscled fellows are not in very good condition. Many of them 
die from consumption and pneumonia. They do not live long; they never 
are good prize fighters or wrestlers; they never win any running races; they 
are never golf champions; they are never good billiard players or bowlers; 
nor do they win any games at tennis. 




Fig. 449. — Great Muscles of the Back, Neck and Arm. 



1076 



THE MUSCLES 



Everyone needs some play out of doors. There is genuine physical 
need of the freshness of the open air in sunshine and in storm. One needs 
differences in temperature — to breathe deeply of fresh air — to have the wind 
and rain beat in the face — to have the heart beat fast — to have the skin red 
from blood in the capillaries — to siueat. 




Fig. 450. — Various Types of Striped or Voluntary Muscles. 

Add to the above program for "auto-muscular" development some exer- 
cise in the open air such as walking to and from the office or even climbing 
stairs instead of using the elevators. 

Striking a golf ball is a wonderful act. For it at least fifty muscles are 
required. Each must do just exactly its work, no more, no less. It must 
do its work at just exactly the right time — neither too soon nor too late. 
Each must do its work in proportion to the work done by each other member 
of the force. If any one lags or fails to do its share some other must com- 
pensate in one way or another. 



THE MUSCLES 1077 

A bowler sends a ball down the alley with just the right speed and aimed 
to strike the front pin at just the right place. In order to do this he makes 
use of almost every muscle in his body. Each does exactly the right amount 
of work in the right way and at the right time. 

If a railroad system were as complicated as ■ the act of bowling train 
dispatchers would score "strikes" and "spares" less frequently than do 
bowlers. Muscle coordination is wonderful and well worthy of development. 

Play builds up long, lithe, quick acting, trained muscles. In addition 
to that it burns up the fuel of the body completely instead of halfway. It 
therefore is an aid to digestion. It uses up gases; it therefore is an aid in 
breathing. It squeezes the waste out of the by-places. It therefore helps 
the organs of excretion. It teaches cooperation, coordination and community 
life. 

As muscles work they make fatigue toxins. These toxins stimulate the 
formation of fatigue antitoxins — a way in which play rests those tired from 
hard work. 

Ten minutes a day is not enough time to give the muscles; but not all 
days are fit for play. Then let one devote a few minutes each day to a system 
of muscle development and add to it training of coordination through play 
as often as it can be made to fit into the program of work. 

We may not agree with Friedman that we are breeding a race of people 
with big minds and little bodies. We may not agree with the statement 
attributed to Wellington that Waterloo was won on the cricket field. But 
we can all agree that average men, those with good (not big) muscles well 
trained, are healthy animals, and that good playing in that it teaches working 
together by healthy men makes good citizens. 

s 

LEG AND ARM MUSCLES 

The fingers, hand and wrist are moved by the muscles below the elbow 
in the arm and those in the hand. The movements of the hand muscles are 
of two kinds: closing the fist and opening it; of the forearm muscles, bend- 
ing the hand forward and backward, bending it to the thumb side and in 
the opposite direction. In addition the hand can be rolled so that the palm 
faces up and turned so that it faces down. 

Here are six movements, three groups of two each. Here are six groups 
of muscles, three groups of two each. 

To build up these muscles there are six exercises. 

1. Close the fist by pulling hard with the palm muscles, pulling against 
these with the muscles of the back of the hand and arm. 

2. Open the fist, antagonizing the same groups. 

3. Move the hand toward the thumb side, pulling hard on the opposing 
muscles. 

4. Move the hand toward the little finger side, pulling hard on the 
opposite group. 

5. Eoll the palm up while pulling hard on the muscles which roll it 
down. 

6. Eoll the palm down while pulling hard on the opposing muscles. 

To exercise the muscles which move the elbow is simpler still. There 



1078 



THE MUSCLES 



are but two groups : Those on the front which crook the elbow and those on 
the back which straighten it. The exercises are but two. 

1. Crook the elbow by pulling hard with the muscles on the front of 
the arm, pulling against them with the muscles on the back. 




Muscles op the 
Leg. 



Muscles of 
the Arm. 



Muscles of the Body. 



Fig. 451. — Muscles. 



2. Straighten the elbow by using the muscles on the back of the arm 
to outpull those on the front. 

The shoulder is lifted upward by the neck muscles and pulled down- 
ward, forward, and backward by the chest muscles. It should be successively 
pulled in each direction by having the muscles in each group outpull its 
opposing group; 



THE MUSCLES 1079 

The leg muscles, including those of the feet and toes, are to be exer- 
cised in the same way. Ten minutes a day given to leg and arm exercises 
will keep these muscles in fine tone, will increase their size and will give the 
brain increased control of them. 

It will not teach rapid or properly controlled use of them. That is 
another story. 

MUSCLE SAGGING 

The organs work best when they are where nature put them. Because 
this is so there are arrangements of bones, ligaments, and muscles to hold 
them in their proper places. No organ is wedged in immovably tight. 
Every organ is so arranged as to permit of a little play. Such an arrange- 
ment permitting of a little play is necessary to save wear and tear. An 
immovable timber in the midst of movable water wears out and breaks up 
much more quickly than one that gives a little with every wave. Therefore, 
whenever there are pleuritic adhesions which fix the lungs from pleurisy, 
pleurisy pains are frequently felt. 

Whenever any organ is firmly fixed in one position "hurts and aches" 
in that organ will be frequent. But the amount of movement in so-called 
"fixed" organs must be but slight. An exaggerated movability is worse than 
too much rigidity. Above all does harm come from a markedly persistent 
•sagging. 

Any of the structures whose duty it is to hold organs in place may 
get out of place or fail to do their work for other reasons, but the muscles 
are usually the worst offenders. 

The organs of the abdomen are held in a box. At the top is the chest; 
there cannot be give in that direction. At the bottom is the bony pelvis; 
there is not much chance to give in that direction. Behind are the spinal 
column and the heavy back muscles; there can be no pouching backward. 

The front is the weak area. Those muscles are not overstrong in mus- 
cular people while they are exceedingly weak in flabby folk. To make mat- 
ters worse, the backward bend of the lower back pitches the strain against 
the front. The weak muscles give; they pouch out; they pot and into the 
pot the stomach, intestines and liver sag. Sagging of the organs is called 
ptosis by the doctors. 

Ptosis is important because it produces intestinal stasis and intestinal 
stasis in turn leads to a great variety of diseases and disabling conditions 
not called diseases. 

In intestinal stasis the intestines do not pass the food along so rapidly 
as it should be passed. Where such a condition is present nutrition is mate- 
rially interfered with, resistance lowered, and the system exposed to attack 
by disease producing germs. 

To Metchnikoff and Lane much credit is due for working out the harm 
done by intestinal stasis. Where intestinal stasis exists the organs of elimi- 
nation — kidneys and bowels — are unable to throw off the waste products. The 
system becomes clogged up. 

It takes the food about six hours to pass through the stomach and small 
intestine. It takes it about forty hours to get through the eight feet of large 
intestine. At best the large intestine has its trouble preventing its contents 



1080 THE MUSCLES 

from stagnating- and when it sags or kinks the movement of the contents 
is more difficult; stagnation is more frequent and stagnation effects are more 
harmful. 

Metchnikoff says: "Particularly injurious are the microbes of the large 
intestine. Thence they penetrate into the blood and impair it alike by their 
presence and the products they yield — ptomaines, alkaloids, and the like. The 
auto-intoxication of the organism and poisoning through microbes are an 
established fact." 

MetchnikofFs theory is that the arterial changes which cause many of the 
diseases of old age are due to bacteria in the intestines. He* says that the 
poisons generated by these intestinal bacteria are the cause of the common 
diseases of degeneration of the organs of the human body and the chief 
cause of premature old age; that if we could preserve the intestinal tract 
in a state of freedom from intestinal bacteria we could prevent most of the 
diseases that can be traced to the action of these germs, including chronic 
heart disease, arteriosclerosis and most kinds of headaches. Not only that 
but we could greatly prolong life because the greatest cause of old age, 
the absorption of bacterial poisons in the intestines, would be nonexistent. 

The process of tearing down and building up is going on in the body 
all the time. Waste which results from this process should be promptly 
removed if the individual is to enjoy good health. To carry away the waste 
product nature has provided us with lungs, kidneys and bowels — the latter 
being by far the most important as they have so much more work to do. 

The retention of waste products affects the system by undergoing changes 
which produce gas and various forms of disease-producing germs. These 
products of fermentation and decomposition are harmful in two ways. 

1. The gaseous condition causes distress particularly when present in 
the colon. On account of the size of the colon, when it becomes distended with 
gas it crowds the neighboring organs. It may even irritate them and if 
greatly overdistended interfere not only with its own function but with those 
of its neighbors. Many times when the irritation is of sufficient degree, if pro- 
longed it may excite inflammation in the neighboring organs. 

2. They are harmful in that the poisons which result therefrom so fre- 
quently get out into the blood current and produce a train of symptoms 
which are not always easily classified. 

Where the colon is overdistended and full of gas it may materially 
interfere with stomach digestion. It may interfere with the free and easy 
movement of the food in the stomach and even cause undue retention. It 
is this interference with the normal disposition of the food once it has 
arrived in the stomach, that produces such distressing symptoms of stomach 
indigestion. 

The chief source of danger resulting from the accumulation of products 
of decomposition and fermentation in the bowels and stomach is absorption. 
When large quantities of poisonous materials result therefrom much of 
it is likely to get through the walls of the intestines into the blood current 
and materially interfere with nutrition to the part. 

The colon particularly has great absorbing powers. For this reason 
when decomposition of organic substances (comprising food) occurs in the 
colon the products are rapidly absorbed and borne away by the blood to 



THE MUSCLES 1081 

all parts of the body, to be brought in contact with the tissues to their serious 
injury. Thus the kidneys, lungs, nerves, arteries, in fact all the organs in 
the body, undergo a change which diminishes their vitality and resisting 
power. 

While it is accepted that most diseases are of germ origin it should not 
he forgotten that lowered physical resistance and loss of vitality have much 
to do with preparing a field in which the particular germ may lodge and set 
up its particular type of disease. 

A certain germ may lodge in the crypts of the tonsils, may remain there 
indefinitely and do no harm. If, however, its environment should be changed 
so as to reinvigorate it and give it new life it may immediately get into 
the blood current, be carried to some remote joint, lodge there, and cause a 
train of symptoms of a rheumatic type. It may pass out into the muscular 
structures and lodge producing a muscular rheumatism. It may produce 
other diseases. 

If, however, the system had not become so changed that the germ was 
given a renewed vitality it might have remained in its original lodging place 
and have done no harm. 

Dr. Franklin H. Martin considers ptosis responsible for the kinks in the 
lower end of the small intestine, the lower end of the stomach, cystic duct of 
the gall bladder, transverse colon and in other portions of the large bowel. 

When sharp kinks in the various abdominal viscera are subjected to pro- 
longed mechanical irritation and inflammation it happens sometimes that 
strong fibrous adhesive bands fix the organs in unnatural positions or fix 
the unnatural kinks. 

Such adhesions may produce a long line of symptoms often vague. 
These have been worked out and described in simple language by various 
writers. None, however, has expressed them more systematically than Mr. 
Chappie. He made a study of a number of cases and found the symptoms 
complained of by most of them about as follows: 

1. Headaches, severe and frequent. 

2. Attacks of nausea often followed by retching or actual vomiting. 
In some cases the vomiting was frequent indeed and of a severe nature. 
It was interesting to note that in several of the cases blood was frequently 
present in the vomit and had led able men to the diagnosis of gastric ulcer 
although none such was found in the operation. 

3. Loss of appetite was almost constantly present. 

4. Loss of weight was present in all cases. 

5. Markedly cold hands and feet, which gave an indication of defective 
circulation. 

6. Mental apathy. This was definite in most cases. Many felt that death 
would be a welcome relief from their physical and mental misery and two 
had actually attempted to bring about that end. 

7. Constipation, which in all was persistent and its previous treatment 
a failure. One case had gone on several occasions for twenty-eight days 
without an action of her bowels, in spite of treatment. 

8. Attacks of abdominal distension due to gas. 

9. General muscular pain and a loss of freedom in the action of the 
joints. 



1082 THE MUSCLES 

People whose abdominal organs had sagged, particularly those in whom 
sagging had caused kinks which had later become fixed, generally had a 
sallow skin. In many were the so-called liver spots. In some there were 
brownish patches under the arms and in the groin. 

The farther from the stomach the intestinal kink was located the deeper 
the color of the patch and the larger it was. 

The people who have been going to beauty specialists for liver spots 
should have been hitching up their abdominal organs. 

In some cases not much can be done in the cure of ptosis and stasis 
by building up the muscles, until the adhesions have been broken up by 
operation. Breaking up of adhesions by operation may require more than 
one operation. 

Following the breaking up of adhesions and the reduction of misplaced 
organs to their normal positions active muscular exercises and massage may 
be employed to build up the muscles of the walls of the abdomen, chest 
and back. These are the muscles that need especial care and training in the 
treatment of ptosis. 

Dr. Martin has proposed a plan of exercises to develop these muscles. 
These exercises consist in placing one end of an ordinary ironing board 
or board of about similar dimensions on a chair, allowing the other end to 
rest on the floor. The patient is then required to lie down on the board 
with the head downwards. This position of the body permits the gravita- 
tion of the viscera upward under the border of the ribs. 

While in this position the patient is required to practice active exercises 
by flexing the lower leg on the thigh and the thigh on the abdomen. 

Dr. Martin also recommends deep breathing exercises. These are to be 
practised while the body is in the same position as when taking the muscular 
exercises. 

1. Place both hands on the lower abdomen towards the diaphragm. 

2. Elevate the shoulders with arms extended slowly at right angles to 
the side. 

3. Elevate the arms above the head perpendicular to the body. 

By practicing these exercises one brings into play the diaphragm, the 
abdominal muscles, the back muscles, the muscles which raise and lower the 
ribs, the shoulder muscles, the strong muscles over the front of the chest, 
those of the back covering the shoulder blades and even the muscles about 
the neck. 

Walking Will Help. — M. H. wants to know if the muscles can be 
exercised without moving the joints. He has no time to play golf or 
any other game. He has lived in the country and got plenty of exercise 
there but does not have any chance in the city. He has tried exercising 
his muscles as he sits at his work but does not know that he does it right. 

Reply. — Yes, the muscles can be exercised without moving the joints. 
Take, for example, your hand. You can tighten each group of muscles 
without bending a finger. You know that you have exercised them be- 
cause you can see and feel them contract. With a little practice you 
can do the same with the muscles everywhere. Facility in picking out 
muscles and in exercising them can be acquired without having set 



THE MUSCLES 1083 

exercises and a set time to do them in. At the same time this does not 
take the place of play or exercise in the open air. I wonder if you walk 
to and from your work or two miles of the distance riding the remainder, 
or if you walk up and down stairs. 

Deep Breathing Benefits. — 0. B. Q. writes: "1. What, please, is the 
benefit of taking deep inspirations? 2. Does the practice of holding the 
breath for a minute or longer do one's lungs any material good?" 

Reply. — 1. The breathing automatically regulates itself. We breathe 
as often and as deeply as we need to to get rid of the gaseous wastes of 
the body and to provide the blood with oxygen. 

Deep breathing for a short while drives the blood out of the lungs 
and into the circulation. It is a great quickener of capillary circulation. 
It is an excellent means of overcoming drowsiness and cold feet. It is a 
means of exercising the trunk muscles, especially the accessory respiration 
muscles. It has some effects in ridding the body of carbonic acid and 
increasing the oxygen in the blood. 

2. No. 

Arm Muscles Exercise. — M. B. says that she does not know how to go 
about making one set of muscles pull against another. For example, how 
could she exercise her lower arm muscles? 

Reply. — Take a brick in your hand. Lay your arm on a table, hold- 
ing the brick in your hand. Keeping the elbow on the table, raise the 
brick slowly until it is one foot above the table. Slowly lower it. Now 
go through the same movement without the brick using about the same 
amount of muscle pull as when you held it. 

Cramps While Swimming. — F. K. L. writes: "Every time I go in 
swimming I get a cramp 'in the arch of my left foot. What causes it, and 
what will prevent it?" 

Reply. — It is caused by a combination of unusual exercises, cold, and 
apprehension. 

To prevent it: (a) Exercise every morning in your bathroom; per- 
form exercises that make use of your leg muscles, (b) Exercise when 
nude in a cold bathroom, (c) Quiet your apprehension; to fear cramps 
is to invite them. 



CHAPTEE LIX 

Housing 

Charles Dickens said: "I have systematically tried to turn fiction to the 
good account of showing the preventable wretchedness and misery in which 
the masses of the people dwell and of expressing again and again the con- 
viction, founded upon observation, that the reform of their habitations 
must precede all other reforms, and that without it all other reforms must 
fail." 

WHERE SHALL ONE LIVE? 

Many people move on October 1. The October crop of movers is next in 
size to the May crop. 

What do they look for? They consider transportation, accessibility, the 
neighborhood, the general appearance of the house, the front entrance, the 
parlor, the bathroom, the kitchen conveniences and the price. This is about 
as much as the average house hunter goes into it. No one of these considera- 
tions should be lost sight of. They are immensely important. 

Important though they are, they should not be the "only things thought 
of. Whether the house is a healthy place to live in is very much more 
important. 

Houses are built of brick and stone. Health is not built in. The man 
who builds is not thinking of that. He was not thinking of it when he 
bought his lot. So when the house hunter goes around with health as one 
of his yardsticks he does not find much that measures up. 

The employed members of the family are going to be in the house about 
twelve hours out of the twenty-four; the school children somewhat more than 
that; the younger children and the housewife will be there for twenty hours 
out of the day's total. 

A healthy home is highly important. It is important in shielding against 
definite disease. It is more important in making for efficiency. What we 
mean is this : It is more important that a man should go to his work or that 
the child should go to his study bright, clear and vigorous, well rested and 
overflowing with life, than it is that they should be protected from particu- 
lar diseases. 

I am going to write about some things in a house which are more 
important than the front entrance. 

HOUSES AND HOUSING 

Houses are one thing; housing is another. Houses may be all right; 
the housing may be poor. The housing is what counts; the house is of 

1084 



% HOUSES AND HOUSING 



1085 



secondary importance. Improving the houses may make the housing worse. 
In fact, it usually does. With us it certainly will. Why? Because we 
have our minds set on houses. It is the common experience that even when 
a housing situation is tinkered with just enough to improve the houses the 
housing is made worse. 

It is a basic law that rent cannot take more than 25 per cent of the family 
income. Generally it takes less. If the family is one of low standards it 
will not allow the proportion to get to 20 per cent, or anywhere near it. 

If the rent goes up the family moves to a cheaper place or it takes 
lodgers or the women and children go to work — which means that when 
the rent goes up the housing goes down. To improve the houses puts the rent 
up; therefore it puts the housing down. There are too many experiences 
demonstrating the working of this rule to leave it in doubt. 

When we require larger rooms, more windows, more of the lot un- 



% 



■JKircH nor cn/iyv.y to jr/iif. 



FVRNITVR.E STOR£ ROOM 

eriTEAncc 



Ml ^- -SINK. ■ »«•■■•• ".>.■. w t ~.v^« 

1 CLOSETS CLOSET 2> CLOSET 3 <^ 

j \ j r £- 4 a 

' Oi/ntt/* uati ^7 rt rANA A F' 



CLOSET 4 CLOSET J 



PUBLIC HALL 37 MT LONG . 4- Ft. WIDE 



¥ 



£=--£ 



Russell Sage Foundation. rmr <* Bu "- Omo 

Fig. 452. — Diagram of a Bad Tenement in Springfield, III. 

occupied, better construction, better plumbing, we increase the rent. When 
we do many of the people who formerly occupied houses in that neighbor- 
hood must move into basements or into alley houses. Others will pay 
the greater rent but they will crowd in lodgers to make the extra money. 

There must be better housing. Health demands it. Business demands 
it. Labor demands it. The life of the .nation demands it. To have better 
housing we must have better houses. 

Is there any way to get them without raising the rents? When you 
tackle that question you quit thinking. 

Several remedies have been proposed. One is for the government to buy 
up the bad housing districts, tear out the old houses, build new ones and 
rent those to the people. This plan is based on the idea that if all the land 
were used to the best advantage and all middlemen were eliminated the 
government could furnish a workingman a good house for the rent he now 
pays for a poor one. 

Another is excess condemnation. By this is meant that the government 
would buy up all the bad housing, tear it out, rebuild, improve, — and sell 
back enough of the beautified, adorned and homogeneously developed land 
to pay for the improvements. 

Another is the tax on unearned increment and use of the funds for re- 
building poor districts. The plan is for the government to get a certain 
part of the increase in value of privately owned land and to use the funds 



1086 



HOUSING 



so collected as a land fund. This land fund is to be collected in order to 
purchase poor houses, rebuild them, and rent or sell them to workingmen on 
easy terms. 

Another is the single tax or a modification of it. Under this plan taxes 
are to be taken from personal property and from improvements on land. 
This will greatly increase the taxes on land. On unimproved property the 
taxes will be greatly increased. On improved real estate the tax increase 



LOCATION 



FROMTAQE 



REPAIA PROPORTfONOF VOT COVERED SUPPLY 



LOCATION 




FREEVOBSTRUCTFO SCWND'vPATCHED COVERED VXPOSED DAMPNESS 



RLPA1R 



VENTlbATION 



IKJHT FlOOfll^YlHH 



HOUSINQ CONDITIONS IN 1003 HOUSES 

PHinDtiPHia — \ys. 



VyW 



:FA1R. 



Henry Phipps Institute, 
11th Annual Report. 

Fig. 453. — Diagram Giving an Analysis of Conditions in 1003 Houses in Philadelphia. 

will not equal the reduction because of the release of the improvements from 
taxation. With the housing property paying less taxes the rent will be 
lowered, or a good house will rent for what a poor one now rents for. 

There are several cures. Tinkering is not one of them. But even 
tinkering is better than doing nothing. Vis inertia is the hardest of forces 
to overcome in a democracy. 



HOUSING PROBLEMS IN AMERICA 



When the second National Conference on Housing was opened Jacob 
Eiis was noticed in the hall and called on for a speech. He declined. On 
the closing day of the conference he took the platform and told his old-time 
friends the reason he had refused to speak on the opening day was that he 
wanted to size them up first. 

"Let me tell you," he said, "of what I saw of you. I saw the same clear- 



HOUSING PROBLEMS IN AMERICA 1087 

eyed enthusiasm that I was familiar with in the old days and with that I 
saw the calm confidence which knows how to go and how far it can go. 
That was a new thing, friends, to me. I saw a balance had come into you, a 
balance that was good to see. It was clear that yon are no longer only de- 
termined to go ahead bnt that you know also how far to go and how to 
go, and that is a great thing/' 

With this speech the conference closed. 

Some part of Mr. Riis' opinion is justified and some of it is not. When 
men first began to complain about "the horrid slums" the attitude was one of 
wild-eyed enthusiasm. They were for ripping out the tenements and doing 
many other acts born of zeal. Nobody talks that way now except the Pauls 
whose Saul wings were shed overnight. 

It is easily apparent that men working on housing have had a "balance 
come into them, a balance that was good to see." In my judgment, that 
balance is more the result of a recognition of "how far you can go" which 
carries with it always the corollary "how far you cannot go," than it is 
knowledge of "how to go." 

According to my way of estimating it, the housing workers have settled 
down to the work of the day. They are tackling the little problems of every 
day, trying to solve them as sensibly as they can; but they have no greater 
vision of the remedy, the great how-to-go, than they had in the rosier 
morning. 

They seem to have accepted it as inevitable that the children of Israel 
must wander forty years. They have quit climbing mountains to look out for 
the Promised Land and are giving their thought to daily manna, camp 
sanitation and to the other things necessary if any of the Israelites are to 
be on earth when the pilgrimage is past and the Promised Land is at hand. - 

In this three days' discussion there were hundreds of talks on the prob- 
lems that relate to housing. Seventy-six cities and twenty-three states were 
represented and each delegate told of things as they were where he came from. 

Suggestions were occasionally made as to methods of bettering things. 
But at least nine-tenths of the discussion might be termed inventorying — 
telling of conditions, perhaps of machinery for control, perhaps of plans 
for the future — and yet the question, What is the remedy? remained with- 
out answer. How to go was answered by "We are trying this" or "We have 
tried this," but never a clear-cut answer "Thus and so." 

The thread began with the admirable speech of the British ambassador, 
James Bryce, who struck the keynote when he said: 

"I am not prepared to say what are the remedies that can be applied" 
[the how-to-go]. 

It ran to the end, for the association adopted no resolutions embodying 
its opinions or making any attempt to standardize procedure. Mind you. the 
conference was discussing the bad features of bad housing, not the funda- 
mental underlying principles, and not even on the how-to-go of these was 
opinion crystallized. 

Mr. Bryce gave seven reasons why a great city was a great evil. His 
first was as follows : 

"From the point of view of health. In the city — and most of the great 
cities are crowded — there must be less oxygen and more microbes. I believe 



1088 HOUSING 

it is a fact that no city has maintained itself and its standards of physical 
excellence without an indraught from the country. If you were to leave 
the city alone, stop the indraught of the people who have grown up and 
formed their constitutions in the air of the country, the population would 
decline physically and, perhaps, begin to die out." 

I shall digress from the main point enough to impress the truth of Mr. 
Bryce's statement on the readers of this article. For instance, every year 
Chicago gains 15,000 population by natural increase but it gains an additional 
30,000 by drawing on the country for them. 

If it were not for this Constant skimming of the country the city death 
rates would not keep down in spite of its good health department. On the 
other hand, were it stopped the country death rates would drop even though 
the state health departments remained as inactive and inefficient as many 
of them now are. 

Ambassador Bryce said: "Instead of letting a few huge cities grow to 
more than a million in population it would be far better to have more and 
smaller cities not exceeding 150,000 population or perhaps even 100,000. 
This would furnish all the things that are needed for comfort and social 
enjoyment." 

Many authorities place 250,000 as the limits of a city's population, 
beyond which there is loss for the city and the country at large. Thus 
we see that so long as Ambassador Bryce stuck to the problem everybody 
was agreed. When he ventured into the fringe of the remedy opinions 
varied. 

We must not get the idea that bad housing only exists in the huge cities 
of a million or more. Mr. Ball of the Chicago health department has ex- 
amined the housing in Washington, New York, Louisville. St. Louis, and 
Duluth and he tells me that their problems differ from Chicago's only in 
details. 

Professor Tufts has made a housing survey of small cities, towns and 
villages in Illinois, and his testimony is that the variance is only in details. 

Professors Condra and Bailey and other men who have written on rural 
homes and Professor Blair, who has reported on rural schools, all say that 
no pot can call the kettle black. 

In opening the conference President De Forest said of it : 

"It is a propagandist body. It does not attempt to go anywhere and 
tell people with authority what they should do. Its function, if I may put 
it so, is maternal rather than paternal. It seeks to help, but it never seeks 
to command. . . . 

"Have this thought in your minds as you leave this conference : Do 
not let us try to do everything. We cannot do everything. Do not let us try 
to remedy all these bad conditions. We cannot do it in a lifetime. 

"There are certain practical things every one of us can do in every 
city in which we live. Pick out the particular things that can be done; 
center yourselves on those; do them, and, when they are done, turn to the 
next thing." 

Every organization has the right to be measured by the yardstick of 
its choice. These words of President De Forest constitute the yardstick by 
which this conference has the right to be measured. Measured by this yard- 



HOUSING PROBLEMS IN AMERICA 1089 

stick, the failure to adopt standard methods does not in any way argue that 
the meeting did not accomplish its aim. 

About five years ago the Chicago department of health startled the 
community with a description of the relay bed system. Under this system 
the beds are occupied for about eight hours by one shift of sleepers 
who yield them to another set that hold possession for an equal length of 
time. Sometimes the beds are worked in two relays and occasionally in 
three. 

I am sure that many people thought it mistaken when it said thrift was 
more largely responsible than was need. A considerable part of the lodger 
evil is the result of need but a larger part is due to greed. 

In the conference discussion of room overcrowding there was related the 

PROPORTION OF LOT COVERED BY BUILDING. 
Total 



Jewish 

Italian 

Negro 



□ 



.80% and Less of _Over 80% of 

Lot Covered Lot Covered 



Henry Phipps Institute, 11th Annual Report. 
Fig. 454. — A Certain District in Philadelphia. 

old chestnut about a room in which four families lived, one in each corner, 
and one family took lodgers. 

As to the degree of overcrowding, one speaker told of finding thirteen in 
one small room in rural Indiana. A story from Boston was of a man who took 
seventeen lodgers, and these so crowded the rooms that the proprietor's four 
daughters, 16 to 22 years of age, had to sleep in a closet. 

In another place a man occupied three small rooms. In one small room 
he had six boarders while another housed his four grown daughters. In- 
vestigation showed that the five working members of the family had a com- 
bined income of $39 a week. It was thrift that was beneath this bit of over- 
crowding. 

In the experience of the speakers on this topic thrift often results in so 
low a standard of living as seriously to imperil the health and well-being of 
the overcrowded families. As a general proposition, however, the speakers 
found that greed underlay overcrowding. 

When a municipality tries to prevent room overcrowding violent opposi- 
tion always arises. There is much talk about liberty, "invasion of the home/' 
"a man's home is his castle," "the oppression of the poor," "paternalism" ; 
gentlemen of experience record their judgment that when you scratch deep 



1090 HOUSING 

enough you usually find that these battle cries come from men who raise them 
as a means of protection while they earn usurious interest rates by exploiting 
the poor. 

Mr. Veillier came forward with a solution of the lodging evil, based upon 
the idea that greed is the most frequent underlying cause. He would hold 
the landlord responsible. In a dozen ways, under existing laws, he is held 
responsible for various conditions. He has abundant means of knowing 
the use to which his property is put, and he generally does know. A recent 
Chicago experience shows that it is the best way to tackle vice. 

Mr. Veillier proposes the following ordinance: 

"No tenement house, nor any part thereof, shall be used for the letting 
of lodgings without the consent in writing of the board of health, nor 
shall any person not a member of the family be taken to live within an 
apartment occupied by any family without such consent. 

"It shall be the duty of the owner of such tenement house to see that 
the provisions of this section are at all times complied with, and a failure 
to so comply on the part of any tenant, after due and proper notice from 
him, shall be deemed sufficient cause for the summary eviction of such 
tenant and the cancellation of his lease." 

Here was a definite how-to-go which was indorsed by some of the 
speakers but not concurred in by others. 

The advantage of locating factories in the suburbs was advocated by 
John Nolen, landscape architect, of Cambridge, Massachusetts. By suburbs 
he means the peripheral part of a city and not suburban towns trying 
to maintain a separate government without proper revenues to meet the 
demands put on a village government in close proximity to a city. 

In the discussion Mr. Fulton of the Keokuk (Iowa) Industrial Association 
said his society had employed Mr. Nolen to carry out his ideas on 400 acres 
of ground purchased at $250 to $400 an acre to be developed as an industrial 
city in connection with its newly developed electric power. 

In the discussion Mr. Martin of Stapleton, N. Y., referred to "the 
city that is alive to the social value of the nickel fare." One of the walls 
around a city and perhaps the most impenetrable one is "the limit of the 
nickel fare and the one-hour ride." 

In New York City the Public Service Commission has entered into a 
contract with the subway corporations under which the city puts up half 
the money and is then in the position of a stockholder guaranteeing the bonds 
of the bondholders — the subway owners. 

This is a most improvident arrangement, holds Mr. Martin, except for 
the right given the city to command the building of the subway to any 
part of the municipal territory. This right, Mr. Martin thinks, will bring 
vast unoccupied areas into the 5-cent-fare, hour-ride zone. 

Mr. Wright of New York City at once picked a flaw in Mr. Martin's 
point about the subway contract. Of course, the subway will build any- 
where the city wants it to build if the city will pay the bill. This brings 
the question of where lines are to be built back where it began, namely, 
in a proper answer to the question, What will the traffic bear? 

An interesting paper was that of Dr. Frankel on financing the small 
home. As a basis for a policy Dr. Frankel has studied the plans in use 



HOUSING PROBLEMS IN AMERICA 



1091 



in Europe, particularly Belgium and Germany, and he discussed these. 

The discussion of this paper illustrated how far we are from knowing 

what is the best plan for financing the small house. The Albany House 

Building Compan}', the General Electric Company, the Roland Park Com- 











































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Minneapolis Civic and Commerce Assn. Report. 
Fig. 455. — Chart Showing Comparative Standing of Localities as "Cities of Homes. 



pany, Mr. Pischel of the Cook County Real Estate Board and Dr. Bryce of 
the Dominion government each reported on methods that had been given 
a trial. 

Other subjects ably discussed regarding "Housing Problems of America" 
were "Health Departments and Housing," "Regulation by Law/' instructive 
Sanitary Inspection," "Wage Earners' Houses," "Garden Cities," "Rural and 
Suburban Housing," "City Planning," "What Are Tenements?" "To What 
Extent Are Tenants Responsible for Bad Housing" and "The Alley Problem." 



1092 HOUSING 



HOUSE PLANNING 

Housing is the most neglected problem of the present civilization. Towns 
allow houses built without proper regard for health. Then when those houses 
cause disease and the disease causes poverty the county agent or some 
charity takes up the burden — but no one thinks of going back to the cause. 

The tendency all down the line is toward too much housing. Cows 
are housed in elaborate barns and they get tuberculosis. Indians are taken 
out of shacks and tents and placed in comfortable houses and they do not 
thrive. Children who are kept indoors get pale and catch everything that 
comes along. Adults of the races longer civilized adapt themselves more 
readily than children and the semi-civilized, but they do not thrive under it. 

Much of the consumption, pneumonia and colds is due to bad housing. 

pilillllllllllllllllllllllllllllllllllllllllllllllll 

| AN IDEAL WORTH STRIVING FOR 

§j "I picture in my mind a city in which the child, yet g 

m unborn, will feel in its being tne stimulus of sunshine §§ 

H and fresh air ; in which tne babe will be born into a g 

jj house fit to receive tbe gift of heaven ; in which tne ( 

( child -will never know the burden of the slum, but g 

jj through normal development will come to manhood § 

jj ready, joyfully, to do his share in the work of the g 

g world and qualified to assume a worthy citizenship." 

— Chas. B. Ball, Chief Sanitary Inspector, Department of Health, Chicago |I 

liiiiiiiiiiiiiin 

Fig. 456. — Ball's Motto. 

Besides this there are the vague ill feelings, the lack of aggressiveness, vigor, 
and strength, the conditions short of definite illness. These are difficult 
to weigh. One man gives them undue weight; another thinks they are not 
important. Nevertheless, they have much to do with the joy of living. 

Bedrooms should be used for no purpose but sleeping. In so far as 
it is possible work should be done outside the house. In the city garments 
are carried into the house. The children are driven out on the street. The 
rooms get crowded, littered, and dirty. In the country some of the farm 
work is carried into the house. Whereupon the bed and the clothes are pushed 
over into the corner. When the time for retiring has come around the tempta- 
tion to go to bed in the unaired and disordered room is irresistible. The bed- 
rooms will not get the airing and sunning which they need if work is carried 
into them. 

If it is a question of building in the country the house should not be set 
facing squarely north or south or east or west. Never mind the road running 
the section line — set the house so that the sun gets the fairest chance at the 



HOUSE PLANNING 



1093 



rooms. Nor should there be much shade. Shade on the streets and shade 
to a moderate degree in the yard is good, but the sun should have a fair 
chance to reach the house if the products of human contamination are to 
be made harmless. And what if the exposed house is hot in the summer 




Minneapolis Civic and Commerce Assn. Report. 

Fig. 457. — Floor Plan of One of a Series of Basement Apartments. The dark room on 
the right measuring 3x7 feet was used for sleeping purposes. 

time ? The family can move out under the trees, sit there, eat there and sleep 
there until the house becomes comfortable. 

In building in a city there cannot be the same liberty. Land is too ex- 
pensive. The house must set straight with the street. There should be 
enough land to allow sun and air to get at the house. City lots should never 
be laid out on a multiple of twenty-five feet. A twenty-five-foot lot is too small 
for a sanitary house of an approved and inviting type. Fifty feet costs more 
money than the average purchaser can afford. There is no element of city 
planning which means any more for wholesome lives and low taxes than pro- 
vision for thirty-foot lots and a proper number of diagonal streets. 

Recently a new building code was adopted in Chicago and the com- 



1094 



HOUSING 



mission fought for months over materials to be used, size of beams and 
matters of that kind. These matters are of consequence and should have 
had much thought. Important as they are, they are trifling as compared 
with the light and air and other sanitary provisions of the structures. 




Minneapolis Civic and Commerce Assn. Report. 



Fig. 458. — Six Rooms, One Behind the 
Other; Outside Windows Only in 
Front and Rear. Note location of 
bathroom and toilet. 



Fig. 459. — Three Out of 
Five Rooms Dark. 
Not even "through" 
ventilation possible. 



HOUSE PLANNING 1095 

The trouble with the commission was that it was badly balanced. It had 
brains, skill and technical training galore but the men were "dyed by that in 
which they worked." Their life work had been stress and beams and mortar 
and art. The few sanitarians were overbalanced. They brought out a code 
which was one of the best ever produced in this country from the stand- 
point of ventilation and light requirements, yet one in which health was 
written far too small. It went into the city council and certain aldermen 
fought to have it amended so as to make it less good. 

Eastern cities once allowed bad housing conditions to develop to a degree 
that we know nothing of. In those old days of license six-story tenements 
grew up all over lower New York City. They had light courts eighteen to 
twenty-four inches wide. There were dark rooms by the tens of thousands. 
When anyone got consumption, pneumonia or a cold in one of these rooms 
he infected it; and the infection remained potential for a long time. So 
there came to be "lung" blocks. 

New York organized its tenement house commission and passed a 
tenement house law. They ripped out old tenements and made wide sunlit 
courts. They now allow none of the old type to go in. This has cost millions 
of dollars. The diseases caused by the old-style tenements have cost additional 
millions. The yearly appropriation for the commission is more than $800,000. 

The question of the housing of poor people is one of great perplexity. 
The houses should be pleasing to the eye as well as planned right. Houses 
that look slatternly and unseemly lessen the pride in neighborhood, street 
and home. 

There is need for architectural ingenuity. The price of the rental 
cannot pass a certain percentage of the family income. If it does the 
family takes in roomers or boarders and that usually is worse than a cheaper 
house. We will say that a man can pay $12 a month for his house. He will 
not gain anything from occupying quarters for which he pays $16 a month 
if he rents out enough space to bring in $4 a month. 

On the other hand the money invested must earn at least 7 per cent 
net after ordinary carrying charges are subtracted. Deterioration is rapid 
and hazards are high; so that the actual net will not be greater than 4 to 5 
per cent. To build a house that is hygienic and sanitary and that will fulfill 
these economic considerations will require skill. 

A housing commission should have builders of originality as a part of its 
membership. The price of real estate must not be high enough to make 
carrying charges prohibitive. Therefore, real estate men should be repre- 
sented. But, finally, the most important point comes — the house must be 
lived in. Those who live in it must keep healthy and strong. If they do not 
the earning capacity is lessened, or sickness comes and the earning capacity 
ceases and the family unit is wiped out. 

The New York Committee for the Investigation of the Condition of 
the Poor reports that sickness is the largest factor in producing poverty. 
We are sure that the United Charities in Chicago find that sickness causes 
more demand for help than any other factor; and bad housing causes sick- 
ness. And so, finally, a commission on housing should be composed largely 
of sanitarians and political economists. 



1096 



HOUSING 



HOUSING PLANS 

A few years ago a presidential campaign orator said 41,000 of the 100,000 
laboring families of Glasgow lived in one-room tenements. The inference 
was that American methods should be continued as, under them, no such 
conditions prevail. Whereupon Kober commented, "We need not go to 
Glasgow for such illustrations, for, to our shame, it must be confessed that 
similar conditions obtain in nearly every American city." 

The New York Tenement House Commission found 370,000 dark 




Minneapolis Civic and Commerce Assn. Report. 



Fig. 460. — Basement Apartments. Rear Rooms Virtually Unlighted Cellar Rooms. 



rooms occupied as living rooms in 1903. No full survey of Chicago has ever 
been made but two partial surveys indicate, first, that hundreds of thousands 
of Chicago laborers are physically handicapped, made inefficient and fre- 
quently made ill by living in dark rooms and, second, that things are getting 
worse rather than better. 

The fact is that, while our workingmen earn more, our land values 
are higher, our building costs are higher, we have less town planning and 
less regulation of building so that, all in all, our housing is no better and 
in some particulars is worse than that of Europe. 

In Europe and in America the plans for improved housing have taken 
many directions. In some cities homes and housing companies have built 
sanitary apartments so constructed that the rents are low and yet the capital 
invested earns 4 per cent. In other places these societies have built separate 
one-family houses and in still others houses two stories high and for two 
families. Plans for such houses so built as to render a proper return on the 
investment and yet with a rental of only $13 to $14 a month are printed in 
the Survey and in the Journal of the American Medical Association for 1911. 

What makes the situation so difficult is that cities seldom get interested 



INFLUENCE OF HOUSING 1097 

in their housing until conditions are very bad. Then they try to cure rather 
than to prevent and curing anything, whether a sick body, a sick house, or 
a sick situation, is always more expensive than preventing it. 

The crux of the situation is the price of land. English authorities say 
laboring men cannot live on ground worth over $1,500 an acre without being 
badly housed. Chicago's poor people live on ground worth more than $10,000 
an acre. 

Had Chicago planned ahead its people could have been properly housed 
without high rents. Not having done so, square miles of congested, in- 
sanitary, incapacitating housing must remain for many years. The property 
will not stand the burden of the taxation necessary for cure. 



INFLUENCE OF HOUSING 

As I sit here trying to stir up interest in housing among people who 
will be reading this book the question arises in my mind: Why is it that 
the people who live in poor houses are sickly ? That they are is easy to prove. 
But why? It is difficult to put your finger on just the causes and prove your 
point. Time was when we charged it up to sewer gas. 

I have recently reread the public hearings before the Chicago city coun- 
cil on an ordinance which made yard privies illegal and required that the 
plumbing of the houses should be properly done. The main provision of 
this ordinance was one requiring that water closets inside be substituted for 
privy vaults outside. The objectors painted horrible pictures of diphtheria 
and other sickness that would result. 

Ten years ago sewer gas was held responsible for most of the diphtheria 
and scarlet fever. Then came the investigations made by experts employed 
by the plumbers and they proved that sewer gas did not breed contagion. 

Bad house drainage does harm in a way to be developed presently, but 
it is not the most prominent reason for the sickness rate in bad housing. 

We place a good deal of stress upon walls with wet feet. By this we 
mean walls so constructed that the ground water travels up the wall several 
feet from the ground. 

The English building laws are strict on this point. They require that 
every wall that sets on or in the ground must have a layer of lead or some 
other material through which moisture cannot travel, to serve as a barrier 
to the wet foot. They allow wet foot but not wet ankle walls. 

Cellar rooms or rooms which sunlight cannot get into are unhealthy 
if the walls are wet. I know of a few cases of blastomycosis where the germ 
found in the abscesses was also found in the paper of the wet basement 
walls. There is abundant proof that tuberculosis bacilli live longer and are 
more dangerous in a wet-walled room. 

What stays on the walls hurts nobody. It is much better that the walls 
should catch the dirt than that the air should hold it. That is why sanitarians 
are against dusting. Wet walls give up their moisture and the germs that 
have grown therein to the air. 

Yet there is no question but that dry room air does more harm than wet 
room air. If the walls could feed some moisture to the air the average room 



1098 



HOUSING 



air would be improved. We can say that wet walls contribute a part but 
not an exceedingly large part. The cold air leaks through the wall of a 
poor house and the heat radiates out. The poor man from his slender purse 




Minneapolis Civic and Commerce Assn. Report. 

Fig. 461. — Section of Floor Plan in a New Apartment House (1912). Dining room has 
"borrowed" light only. Kitchen has opening to a vent shaft several feet under legal size 
with an odoriferous garbage chute in it. 



must heat not only the air inside his house but a good deal of the outside 
air. The poorly built walls of his house make this a necessity. 

Poorly built walls make for waste and discomfort. They do not cause 



INFLUENCE OF HOUSING 1099 

disease. The consumption causing, cold breeding, adenoid producing house 
is the comfortable, snug house. Surely thin walls are not the reason for the 
high sickness rate in poor housing. 

So we might run down the list, trying to put our fingers on just the one 
thing that does the harm in bad housing, and we should fail. 

I dare say some readers have already called to mind some sturdy, stocky, 
strong bull of a man who grew up in a hovel. They say : "There's nothing to 
it; this man proves that bad housing does not cause bad health." 

In order to form any opinion worth while it is necessary to take a broad 
view. Forget the individual and study a group large enough to have the ex- 
ceptions balance each other. Study one hundred people, or better still, one 
thousand, ten thousand, one hundred thousand. Just so to understand the 
harm of housing one must quit looking for the trees and look for the forest. 

The first thing to do in fairness is to analyze the facts critically. 

The death rate among people who live in poor houses is much higher 
than among people who live in good houses. The excess in the sickness rate 
is just as great but it is harder to prove it by figures. 

The greatest excess is in the baby illness. Consumption, typhoid and 
contagion are also greatly in excess. From time to time health departments 
publish comparisons between the healthfulness of the different parts of town. 
In these comparative lists the districts where the well-to-do live show figures 
to be proud of. The districts where the poor live make us think that our 
boasted civilization is no better than savagery and our religion is but hollow 
form and ceremony. 

The man who would be fair and just says that the blackness of that 
record cannot be charged to bad housing; it is the result of poverty and 
drinking. 

He is in great measure right; but fortunately we are able to compare 
the same people in good houses and in bad. For instance, in the Liverpool 
report the comparison is between the same people with the same income in 
bad houses and in good houses built on the same ground. As would be 
expected, even after these poor people got into the good cheap houses they 
had a higher sickness than prevailed in the good districts. The baby death 
rate was reduced; but it still remained high. The consumption rate was cut 
in half; but it was still twice what other districts showed. The typhoid rate 
was much reduced. A fair way to divide it would be to say that the present 
rate was the normal poverty rate. The difference between the present rate 
and the former rate was to be divided between houses and whisk}'. 

John Burns in dedicating one of the last of these new housing areas 
told of the decrease in the number of saloons. The night before he had 
walked through the district in which as a young dock laborer he had lived 
thirty years before and the decrease in drunkenness had been plainly apparent. 
The police returns of arrests for drunkenness told the same story. 

The reports from other places where housing has been improved tell the 
same story. 

After a few analyses that are fairly satisfactory we come to a point 
where the question does not analyze farther with gain. The fact is that 
influence of bad housing spreads out into many channels, operates in many 
ways; and all of these must be taken into consideration. 



1100 



HOUSING 



Not always but frequently, bad housing goes hand in hand with con- 
gestion. There are from several hundred to four thousand people living on 
the acre. Sometimes this great acreage density is due to the height of the 
buildings occupied. Sometimes it is because of the number who sleep in one 
room. Six, eight, ten or a dozen people using one small room as a bedroom 
is not at all infrequent in the congested portions of a large city. 

What disease does overcrowding cause? The answer is: No one disease. 
^ Anything that gets in among such a 

group is apt to spread to others of the 
group. Consumption is the terror, of 
course. When it gets in there is not 
much hope for the person who gets it 
and just about as little hope that it will 
not get other members of the group. 
In poor houses it is generally nec- 
essary for several to sleep in the same 
bed. The dangers of this are obvious. 
An overlooked danger is this : It is 
not possible to provide enough toilet 
facilities. There are too many groups. 
One toilet must answer for several. 

If scarlet fever gets into one group 
it is pretty certain to spread to the other 
groups. It is not possible to quarantine 
all the people who use the same toilet 
as the sick person; and yet it does not 
do much good to plaster the front door 
with a sign telling people not to mix up 
when we know that they must use the 
same toilet room. Of course in this 
particular the yard privy and the yard 
hopper are the worst offenders. 

In an area of bad housing the con- 
tagion rate is always high. When good 
housing replaces bad the greatest de- 
crease is in the typhoid rate. Typhoid 
is spread by water, milk, flies and in- 
fected hands. 

Good housing cuts out the com- 
mon toilet room. It markedly decreases 
the finger-borne infection. It decreases 
the fly-borne infection somewhat less, yet 
materially. Those are the reasons for 
the fall in the typhoid rate when housing is made better. 

The sharpest contrast between the rates of the rich and those of the 
poor is in the baby death rate. When the poor are moved from poor houses 
to better ones the baby death rate declines. The flies are lessened, the general 
dirtiness lessens, and the baby's milk is bettered. 

When we introduce the subject of general dirtiness we open up a large 




Minneapolis Civic and Commerce Assn. 
Report. 
462. — Dark, Unventilated Rooms 
and Toilets in Buildings. 



Fig 



INFLUENCE OF HOUSING 



1101 



field and one that furnishes a large part of the explanation of the high death 
rate where the housing is poor. 

As I see it, when we answer the question as to what are the standards 
of a neighborhood we get the answer to the questions as to the cause of the 
sickness rate. 

The poor are apt to be fatalists. They are forced to say: "It cannot be 
helped" in regard to so many things that they would like to have changed. 




Minneapolis Civic and Commerce Assn. Report. 
Fig. 463. — Dark, Unventilated Basement Rooms and Toilets Found in Some Buildings. 

When their children die they grieve but before long they come to think it 
cannot be helped. Scores of times mothers have said : 

"Mrs. Blank ought to know what to do for a child. She has had ten." 

"How many are dead?" I have asked. 

"Eight, but it could not be helped," was the reply. 

The first standard is that of the babies under a year. Not over one 
of ten should die. 

The first essential is a proper death rate as a standard. There must be 
a proper contagious disease standard and a militant discontent when that 
standard is violated. There must be a proper standard of household cleanli- 
ness, of yard cleanliness, of alley cleanliness, of street cleanliness, of neigh- 



1102 



HOUSING 



borhood cleanliness. There must be a proper, standard of personal cleanliness 
and of personal conduct. 

When housing is bad all standards go to pot. That statement hits the 
bull's-eye. If the house is ramshackle and structurally disreputable, if sun- 
light and air cannot get in there is no use talking about crowding or cleanliness 




Minneapolis Civic and Commerce Assn. Report. 

Fig. 464. — Typical Floor Plan Showing Dark Basement Rooms. Children sleep in many 

of these dark rooms. 

or anything else. There must be some family pride or household pride; 
otherwise you cannot have standards. Household pride and bad housing 
are as incompatible as oil and water. 

Where the poor housing is replaced by good housing the flies decrease. 
The manure box is emptied; the garbage does not litter the ground. The 
alleys are paved and cleaned; the streets are cleaned. 

* Somehow or other (just how nobody can fully say) the sickness decreases, 
vitality increases, efficiency increases, headaches and minor ills decrease and 
the death rates drop. The health and life phases again merely represent 
the end product. 

This section began by asking: Why is it that the people who live in poor 
houses are sickly? 



EFFECT OF GOOD HOUSING 1103 

The answer is that, while several factors are responsible, the most impor- 
tant is the influence of housing on the people who live in the houses. The 
structure of the house, the method of construction, the amount of air space, 
air and light are of importance, per se, but looming way above these is the 
fact that poor housing destroys the standards of those who live in the poor 
houses. 

Poor people have the right to be protected against poor houses. They 
have enough dragging on them without this added load. 

To keep standards when submerged in poverty is not an easy matter. 
It cannot be done when bad housing makes against it. 

Most of the people in our cities have come in from the country. This 
is just as true of the immigrant as it is of the American born. They begin 
by trying to keep the house clean. 

The poor soon find it impossible under city conditions. When they look 
out over a yard filled with cans to an alley filled with filth and out into a 
street where mud and garbage are mixed a foot deep they give up and let 
things drift. Whenever things drift the death rate goes up. 



EFFECT OF GOOD HOUSING 

When a family income is less than $10 a week the amount paid for rent 
cannot go above $2.50. If $2.50 a week does not pay for a house in which 
a man's family can be healthy (and that is all the man can pay) the burden 
of caring for the sick is put upon the people. 

A rental of $2.50 a week does not mean much on the investment. What 
is the community going to do about it? It might force employers to pay 
enough wages so that 25 per cent of their earnings would healthily house 
their employees. That is slow and difficult. It might carry a part of the 
cost of housing. 

In Liverpool the money spent for housing earns about 3 per cent. The 
bonds sold to buy this ground and build these houses and the sinking fund 
to retire them cost more than 3 per cent. The difference is paid out of taxes. 

How does Liverpool justify this use of taxes? The cost of illness falls 
on the people. The cost of illness in the families earning less than $10 
a week falls on the tax funds. The question arises: Does the money spent 
on housing decrease the cost of illness and immorality materially? If the 
answer is "yes" there is no doubt of the wisdom of the expenditure. 

Kyffin-Taylor reported for the Housing Commission that in the rehoused 
areas the general death rate has been halved, the consumption death rate has 
been reduced to less than half, typhoid has been wholly banished, and infant 
mortality has been decreased 28 per cent. In the Adlington Street area the 
arrests for drunkenness decreased from 81 in 1894 to 2 in 1912 ; for assault from 
40 in 1894 to none in 1912 ; for other offenses from 81 in 1894 to 2 in 1912. 

The report says: "In the rehoused district there is a higher moral tone. 
Self-respect is more in evidence, and a keener love of home prevails/' 

The report contains a ringing contribution from John Burns, once a 
dock laborer in Liverpool, subsequently a cabinet member of the British em- 
pire. He says what he knew in Liverpool thirty years ago had so burned 



1104 HOUSING 

itself into his mind, memory and determination that he took a solemn oath 
as minister to do what he could to wipe out such conditions. 

He declares Liverpool's rehousing was a public health movement and 
not to be measured by pounds, shillings and pence. Housing was not only a 
good investment in itself but was the bread of reform cast upon the waters 
which returned to the people after many days in a manner of which they 
could hardly conceive. 

"I walked out last night in the old districts where I had known the 
abysses of human misery/' he states. "What impressed me on Baptist 
Street was that I did not see a drunken man. As I came out of Baptist Street 
through Ben Jonson Street and Dryden Street, changed from what it was of 
yore, I thought of Eobert Burns' great saying: 

"To make a happy fireside chime 
For weans and wife. 
That is the pathos and sublime 
Of human life." 



FINANCIAL PLAN FOR REHOUSING 

After tearing down about 10,000 insanitary houses and in this way 
unhousing 40,000 people the city of Liverpool asked itself what had become 
of the unhoused people. It found them crowded into cellars and already 
crowded rooms. It found that new model houses and tenements were occu- 
pied by the best tenants of their kind in the city, the cream of the renters, 
while the skim remained in the privately owned houses. 

In 1902 Liverpool began the policy of rehousing the unhoused in sani- 
tary, cheap houses. Since that year it has torn out and replaced 5,358 
houses. There remain 4,585 houses yet to be torn down and replaced. Of 
these 2,939 are exceedingly bad. The balance, 1,646, are insanitary in many 
respects but are less objectionable than the 2,939. 

What has been the cost ? The cost of the land and buildings, of remov- 
ing the old structures and building the new ones has been about $10,000,000. 
The interest charge and sinking fund are about $240,000. The net rent is 
about $55,000. The money invested earns a little less than 3 per cent. This 
rate is averaged over about fifteen years. 

Three per cent will not pay the rate of interest that the city of Liverpool 
must pay for its money nor will it carry the sinking fund; therefore, some 
part of the carrying charge is met by taxes. 

The gross rent received in 1912 was about $130,000. The net rent was 
$53,000. The sum spent on repairs, renewals, general upkeep, taxes, rates 
and general care indicated that the authorities were taking good care of the 
property. 

A statement sometimes made is that owners of property in the poor 
portion of town are entitled to high rents because of the instability of the 
population. It can be expected that a large part of the property will be 
vacant. In Liverpool empties decrease the revenues 8.78 per cent below the 
possible maximum- 



FINANCIAL PLAN FOE KEHOUSING 1105 

Another statement is that bad debts are a high figure always. The loss 
from bad debts in 1912 was 2 per cent. Ninety-nine per cent of the rents 
were collected. During the year 1912, 630 tenants vacated city owned prem- 
ises. Of these 205 left under notice from the corporation. 

The corporation has erected two types of houses — one for the exceed- 
ingly poor, another for those not so poor. The loss from bad debts in the 
two groups is about the same — five-tenths of 1 per cent and 1.2 per cent. 

The sinking fund retires the debt year by year. The amount outstanding 
at the time of the report was $4,500,000. 

Thus we see that the Liverpool improvement, leaving out all public 
benefits, is not quite on a business basis. Taking into consideration public 
benefits it is on an excellent business basis. 



REHOUSING IN LIVERPOOL 

Liverpool's housing policy is this: Whenever the housing of a district is 
found to be well below the standard as the result of routine examinations by 
the sanitary inspectors an intensive study of the district is made. The facts 
as disclosed are set before the Housing Commission. 

Let us say that in a given instance the commission decides that the 
district is a proper one for the application of its housing plan. It purchases 
all of the ground and all of the houses in the district. It then registers the 
names and addresses and income and rent paid by the people living in the 
houses. It keeps track of these people until it is ready to rehouse them. 

The board then tears down the houses, rearranges the lots and builds 
new houses. It leaves open spaces for air ; lays out playgrounds ; builds stores, 
churches, playhouses and schools; erects houses, and sells off the surplus 
land, for, since the use of the land is carefully planned, it can give the homes 
more ground than before and still have land to sell. The commission then 
hunts up the former occupants of the space and gives them the refusal of 
the new houses. 

Liverpool is the home of untrained workers. It is a great port, and a 
large part of the population are dock laborers, firemen on boats, and others 
who receive but small wages. 

Most of the districts selected for rehousing are near the docks. The 
houses are built for men of small earning power. Men who earn 16 to 20 
shillings a week ($4 to $5) are catered to. A dollar in England purchases 
about as much as two here. Therefore (let us say roughly) houses are built 
for men earning $8 to $10 a week. 

The premises rent from 1 shilling sixpence a week to 6 shillings a week; 
say, 74 cents to $3 a week according to money's buying power in America. 
The average rent paid is around 75 cents a week. For instance, in the Grafton 
Street dwellings a man can get a three room flat with a separate kitchen and 
a separate bath and toilet room, all taxes paid, for $1 a week. 

Of the 2,747 dwellings built by the Housing Commission 2,193 are 
reserved for persons dispossessed when the district was rebuilt. In Burlington 
Street 99.5 per cent of the people dispossessed moved into the new houses 
when completed. In Bevington Street, the proportion was 93.93. 

The enterprise is run on business principles. Men who do not pay their 



1106 



HOUSING 



rent are thrown out. The bad debt losses are small. It is not a something- 
for-nothing scheme. 

You ask what has this to do with health? That question will be answered 
later in this chapter. 



PUNISHMENT FOR BAD HOUSING 

A committee once analyzed the Chicago ordinances relating to buildings. 
Eighty-five per cent of them related to fire only; 12 per cent to contagion, 
sewage and garbage and 3 per cent to supply of air and light. If the group 




Fig. 465. — Water May Become Impure in Badly Located Wells from Surface Drainage. 



— contagion, sewage, and garbage — is split evenly between the welfare of 
the inhabitants and the welfare of the property and the 6 per cent added 
to the 3 per cent of the third group we get a total of 9 per cent. More 
than nine times as much legislative attention has been put on fire protection 
than has been put on health protection. 

Theoretically, government is divided into three branches — administrative, 
legislative and judicial — and each must keep its hands off the work of the 
others. It would not be fair to place all the blame on the legislative depart- 
ment and none on the other members of the triumvirate. Therefore, the 
exhibit shows why it costs so much to get bad housing corrected even when 
occasionally there is correction. 

A chart shows a case of bad housing complained of on June 27, 1911. 
The first inspection was made by the health department on June 30. Bad 
conditions were found. Fourteen inspections were made. 

The owner paid no attention to orders. After months of disregard of 



DISEASE HISTOEY OF HOUSES 



1107 



notices the owner was sued. On October 23, 1912, the case was dismissed 
with costs. There had been six continnances. 

The cost to the owner was $7.75; the cost to the taxpayers for inspec- 
tions, health department attention and conrt expenses had been more than 
$250. The taxpayer paid the bill; the owner went free. 

The usual method of improving the sanitation of housing is by fines— 
a remedy both inefficient and expensive. In speaking to the English parlia- 
ment in favor of the national 
insurance bill David Lloyd- 
George, then Chancellor of the 
Exchequer, especially empha- 
sized those features of the bill 
that raised the taxes on insan- 
itary buildings. Since they in- 
creased the cost of government 







J.Q:^.$:c:: 



Mr. Lloyd-George proposed 
that the taxes be increased on 
them. He said: 

"That will be a much 
more effective check [on the 
causes of excessive sickness] 
than the old, obsolete form of 
mandamus." 

In this country (except in 
Pennsylvania) we employ the 
fining method — a method 
much more ineffective and 
much more expensive than the 
mandamus. 

If the mandamus is a poor 
tool how inexcusable is our use 
of the much poorer tool, the 
fining system! 

In 1907 the Chicago 
health department began keep- 
ing the record for preventable diseases of every residence in the city. One 
chart contains the records of two small houses. 

One of these in four years had seven cases of consumption charged 
against it. Another had a record of eight cases of consumption, two of 
scarlet fever and one of diphtheria. 

In spite of all this, so good an authority as Professor Winslow pronounces 
the Chicago air and light ordinances of 1910 as basically the best in the 
country and I think he is right. 







ffq^-'-x-vX' — . 



Fig. 466. — Wrong Construction of a Well. Usual 
method of pollution and even infection of wells. 



DISEASE HISTORY OF HOUSES 



In 1907 the Chicago health department started a card index of com 
tagion in Chicago according to the houses in which it occurred. This file 



1108 



HOUSING 



shows the contagious disease record of every house in the city. Nobody in 
Chicago needs to move into an unhealthy house. Anyone who wants to know 

the disease history of a house which 
he is thinking of buying or renting 
can get the information at the 
health department. 

This is a very important point 
in consumption. One of the sec- 
tions of the model ordinance adopted 
by the Section on Preventive Medi- 
cine of the American Medical Asso- 
ciation requires that all houses 
wherein people with consumption 
have lived should be disinfected, 
cleaned and aired before the next 
occupant is allowed to move in. 

Every now and then a house 
gets a bad sanitary reputation. This 
is not always owing to the fact that 
lost their lives by certain contagious 
its bad construction. Its walls may 




Fig. 467. — Proper Construction of a Well. 




Fig. 468. 



-Ground Water. A, high level; 
C, intermittent spring. 



B, low level; 



it has been occupied by people who have 
diseases. It may be laid to the fact of 
be damp or they may be 
cold. Proper sanitary sur- 
roundings may have been 
disregarded in the selec- 
tion of a site. 

In the construction 
impervious materials were 
perhaps left out of the 
walls, especially of the cellar, so that they are not properly protected against 
dampness. Due consideration for scientific ventilation may have been over- 
looked and a poor sys- 
tem of heating in- 
stalled. For these rea- 
sons the house lowers 
the vitality of the oc- 
cupants until they are 
more liable to contract 
contagious diseases 
than if they lived in 
houses in the construc- 
tion of which due 
regard for sanitation 
had been observed. 
The neighbors gossip 
about the amount of 
sickness in this house. 
Usually the reputation 
is not deserved. 




Fig. 469. — Wells Curbed with Brick, Stone, Crock or 
Wood are Improperly Protected and Seldom Safe if 
there is any source of dangerous contamination in 
the Vicinity. 



CONGESTION" OF POPULATION 1109 

If a careless consumptive has infected a house it may stay infected for 
a few months but in less than a year all of the consumption germs in dark 
corners will be killed off. On the other hand, an insanitary house may lower 
the resistance of the occupants until they are more liable to catch consumption 
than if they lived in healthier houses. In so far as certain houses deserve 
a reputation for being a causative factor in producing disease, it may be said 




Fig. 470. — Safe Well. Cement Curbing. 



that it depends upon how much they are responsible for putting people in a 
condition to catch the disease. 



CONGESTION OF POPULATION 

There are parts of New York City where 4,000 people live on a single 
acre. A few years ago New York held an exhibit in which one could learn 
something of the density of population and of the harm which it was doing. 

Congestion of population grew in New York because nobody had planned 
ahead. Planning to cure is always more expensive than planning to prevent ; 
but planning to cure is less expensive than allowing present conditions to 
continue. 

They appointed a Commission on Congestion of Population. This com- 
mission is composed of ten aldermen, two representatives of the administrative 
arm of the city government and nine others. 

Their recommendations come under fourteen heads, as follows : 

1. Restriction of the height or volume of buildings other than tenements. 

2. Restrictions upon the lot occupancy of buildings other than tenements. 

3. Restriction upon the height of tenements. 

4. Methods of encouraging three family tenements. 



1110 



HOUSING 



5. Measures to prevent room and apartment overcrowding. 

6. Measures to secure better conditions of labor. 

7. Measures to secure a better distribution of factories. 

8. Parks, playgrounds, schools, and recreation centers. 

9. Measures to keep land cheap and to provide good and cheap housing. 

10. Measures to promote health and safety. 

11. Distribution of population through municipal control over charities. 

12. Immigration. 

13. Delinquency. 

14. Public squares and buildings. 

Chicago is headed toward the corner which New York finds itself in. 




Fig. 471.— Diagram Showing How a Well (with waterproof wall) May Extend Through 
Danger Zones and Risky Zones to Reach Water in Safe Zone. 

The Association of Commerce, the Chicago Plan Commission, the real estate 
board, the School of Civics and Philanthropy, the Chicago Homes Commis- 
sion and the health department are each doing a little to stem this tide. But 
the little is overshadowed by the need. 

Professor Tufts found some bad housing in every town in Illinois which 
he studied. There is some bad housing in the best of our towns and villages. 
It is a matter which, uncontrolled, automatically gets worse. No village can 
be "smuck" on the question of congestion. While one citizen may have a 
hundred acres somewhere in the village other people are sleeping more than 
three in a room, and a room with bad sanitation at that. 

Why not read the report of the New York Commission on Congestion of 
Population? Address City Hall, New York, for a copy. 



PRICE OF LAND 

Upon no other item rests so much responsibility for congestion of occu- 
pation as the high price of land. In the case of central real estate the build- 



TO PREVENT LAND SWEATING 1111 

ings placed on it must go hundreds of feet into the air and two and some- 
times three stories underground in order to earn the carrying charges. 

But of more importance is the effect of the high price of land on resi- 
dential congestion. There are forties in Chicago averaging more than 400 
people to the acre and single acres housing more than 1,000. In New York 
there are acres which house more than 4,000. Whenever land goes over 
$10,000 an acre you have to jam people 'together like flies to keep the rent 
within their means. 

Whenever a building lot for a laboring man's cottage costs more than 
$200, or $8 a front foot, things are tending in the wrong direction. When- 
ever it passes $800, or $32 a front foot, the space for sunlight, air 
and vegetables is going to be cut down, the house is going to be less well 
built, the tendency to build two or three houses on the lot is going to increase, 
the number of boarders is going to increase — to sum it all up, the death rate 
will rise some, the preventable disease rate will rise, more women and children 
will have to go to work in factories or in service — and the men will work at 
lower efficiency. Seventy-five to $100 a front foot makes a situation for which 
there is no cure. 

As Nettleford says: "Poor people live on dear land, rich people live on 
cheap land, which is absurd." 

The death rates run up* pretty nearly parallel with congestion of occu- 
pation. In Glasgow, where the people average 1.3 persons to the room, the 
death rate is 21.7; where the average is 2, it is 28.6. In Budapest, where the 
average to the room is 2, the death rate is 20; where it is 10, the rate is 79. 

Jewett, in Toiun and City, says: "In Berlin, among the 73,000 people 
who live one family to one room, the death rate is 163 per 1,000. Among the 
398,000 people who live one family to four rooms or over, the rate is 5.4." 

Not all this difference was due to differences in congestion, but if even 
a tenth of it came from crowding it still would be a powerful argument 
against congestion. 

TO PREVENT LAND SWEATING 

To keep the price of land within bounds, to prevent what the English 
term "land sweating/' several plans have been proposed. 

Mr. Foulke, while president of the National Municipal League, re- 
ported to his association on the plan used since 1904 by Frankfort-on-the- 
Main. That plan provides that every change in land ownership not depending 
on inheritance (that being otherwise provided for) is subject to a city tax 
of 2 per cent and if since the last preceding transfer there has been an 
increase in value of more than 30 per cent of the former price there is an 
increment tax as follows: Five per cent for an increase up to 35 per cent, 
6 per cent for an increase up to 40 per cent, 7 per cent for an increase up 
to 45 per cent and so on — 1 per cent being added for each 5 per cent of 
increase. 

The limit of the total tax is 25 per cent. This is in addition to the gen- 
eral increment tax lav/ of the empire, the maximum limit of which is 30 
per cent. At the end of five years the relation of the general and local 
increment taxes is to be adjusted. 



1112 



HOUSING 



A second feature of their plan is to nave the city go into the real estate 
business, in part through that power of excess condemnations (generally held 

to be illegal in this country). 




v*- 



D£ ZUYD REVIEH.ofDeLAWAJBE Re,VJR 



Fig. 472. — William Penn's Plan of the City of 
Philadelphia. The system that might serve the 
small city is ill adapted for extension to the large, 
though even on this little plan the waste and in- 
effectiveness of straight streets and rectangular 
blocks, with no diagonals, is obvious. ("Charities 
and the Community.") 

Will our Liverpools try to emulate Liverpool, England, our Berlins the 
German capital? 



The city owns 2,860 acres be- 
sides the city forest — about 21 
per cent of the total acreage. 
"The purpose of securing this 
acreage was to prevent undue 
and unsound speculation by 
private persons and the hold- 
ing back of property for ex- 
cessive prices, intermediate 
agencies enhancing the price 
of land." 

According to Foulke this 
policy was inaugurated in 1898 
in the German settlement of 
Iviao Chau in China, "where 
the government evidently in- 
tended to receive part of the 
increased values resulting from 
the growth of a new com- 
munity/' 

Two cities in Saxony 
adopted the plan in 1902. Hel- 
bersdorf inaugurated it, term- 
ing the tax an increment tax, 
in 1902. In 1911, 652 other 
German communities had 
adopted it including Co- 
logne, Essen, Dortmund and 
Berlin. 

There are many other ad- 
mirable features of the Frank- 
fort plan. 

In this country there are 
ten Frankforts, each probably 
named for Frankfort-on-the- 
Main. How many of them are 
planning as thoughtfully, as 
learnedly, as wisely as old 
Frankfort? What say Frank- 
fort, Ky. ; Frankfort, Mich.; 
Frankfort, Ind.; Frankfort, 111.; 
Frankfort, 0. ; Frankfort, Okla. ; 
Frankfort, S. D. ; Frankfort, 



MOKE ABOUT TOWN PLANNING 



1113 



MORE ABOUT TOWN PLANNING 

One of the best laws passed on this subject is the British town planning 
act of 1909. Part 3 of this act relates to the provisions for and organization 
of health departments — a recognition of the principle that town planning 
and housing provisions are essentially health matters. 



AVCWJIS, TO A.ff.STATIOli 
WITHOUT A WAP. 

Z. G-o rnon 5hoi?££mo 

Of rtONHO£ St TOSHOrtC 
£-Y0 Of JACKSO" i 
OUT CI HIS' "^ ■" /"/»*£• 8 



T^/C^L PLAN 
OF 5*/OflE;d£TrL£rJ£flfr 
//A f?/fA GAtfSETTBA K 



ABOUT Firrr.cn rJojscHOLOcfis of e#oAOfi£i.D momopoluZ 

THE. iVHOlC 3HOXE. f/?OMT- TH£ P£SrOF TH£ P£OPl.£ MUST 
BZCOfrrpfTEO MTst OCCASIONAL l/l£tVS f/?0W TH£*D£AO £W0S' 
?AL\ Sr/f££T3 • Qfrftf TH£i£ AJfce. QUILT UPO",ALSO. 




« R A O AA/,S ZTT 



e a r 



Fig. 473. — The Usual Way — the Water Front Shut Off. ("Charities and the Community.") 



The Canadian Public Health Association has a housing section and the 
American Public Health Association has recently organized a sociological 
section in which housing is to be discussed. 




Fig. 474. — An Admirable Exception — a Promenade along the Shore. 
("Charities and the Community.") 

ISTettleford quotes Professor Muirhead as follows: 

"The problem of the last generation was to provide gas and water; the 
problem of the next is to provide light and air/' 



1114 HOUSING 

That health authorities are not well posted in housing and have shown 
no special interest in the subject is no reason for separating the work from 
them. I think it fair to infer that health officers will be ready to handle 
housing by the time the people are ready to have it handled. Town planning 
and housing are health problems. Let us do all that we can to encourage 
and nothing to discourage this idea. 

Berlin and Paris were made beautiful by tearing out slums and building 
boulevards and parks on the vacated grounds. That these improvements did 
not increase the taxes was because the government condemned large tracts 
of ground, razed the buildings, improved the property on them and then sold 
a part of the ground at a price justified by the improvements. The people, 
rather than land speculators, got the benefit of the increase in price from 
betterments and public use. 

The legal right to proceed in this way is called the law of excess con- 
demnation. In this country some communities have tried to proceed in this 
way but the state supreme courts have found the state laws provided for it 
to be unconstitutional. 

Crawford, at the 1911 Conference on City Planning, said: "A decision 
by a state court upholding excess condemnation within reasonable limits would 
in turn be upheld by the Supreme Court of the United States." 

Without this principle of excess condemnation American cities must 
either be planned from the very beginning or else city planning on any 
effective scale must be abandoned, for the cost is prohibitive. How can we 
make a Supreme Court see this? 

One of the provisions of city plans which is both logical and difficult 
to bring about is division of the city into zones with a series of regulations 
adapted to each. 

The following resolution was introduced in the city council at Eochester, 
N. Y., in 1900 : 

"It is inequitable, as often happens, to sections of our city which have 
achieved a trade mark of special value by reason of residential unity and 
beauty, to have some vandal destroy such special value upon the plea that 'he 
has a right to do as he likes with his own property.' " 

A part of a proper zone plan is variation in the width of streets and 
in their method of paving. To provide that no street shall be less than 
100 feet wide and that no house shall be wider than the street on which 
it is located is wise for central areas. Had it been inaugurated when Chicago 
was begun downtown property values would never have attained their present 
dangerously high levels and the city at large would have prospered more. 
In the outlying districts ordinances requiring wide streets and expensive pav- 
ing work great hardships. 

Alderman Thompson of the National Housing Reform Council of Eng- 
land says that under modern conditions of subdivision the cost of roads and 
sewers reaches from $45 to $225 a cottage and puts up the cost of rents. A 
forty foot paved road on the outskirts of a town costs $1,000 to $2,500 
an acre. 

Nettlefold says that where there are fifteen houses to the acre the rent 
must be advanced one-sixth to pay for the cost of street paving and repair 
on a forty foot street, 



MORE ABOUT TOWN PLANNING 



1115 



Unwin has worked out a plan of adapting the width and improvement 
of the street to its use so that an owner with twenty acres can put in the 
improvements and build 340 houses for the same money as 200 houses would 
cost if rectangular streets of uniform width and paving were paid for. 



• 


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B 



Fig. 475. 



-Showing Difference Between Haphazard (B) and Scientific (A) Street Plan- 
ning of Irregular Plot. ("Charities and the Community.") 



In the London Town Planning Convention of 1910 Hogemen of Berlin 
and Adams of England both said that wide streets caused tenements. "It 
was necessary that the owner extract from each yard of his frontage enough 
rent to pay its share of the costly street." 

For outlying districts narrow, winding or diagonal streets make it 
possible to spend more on the sanitation of the homes. Where traffic of 
the future promises to be dense and a wide street may at some time be wise 
in the intervening years a narrow paved area bordered by grass and trees 
is good economy, good sense and good health. 



1116 HOUSING 

As between rectangular streets exclusively and a combination in which 
some of the streets are diagonal and some rectangular Eobinson says esthetics, 
sanitation and convenience all favor the latter. 

In Vienna the crowds are handled with less inconvenience than in any 
other city and there the cars come in on diagonal streets to the Eigstrasse, 
which they follow around to deliver their passengers as near as possible to 
their destinations. 

Eobinson says : "The two diagonal streets, Broadway and the Bowery, in 
New York, saved for the city breathing spots like Madison and Union 
squares — space out of reach if condemnation had been required." 

Of much more importance than plans for the streets, however, are those 
for the structures on them. In fact, often expenditure for streets indirectly 
raises death rates. 

I have in mind several cities near Chicago that have spent all of their 
money, bonded themselves to the utmost and are now practically bankrupt, 
having exhausted their resources for expensive paving. Their death rates are 
high ; yet they can do nothing for their people because of their orgies of street 
building. They have no health department, no hospitals, no laboratories, 
no school inspection, no building inspection, no anything which runs straight 
to the welfare of the people, because of their street improvements. 



FLAT AND COTTAGE 

E. E. Pritchard has lectured for years against flats. His lecture is 
illustrated by epigram, anecdote and poetry. His auditors go away inter- 
ested and impressed but the percentage of people living in flats mounts year 
by year. 

There is much to be said against trying to raise a family in a flat and 
Mr. Pritchard says it well. Many others have said it. Yet the trend is flat- 
wards and no amount of preaching stops it. 

In 1912, in Chicago, 42.1 per cent of the building permits were for 
flats and but 28.8 per cent for residences other than flats. Only 18 per cent 
of Chicago families, according to the survey displayed at the City Club, 
live in single family residences. 

An analysis of 12,628 Chicago building permits shows that less than 1 
per cent of the apartments are to house a household in two rooms. The 
three-room apartments make up 3 per cent of the whole; the four-room 
apartments, 33 per cent; five-room, 30 per cent; six rooms and over, 33 
per cent. 

Not at all a bad showing. A five-room flat with all of its space and labor 
saving provisions will serve a family as well as did an old-style eight-room 
house. 

When we study the heights of buildings we find nothing to complain 
of. Of the permits issued in 1910, 37 per cent were for buildings one story 
high, 46.2 two stories high, 3.7 three stories high, 1.7 four stories high, 
and over four stories, 1.1. 

Comparing the type of building with that in vogue in 1870 we find the 
greatest change is in the reduction of the percentage of one story buildings 



FLAT AND COTTAGE 



1117 



from 73 to 37 per cent, and the increase of two-story buildings from 20 to 
46 per cent. 

No type of building is more unsatisfactory, more uncomfortable and 
more expensive to maintain than is' the one-story cottage. In fact, much of the 
trouble in housing at present is the result of one-story house building in 1870. 



ALLEY 



AllCV 




riPSTTIpp'g'RAN 



5e:cond fLporepLAN 



Fig. 476. — A House for Each Family. (Philadelphia.) Two-story brick houses, 4 rooms 
and bath. Selling price, $1,750. Rent $13 a month. (National Housing Association Publica- 
tion No. 7.) 



1118 



HOUSING 



A study of the location of living apartments with reference to "the street 
is disquieting at first blush. In a study of about 2,500 insanitary living places 
over 1,400 were found fronting on alleys, yards and courts rather than on 



Auey 



ALLty 




First Floor 



Second Floor 



Fig. 477. — Mechanics' Homes. (Philadelphia ) Six rooms and bath. Rent $16 a month. 
Brick houses, built in rows. Sale price, $2,000. (National Housing Association Publication 
No. 7.) 



FLAT AND COTTAGE 



1119 



the street. Yet in old style premises the servants' quarters were reached 
through the alley. 

Two hundred and seventy-six premises were in the rear of stores and 




Fjg. 478. — Another Type of Mechanics' Homes. (Philadelphia.) Six rooms and bath. Cost 
about $1,400. (National Housing Association Publication No. 7.) 

yet everybody is agreed that the tendency of modern times is to get industry 
and trade away from the home. 

Things are getting better; but our standards are climbing faster than 
the conditions surrounding us. 



1120 HOUSING 

Bad Housing Conditions. — Miss. J. I. F. thinks Chicago housing condi- 
tions should be receiving more attention than they are at present. She says 
that looking north from West Chicago Avenue, near the terminus of the 
street-car line fifty newly erected cottages can be seen. They are set along 
the front line of the lot. They are but two or three stories high but they 
have not been so erected as to get as much light and air as they should 
have. One remedy suggested by her is that the houses alternate with re- 
spect to their positions on the lot, that one house be set in front of the lot 
and the next on the back. 

Reply. — There is no question that neglected housing constitutes one of 
the great wastes of the day. We are drifting into congestion and bad 
housing situations which are going to prove almost impossibly expensive 
when we come to remedy them. They are costing vast sums now in the 
way of inefficient labor and consumption and other diseases; but we are 
drifting along toward worse conditions. Nor is it limited to large cities. 
Lake Forest has bad housing; Springfield has much of it. The farmer 
suffers from it. 

The Chicago ordinances passed January, 1911, cannot be enforced be- 
cause there is no appropriation. The poor people are without protection. 

The checker board plan would give more light and air under certain 
circumstances and yet a twenty-five foot lawn, plugged on three sides, 
would not help much. Generally speaking, authorities believe it vital to 
keep the rear of the lot unoccupied. 

I think the present Chicago ordinances a better solution than yours. 
The problem is to get money for the health department so that the present 
ordinances may be enforced. 



CHAPTEE LX 

The Home 



SITES FOR BUILDINGS 

Soils have been frequently and justly, too, charged with having much 
to do with the prevalence of certain diseases not only among men but cattle 
as well. A knowledge of soils, then, is highly important, since their constitu- 
tion with reference to moisture and dryness, chemical and physical makeup, 




Fig. 479. — Two Springs. One Protected from Surface Contamination; the Other Not. 

permeability and impermeability and their configuration will have much to do 
with the selection of building sites. 

Building sites should receive the most careful attention. First of all, 
the site should be dry and free from the accumulation of organic matter. 
Granite, limestone, clay, sandstone, slate, chalk, gravel and sand (when 
the subsoil water is not too high and is free of organic impurities) make 
excellent sites for building purposes. 

In determining fhe building site high ground is naturally preferable. 
In the country districts you usually find the house built on the top of a 
hill, on the hillside or on a knoll. They are usually built when possible in 
close proximity to a supply of pure water for domestic purposes. 

1121 



1122 



THE HOME 



Alluvial soils, marsh lands and gravel and sand with clay subsoil are 
regarded as unhealthy selections for building sites. Buildings should not be 
located near marshes, stagnant ponds, swamps, badly kept mill dams and 
polluted creeks. Sites on the banks of rivers which are subject to periodical 
flooding or which have a sluggish flow are usually unhealthful. 

In the selection of building sites made lands and sites formerly occupied 
are to be regarded with suspicion, if not rejected. Such sites are either 
contaminated with garbage, rubbish and decaying animal and vegetable 
matter or are honeycombed with cesspools or the accumulated filth from 




Fig. 480. — Popular Idea of How Wells Become Infected from Surface Pollution. 

broken drains, soakage from barnyards, pig sties, stables and outhouses. A 
well should never be sunk through such ground. 

Finally, in the selection of a building site due regard should be had for 
the disposition of garbage, household waste, sunlight, air, dampness and 
ventilation. In valleys and ravines, for instance, the ventilation is not so 
good; hence the air may become damp and chilly. The same might be said 
about building a house too close in to a rather steep hillside; in the latter 
case it ofttimes becomes necessary to construct artificial drains at some di- 
tance up the hill from the house in order to correct excessive dampness. 
This is best accomplished by digging a ditch of suitable length into which 
a number of stones are rolled and then covered over with earth. This ditch 
should lead into some main drain so that it will offer a proper outlet for 
the seepage from the hillside above it. 



SELECTING A HOUSE 



From the health standpoint, the bedroom is the most important part of 
the house. Then, should it not be the best room in the house? — not the 



SELECTING A HOUSE 1123 

largest nor the most ornate but the sunniest, the best ventilated and the 
most quiet, at least during the night hours ? 

The human body throws off much waste during the night hours and 
sunlight is required to purify. To keep things clean may make amends for 
lack of sunshine but no sweeper or mop can search out the germs and kill them 
as well as can sunshine. 

The next most important is the ice box. When the summer time is on 
it will be no easy matter to keep food free from taint. Some changes in food 
change the taste and odor; many do not. Ofttimes food is dangerous when 
it tastes and smells good. Especially is this true of milk. 

We must remember that babies do not have a long list of foods to choose 
from; it is milk or nothing with them. 

A poorly drained, badly constructed or badly kept ice box means that a 
few times at least during the summer baby's milk will be unsafe or un- 
palatable. 

Ice boxes do not keep themselves clean merely because they are cold. 
They produce odors and slime that grows well in cold water, or on the walls 
of an unclean but cold ice box. 

Next in importance is the kitchen. However careful one may be the food 
will touch something here and there. The cap will be removed from the milk 
bottle, laid wet side down on the kitchen table and then put back in the 
milk bottle. Such acts will occur in spite of everything. 

One cannot be dodging germs all the time. This means a need for a 
spotless kitchen, which means a kitchen so built that it can be kept spotless. 

This is no easy matter, as the grease vapors make the dirt stick in the 
kitchen. 

A part of proper construction is step-saving and back-saving arrange- 
ments. When the cook gets tired her back aches, and she is certain to quit 
trying to keep things spotless. 

Next come the pantries and closets; not that they are so frequently 
visited or are of themselves so important, but because the custom of having 
them dark and ill ventilated is so nearly universal. 

Two-thirds of the day is spent 'in sitting rooms and one-third in bed- 
rooms, therefore both of these must be right. Insanitary bathrooms and im- 
proper kitchens are offensive out of proportion to their use and, therefore, 
they are of importance. The balance of the house does not count for much 
from the health standpoint. 

A common fallacy is that large rooms are better than small. Carnally 
and Haldane found that a man could be comfortable with 100 cubic feet of 
air space if the air was changed often enough and that 800 was really 
an excess. Where each occupant had 2,500 to 4,000 cubic feet the air was 
not so good as where he had a third as much. Large rooms are dirt catchers, 
coal eaters and a nuisance generally, while they give poorer air than smaller 
ones. 

Especially is it true that bedrooms should be small. But small rooms 
must be ventilated. We may trust to leakage to ventilate a large room but 
not a small one. 

An ordinary wall will leak somewhere about five cubic feet of air per 
square yard per hour when an ordinary wind is blowing. If the plaster has 



1124 THE HOME 

a hard finish, is painted or papered, wall leakage will be about done away 
with. 

Not so with window leakage. On a very windy day an unstripped win- 
dow will leak about 400 cubic feet of air per hour. When stripped it will 
leak only one-twentieth as much. The air which leaks in around unstripped 
windows is cold air and it falls straight to the floor. The warmer the room 
the quicker the window leakage falls and the more uncomfortable it becomes. 

The old idea was that a room with a high ceiling was preferable because 
ventilation would be better. In figuring cubic feet of air space for ventilation 
calculation engineers have long ago learned to count all over fourteen feet 
as a liability and not an asset. 

Where the ceilings are not over ten feet high the windows can reach 
entirely to the ceilings and nearly to the floor. ' The first detail is excellent 
for lighting; the second makes it easier on very cold days to warm the air 
which enters. 

The Bohemian school building laws provide that 70 per cent of the 
students as they sit at their desks must be able to see the sky. The common 
rule in this country is that the window area must be one-tenth to one-fifth the 
floor area. 

And then what of the radiation — not only in relation to the size of the 
room but also to the window and wall leakage? 

Another point worth while inquiring into is whether the walls and floors 
are deadened and insulated. Where people live in flats noises above and 
below often spoil the serenity of life. It costs but little to fill the space be- 
tween ceiling and floor with cinders or sawdust and to do so saves heat as 
well as nerves. 

Outside walls built hollow and filled in with insulation save coal. They 
will not sweat when the humidity of the room goes over fifty; and walls that 
do not sweat keep clean. When walls are hard finished or painted the window 
leakage is reduced to nothing and accumulated dust is easily removed. 

Houses with basements are to be preferred even in warm climates but 
the basement must be kept dry. Houses without basements have cold floors, 
the ground under them is not dry, and wet ground wider a house always breeds 
molds. 

The English laws provide that basement floors shall be covered with six 
inches of cement or asphalt and that one surface of this must be treated 
so as to be impervious to water. The walls are to have a vertical air space 
running from a point six inches above the ground level to one below the level 
of the cement floor. Just above the top of the air space and just below its 
bottom an impervious layer is to be placed — vitrified brick, slate or lead. 
Ground water cannot travel through the wall into the basement nor up the 
wall into the house. The basement, if it is to be occupied, must come two 
and a half feet above the surface of the ground and the window surface must 
be at least nine square feet. 

The roof of a building is not of much service in tempering the air. The 
space just beneath the roof is usually hotter than that above it. 



SANITARY BATHROOMS 1125 



SUNLIGHT IN THE HOUSE 



A room that does not get some sunshine is not fit to live in. 

If you will notice the ceiling in your kitchen you will see shaggy soot 
collected here and there. In the main, this soot is grease evaporated on the 
stove and condensed on the wall. With it is some other organic matter, 
some harmless dirt and some bacteria. One day's accumulation is too little 
to be seen but the mass increases day by day until, around cracks, openings, 
and flues, the mixture hangs like whiskers. The cleanest of kitchens have 
some whiskers. 

The same process, though less in amount, is taking place on every wall. 
The condensed matter has not so much grease in it and therefore does not 
show so plainly. But whether in kitchen or parlor wall dust consists of 
organic matter capable of decaying and of germs capable of making it decay. 

So come house odors ! Not always harmful but never helpful and always 
unpleasant. To cure these odors wash the walls and air and sun the rooms. 
To prevent them either the putrefying matter must be removed or else it must 
be disinfected. Washing can be done only at long intervals but airing and 
sunning can be done every day. The organic matter will no more decay 
without germs than eggs will rot without them. Germs make no headway 
where there is sunlight and air. 

There are other harmful results of house occupation which call for sun- 
shine just as much as wall dirt and house odors — the illustrations used above. 

How can sunlight be secured? 

By placing the house, first, so that trees will not keep sunlight out of 
the rooms; second, so that neighboring houses will not darken the rooms; and 
third, by facing it in a direction that will expose every room to some sunlight. 

Houses set so as to face squarely east or west or north or south are pretty 
apt to have some sunless rooms. As a general proposition, houses facing east 
or west or north are to be preferred. So fronted, an architect can find a way 
to get sunshine into every room. 

If there must be dark rooms the walls should be washable and they 
must be aired enough to compensate. See to it that the kitchen and bedrooms 
are not of them — the kitchen, because its walls gather dirt; the bedrooms, 
because the bedclothes need sunlight. 



SANITARY BATHROOMS 

The development of house drainage has made the growth of cities pos- 
sible. It is not possible to house more than ten people on an acre of ground 
and have them enjoy good health unless the toilet facilities are built inside 
the houses. 

When people began to understand this and to legislate against outside 
or yard toilets there was much opposition. It was argued that toilets in 
houses would increase discomfort and produce illness. In the then state of 
the plumbing art there was a good deal of force in the argument and many 
fair-minded people believed and accepted it. But plumbers exercised their 



1126 THE HOME 

inventive genius. One device scarcely got on the market until an improve- 
ment was crowding it out. The present state of the plumbing art represents 
practical perfection. 

The sanitary standards of house drainage are years ahead of those of 
any other feature of the house. Even the yard hopper, crude as it is, is 
in advance of the ventilation, heating, lighting or floor and wall construc- 
tion of the houses to which they are attached. The high standard of the 
plumbing has served to elevate other standards and to teach other health 
lessons. 

Customarily, bathroom iv-alls have a hard -finish, are of washable con- 
struction, hung with less molding, decorated with less claptrap and freer 
from dusty foolishness than any of the other ivalls of the house. The kitchens, 
sitting rooms and bedrooms ought to go to school to the bathroom. 

Another lesson taught, rather incidentally but nevertheless wisely, is 
the advantage of having wash bowls located in close proximity to toilets. 
This arrangement prevents some finger-borne typhoids, some venereal diseases 
and some other consequences. On this point, many factories, stores and 
offices could advantageously go to school to the bathroom. Inaccessible, 
inconvenient, uncomfortable facilities might as well not exist. 

And finally, the perfection of house drainage should and will stimulate 
the inventive genius of ventilating engineers to solution of their problems. 
While improved house drainage grew in response to a demand that living 
be made safe for those who are crowded together it has demonstrated its 
advantages for houses surrounded by an abundance of room. Sanitary toilets 
and bathrooms in country houses will help to keep the country people from 
moving to the city. 



KEEPING THE HOUSE 

How hot do you keep your house in winter? 

How dry is the air? 

How often do you blow out your house? 

How much sun do your rooms get? 

How clean do you keep your house ? 

The way you build your house is more important than looks. While 
this is entirely true it does not diminish the importance of the way you keep 
your house. 

Guard against a hot house. 

To go into a warm room for a few minutes probably will do you no 
harm. To stay there throughout the day may do so little harm that it cannot 
be noticed. To stay there days in succession will first make you languid, 
then distinctly below physical par and finally definitely sick. 

The sickness may be called one scientific name or another; the basic 
trouble is bad ventilation. 

Nearly everybody who speaks of flats says abusive things of them. Sev- 
enty per cent of the basis of this abuse is dry hot air. 

Dry air is the curse of flat life. If some of the energy spent in complain- 
ing was spent in throwing up the windows occasionally (so that the rooms 



COLD WALLS 1127 

might blow out), in ventilating better all the time and in keeping the air more 
moist, everybody would be happier. 

No amount of air can entirely replace sunshine. The woman of the 
house can go out to get the light. Is it not better that she should get it in 
the house also? Besides, it is needed to keep the bed and furnishings pure 
and sweet. 



KITCHENS, ICE BOXES, PANTRIES AND CLOSETS 

Living rooms are usually too hot and too dry. Kitchens are usually too 
hot and too moist. 

What is sought in a kitchen is that it be cool and clean. The kitchen 
is rarely a dark room in the private home. From the standpoint of being 
supplied with outside windows it ranks next to the company room. 

In order to keep the kitchen cool it is wise to have a hood over the stove. 
This hood should lead straight to the stack. The room should have a venti- 
lator into the stack near the ceiling. The hot air from around the stove goes 
straight up and any system, which tries to take it out from near the floor is 
sure to fail. Nor can kitchen odors be pulled around in any unnatural way. 
They must go out over the stove or from the top of the room or else they will 
go into the house. The same thing is true of the steam. 

Ice boxes must be frequently aired and sunned. There are molds, yeasts 
and bacteria which grow pretty well at low temperatures. Many of these 
are odorous. The only way to keep them down is by sunning and airing. 
In the winter the box can be aired all the time and this is economical and 
hygienic. The plan is to use the cold outside air in place of ice. The best 
way to arrange this is to have the ice compartment open to the outside air. 
When the weather gets cold the door is left open and no ice is bought. Pans 
of water placed in the ice chamber will freeze solid and will keep the box cold 
during the days when the temperature rises. 

Just as you never see kitchens crowded into basements wholly under- 
ground except in some hotels and restaurants, so rarely, except in such places, 
do you find ice boxes which cannot be ventilated or sunned. 

Pantries need to be well ventilated, dry and clean. If they are not the 
food goes off rapidly. Molds are more liable to grow in a pantry than in 
any other room. There is more food for mold in a pantry than in any other 
room. This means that a moldy pantry is not as clean as it ought to be. 
It is also moister than it ought to be. 

If any room in the house must be dark let it be the closet. Dark space 
can be better used in this way than in any other. It is better to have air 
ducts in the walls and have an opening into such a duct in each closet. The 
opening can be made so that it can be closed. This and periodic airing will 
be the only health needs of closets. 

COLD WALLS 

One of Browning's poems, called "House," tells of a home with the front 
wall cut off and how the wayfarers gazed in at the rooms. While the walls 



1128 THE HOME 

of a house may keep you and me out or even from looking in they do not 
stop the air from leaking in. 

When the temperature of the outside air is thirty-two degrees lower 
than that of the inside an ordinary brick wall will leak eight cubic feet of 
air an hour for every square yard of wall. If a hard north wind is blowing 
against the wall the leakage will be much greater. When the wind is 
blowing twenty-four miles an hour, a crack of one-sixteenth of an inch around 
a window sash will leak 402 cubic feet an hour. 

These rough figures teach us that air leakage through walls and around 
windows are things which we must think about in selecting a house. They 
tell us that on account of the cold air leaking into the rooms the occupants 
may mistake the coldness for fresh air and not keep the rooms properly 
ventilated. 

Improperly ventilated rooms {especially when they are furnace heated or 
heated with a gas or oil stove) where there is no proper provision for carrying 
away the product of combustion mean ofttimes that the air in these rooms is 
charged with poisonous gases, poisonous products of respiration and disease- 
producing germs. This means that you may expect to find a chronic condition 
of low vitality followed by such winter diseases as pneumonia, tonsilitis, diph- 
theria and smallpox. 

Does it face south? If so, the lived in part of the house may be cold 
in winter. Is it exposed? Can the wind get a good drive at it? How are 
the walls constructed? Is there any building paper between the inside and 
outside walls? Is there any other insulation between these layers? How is 
the inside wall faced? Has it a hard finish that will stop air from coming 
through and can be washed? Is it papered so that it stops air and can be 
cleaned? Has the paper been put on over old paper? Does the wall sweat? 
If there is a basement how are the walls there ? Is there any mildew on them ? 
Are they stained from old mildew or from old leakage and seepage? Is 
there an airway around the wall? Is there a "damp course" in the wall 
so placed as to prevent seepage ? 



DAMP WALLS 

In the north damp walls are a menace in the summer time only. During 
the winter the heat required to maintain temperature is sufficient to dry 
the walls even though ground moisture is going into them as oil goes into 
a wick. 

In the south, on the other hand, damp walls are only troublesome in the 
winter time. The summer heat dries them out. 

A damp wall does no harm except by keeping alive the germs of the wall 
dust and making the organic matter of the dust more apt to decompose. When 
there is plenty of air and sunshine in a room a damp wall is no more harmful 
than a dry wall, for air and sunshine kill the wall germs. Therefore, damp 
walls are only of health importance in dark rooms. It is in basements without 
adequate lighting and in tenements where there is no sunlight that damp walls 
are productive of disease. 

A solidly built wall is a good conductor of moisture. Walls wet from 



CURTAINS AND CARPETS 1129 

rain will get wet through if the outside is not adequately painted and the 
rain persists. But most of the wet walls are so because of absorption of ground 
water. A leaking gutter allows water to drop close to the wall or a drain 
or ditch keeps the foundation wet. 

A few layers of slate, a layer of lead or of vitrified brick a foot above 
the ground will prevent moisture from climbing. In the case of basement 
walls an airway outside the wall will keep it dry, but such airway is liable 
to become insanitary. A better plan is to build the wall hollow. Whatever 
braces cross the hollow area or cross the wall above the hollow area must be 
of some material impervious to water. 

Damp walls mean insanitary conditions; insanitary conditions mean 
lack of efficiency, less likelihood of employment, therefore more poverty, 
bad food, bad housing and conditions tending to increase the spread of tuber- 
culosis and other infectious diseases. The problem of damp walls, then, 
is all important, since its influence, especially on the younger members of 
the family, will have much to do with the health, comfort and happiness 
of the community. 

CURTAINS AND CARPETS 

Occasionally a method which is right will develop entirely away from its 
original lines. The underlying idea may be entirely changed. A good illustra- 
tion of this is the use of curtains. 

The first people who used curtains wanted to make it possible to keep the 
windows open. Curtains gave more privacy and also took some of the dirt out 
of the air. Then the use of curtains to adorn the room became the custom. 
Now curtains are made of delicate fabrics. They are no longer used to filter 
air. On the other hand they are so difficult to clean that the windows are kept 
down in order that the curtains may not be soiled. No doctor would do a 
surgical operation in any curtained room. Contagion cannot be cared for in 
curtained rooms. 

Then why not get fine curtains out of the bedrooms and living rooms? 
Leave them in the show parts of the house — for instance, in the parlors. Let 
the curtains of the living rooms be plain, simple and cheap. 

As between curtains and air, let us have air. 

Carpets furnish an illustration of a similar point. The old-style wooden 
floor was cold. It leaked air. It was hard to keep clean. Dirt showed 
plainly on it. Then came rugs which developed into carpets. The floor was 
much warmer. It did not show dirt. The carpets increased in cost. The 
shades were kept down to prevent fading. The windows were kept down to 
prevent dust from blowing in. 

Now there is a different idea and it deserves every encouragement. 
Floors are deadened. This makes them warmer. They are being made of 
hard wood or some impervious composition — not all of them but in increas- 
ing numbers. The corners with the side walls are being made round. And 
when they are covered it is with rugs. But rugs are no better than carpets 
unless they are kept clean. 

Dust from Rugs. — Mrs. W. J. 67. suggests that leases include a pro- 
hibition of the practice of beating rugs on the porches. 



1130 THE HOME 

Reply. — No good neighbor will dust her rugs in any way that sends 
dust into her neighbor's house. Bad neighbors render life in flats well- 
nigh unbearable. 

A SENSIBLE CAMP 

Two gentlemen in Mississippi have built an outing home along right 
lines. They started right by locating right. The spot selected was in the 
middle of a fifty-acre pasture on soil that is a mixture of sand and gravel. 
When it rains the water quickly soaks in and there are never any puddles of 
water standing around. This means no mosquito breeding places as well 
as no hours of mud-bound idleness and discontent. 

There being no trees, the breezes are not obstructed and the sun gets a fine 
chance at everything. It is impossible to prevent some ground pollution around 
a dwelling but this matters little if the sun gets a good chance to sterilize. 

The next exhibition of good sense was in the type of house built. Ninety 
per cent of the time in summer and 60 per cent of the time in winter the 
house consists of a roof and a floor. The floor is of cement. In the center is a 
chimney with two fireplaces. Over the top is a high pitched roof. 

All four sides of the house are so hinged that they swing out until horizon- 
tal. To facilitate swinging out the side walls are divided into ten foot sections 
and the counterweights, made of cement, are used to balance the weight. 
The walls hinge ten feet from the ground. 

The breezes are unobstructed. There are no side walls to absorb heat 
during the day and radiate it at night. Sunlight and air and an easily washed 
floor keep the house always free from house odors. Privacy is had by use 
of light, movable screens. The house is cooler than if it were placed in the 
woods. 

The next exhibition of good sense was in providing a good water supply. 
Sixty feet from the house they sunk an artesian well flowing seventy-two gal- 
lons of water. Artesian water is bacteriologically pure. It is not contaminated 
and it cannot be. 

The water run-off passes through a milk, butter and meat box, furnishing 
the next exhibition of good sanitary sense — provision to prevent fresh food 
from spoiling. 

Over the artesian well is a pagoda with a cement floor. Curtains that 
can be dropped around this pagoda give a cement-floored bathing pavilion 
provided with a stream of cold, clean, running water — a shower bath proposi- 
tion. This is the seventh exhibition of good sense. 

The statement that when these side walls were raised the house con- 
sisted of a roof and a floor omitted mention of mosquito and fly screens 
extending from the eaves to the floor on all sides — the eighth item of sanitary 
sense. 

Compare this simple, inexpensive, sanitary equipment with the usual 
camp under sun-excluding trees, stuck in a dense mass of foliage, on wet, 
soggy ground, on polluted soil, with polluted water and insects galore, with 
no provisions for keeping food cold and with no bathing facilities. 



ARRANGEMENT OF HOME 1131 



PORCHES 



Porches can add to or detract from the hygienic qualities of a house. 
In country homes and sometimes in homes in smaller cities the house is so 
nearly surrounded by porches that the sun cannot shine into the rooms. 
Especially is this true of latticed and vine-clad porches. With this reserva- 
tion porches are to be sought for in finding a home. This is much more 
necessary in a city than in the country. When houses are standing on lots 
thirty feet or less in size there is insufficient chance for light and air unless 
there be porches. 

Sleeping on a porch is much more comfortable than sleeping in a room 
in most places from May 1 to December 1. With a moderate amount of 
preparation it is just as comfortable as room sleeping during April and 
December. With proper preparation and forethought it can be made com- 
fortable during January, February and March. 

It is much more healthy than sleeping in a room. This is true of the 
midwinter months as well as the months of spring, summer and autumn. 
Perhaps there is, here and there, a lingering idea that night air is harmful. 
It is both cleaner and purer than day air. 

The people of southern California say that 50 per cent of their popula- 
tion sleep on screened-in porches. With them the percentage should be 90. 
Sleeping out is so easily made comfortable with them. 

Much the most satisfactory arrangement is to "glass-in" the sleeping 
porch. This is expensive. Glassed-in sleeping porches may be made so snug 
and free from drafts that they have no advantages over cold rooms. If 
the sleeping porch is glassed-in the windows should be movable and free 
air movement must be had during all sleeping hours. 

The next best arrangement is protection by curtains. The short> 
coming of curtains is their noisiness in stormy weather. This can be prevented 
by fastening with strips of wood placed at short intervals. In those parts 
where roller curtains are used buttons, buckles or hooks should be provided 
at intervals of two feet on all posts and pillars and supports. 

The simplest arrangement is to have a heavy tarpaulin to cover the bed- 
stead as well as the bed. This should be rolled out of the way on the head 
of the bed. When storms come up during the night the covering can be 
arranged tentlike over the bed. The occupants sleep elsewhere on such windy, 
rainy nights. 

The other uses of porches will appeal to more people than their use as 
sleeping places. Has your prospective home a good back porch where you can 
eat in the open air in the summer time? Does the sun reach it that things 
may be sunned and aired? Is there a comfortable fr^nt porch where some 
fresh air can be taken without dressing for the street ? 

ARRANGEMENT OF HOME 

As one goes about seeking a home it is well to ask oneself certain 
questions about the requirements of a home for comfort and health, to answer 
the questions in one's own mind and, when a proposed location is being 



1132 THE HOME 

looked into, to see how many of the answers apply to the place under in- 
vestigation. Some of the questions which should be asked and my answers 
thereto follow: 

Q. — What is the principal source of flies in a neighborhood? 

A. — -Manure boxes and stables; garbage is second in importance. 

Q. — What is the principal source of mosquitoes about a house? 

A. — Small collections of water located inside the house or within 300 
feet of it. Ninety-five per cent of mosquitoes and flies never get 300 feet 
away from their hatching place. 

Q. — In which direction should a house face? 

A. — North. The front portion of the house is not often used constantly. 
On cold, windy days the north rooms generally leak so much cold air that they 
are uninhabitable. There is advantage in using these rooms as parlors and 
spare rooms. It is even better to have the house face somewhat west of 
north. 

Q. — On which side of the house should the bedrooms be located? 

A. — The east side. The beds should have the morning sun and in sum- 
mer should escape the heating effect of the afternoon sun. Especially is this 
necessary with the nursery. 

Q. — Is a house in a dense woods advisable? 

A. — No. It is almost impossible to rid a house thus located of mosquitoes 
and flies. The sun does not get a fair chance to purify the ground around 
the house nor the inside of the house. 

Q. — Should the house have a cellar or basement? 

A. — Yes. It is a protection against cold floors in winter. It does 
not make the house warmer in summer. 

Q. — How can a cellar wall be kept dry ? 

A. — A tile drain should be laid around the outside of the cellar wall. 
The drain should be four inches below the foundation wall, beginning at the 
corner, and twelve inches below at the opposite corner. 

Q. — Of what material should the cellar wall be built? 

A. — Of concrete or stone, laid in cement mortar. 

Q. — What is the objection to a wall of ordinary brick? 

A. — Brick walls absorb water too readily. 

Q. — How can water be prevented from creeping up the wall? 

A. — By interposing a damp-proof course consisting of one-half an inch of 
asphalt or slate and by having air spaces in the wall. 

Q. Should the cellar extend above the ground and be provided with 
windows ? 

A. — Yes. Unless a cellar can be aired and sunned it is liable to be a 
source of ill health. 

Q. — What are the signs of a damp cellar? 

A— Wingate's "Sanitary Question Box" gives the following: 

1. Eust on exposed metal pipes and flues. 

2. Broken plaster and "bucking" lath. 

3. Dry rot on the floor beams. 

4. Fungous growths on walls. 

5. Spots of mildew and moisture between the cracks of the flooring 
together with a musty odor and a general sense of closeness. In addition, 



ARRANGEMENT OF HOME 1133 

look for wet dirt in the spaces of the flooring and for rotting of the ends of 
wood in posts that support the floor. 

Q. — How can one tell that the walls of a building absorb moisture 
from the ground? 

A. — Look for so-called wet feet. Walls that show scaling of the paint 
and incrustation with a mineral extending a foot or two above the ground. 

Q. — Should a house have high ceilings? 

A. — No. High ceilings add nothing to the ventilation of a house. In 
fact, they increase the difficulties of ventilation. They likewise increase the 
difficulties of heating. 

Q. — Should not the houses in warm climates have high ceilings? 

A. — No. The houses in Havana have high ceilings but it is a mistake. 
It is desirable to have a good deal of space below the roof but that space 
should be between the roof and the ceiling, not below the ceiling. 

Q. — Should attics have windows? 

A. — They should, especially in warm climates. Attics need sunshine. 
In warm weather, unless they have windows, much of the roof heat is 
transmitted to the rooms. In cold weather the windows can be made tight. 

Q. — Can a house have too many windows ? 

A. — Yes. The purpose of windows is to illuminate the room, to secure 
for it the bactericidal action of sunlight and to permit of ventilation. Too 
many windows means that the room will be cold, will have cold floors and 
will be hard to heat. 

Q. — From the standpoint of health what is the most important room 
in the house? 

A. — The nursery. 

Q. — What is the least important? 

A. — The parlor. 

Q. — Why is it important that the pantry should be right? 

A. — Because food may be dangerously spoiled without being altered in 
taste, smell or appearance. 

Q. — What is the most important piece of furniture in the pantry? 

A. — The ice box. 

Q. — What are some of the more important points to note about an 
ice box or refrigerator? 

A. — It should maintain a temperature, when iced, of less than 55°. In 
comparison with this all other points are of minor importance. It should be 
lined by some white waterproof easily cleaned substance. The shelves and 
partitions should be removable. It should be drained by pipes and traps that 
are easily reached and readily cleaned. It should be in such a position 
that it can be sunned at times, or else it should be on rollers, so that it can 
be moved to a place where it can be sunned. It should have walls thick 
enough and composed of material which will not absorb moisture or pack or 
lose its air spaces. It must not be an ice eater. It must be open to the out- 
side so that ice may be put in from the outside in warm weather and so that 
the outside air may serve for refrigeration in cold weather. Its outward ap- 
pearance must be one of neatness and cleanliness. 

Q. — Should the pantry shelves be removable? 

A.— Yes. 



1134 THE HOME 

Q. — Should the pantry walls have a hard finish ? 

A.— Yes. 

Q. — Should the kitchen have a hard-finished wall? 

A. — Yes. The kitchen should have a washable wall free from molding 
and dish racks, even if it is the only room in the house with a wall of this 
type. The vaporized greases soon soil the kitchen wall and nothing suffices 
except washing. 

Q. — Should the kitchen have an electric fan? 

A. — Yes, an electric fan is needed to distribute the heat properly in 
both winter and summer. In hot weather the food will not be sanitary if 
the cook is overhot and perspiring profusely. 

Q. — Should the kitchen have every convenience not only for cooking but 
for handling the food and for caring for the dishes? 

A. — Yes. Efficiency demands it. 

Q. — Of what material should a kitchen sink be made? 

A. — Enameled sinks are much the best. Porcelain is good. Galvanized 
iron does very well though it rusts after the zinc has worn off. Slate, soap- 
stone and iron have much against 'them. 

Q. — How can the kitchen sink be kept free from small scraps of food ? 

A. — Every sink should be equipped with a removable strainer through 
which all washings should pass. 

Q. — Should the dining room be light? 

A. — While it is very desirable it is not especially necessary. 

Q. — How should the bedroom be arranged ? 

A. — There should be the minimum amount of furniture and the fewer 
dirt-catching ornaments and trinkets the better. 

Q. — Should the floors be covered with carpet or rugs ? 

A. — Rugs. 

Q. — How should the floors be built? 

A. — Between the floor and the ceiling of the room below there should 
be enough deadening substance to silence all sounds else the floors will be 
cold. Where floors are not deadened the flooring shrinks unevenly and in 
time it draws and creaks. 

Q. — How should the floors be cleaned? 

A. — The house should be equipped with vacuum cleaners whenever it is 
feasible. 

Q. — What is the objection to beating rugs and carpets on the outside ? 

A. — The noise disturbs the neighborhood; the dust pollutes the air 
and the bacteria kill the rug beaters. 

Q, — Should the bed be set against the wall? 

A. — No. One's smell tells him that the air on the side of the bed next the 
wall is not fit to breathe. Crowder has proved it by analysis. 

Q. — Should the bed be put in an alcove? 

A. — No. The bed should be where sunlight and air can get at it. 

Q. — Should a house have sleeping porches? 

A. — It should. When one sleeps in cold circulating air in a room which 
has had an abundance of sunshine during the day hours he will find that 
there is a material increase in his working capacity and also that he will 
be less liable to colds and pneumonia. 



SPKING CLEANING 1135 

Q. — Is a glassed-in porch better than one with awnings, curtains or 
shades ? 

A.— It is. 

Q. — Are glassed-in porches with fixed windows and radiators advised? 

A. — No. Unless the windows can be opened, the air allowed to come 
in freely, and the temperature to drop the porch loses many of its advan- 
tages as a sleeping place. 

Q. — Where should the bathroom be placed? 

A. — Convenient to the bedrooms. 

Q. — Should the bathroom have a window opening to the outside air? 

A. — It is desirable but not necessary. 

Q. — Is it proper to put a bathtub, a wash bowl and a water closet in the 
same room? 

A.— It is. 

Q. — Should a bathroom be heated by a gas heater? 

A. — It is never to be desired. It should be permitted if the heater has 
a flue or pipe to the outside air. Gas heaters without flues should not be 
allowed in bathrooms. 

Q. — Should a bathroom have a wall thermometer? 

A.— Yes. 

Q. — What is the reason for special care as to the temperature and the 
air conditions of the bathroom? 

A. — The disrobed body of the bather requires that the temperature of the 
bathroom should be several degrees warmer than the temperature of the re- 
mainder of the house. On the other hand, fainting in the bathtub must be 
provided against by watching that the temperature of the bathroom does not 
go too high and that the air is not too much polluted by products of com- 
bustion. 

Q. — What type of closet should there be? 

A. — Syphon jet, syphon, or washdown. Washout or hopper closets are 
not satisfactory. 

Q. — Are the present plumbers' methods proper from the health stand- 
point ? 

A. — They are. 

Q. — How can the air from an open window or from a hot-air register be 
cleaned ? 

A. — By fastening cheesecloth over the opening. 



SPRING CLEANING 

Spring cleaning is a law of nature. As the glow of spring banishes the 
winter's chill everything in nature casts off its winter coat, worn and dirty 
from use, and takes on clean raiment. The Easter bonnet is but a poor 
response to the great nature call. The trees shed their old dead parts and 
new clean buds break out. The flowers displace the dirty coverings, the 
dead grass is washed away and a bright green carpet covers the earth. Nature 
cleans in the spring. 

Spring cleaning is an instinct. The animals tumble the winter's waste 



1136 THE HOME 

out of their lairs. The birds that during the winter have accumulated 
dirty coats are seen to spend hours in washing and cleaning their feathers. 
The old drake that has been contented to look like an ashbox will give up 
hours to drawing its feathers through its beak, cleaning and oiling them. 

Spring cleaning is a custom and always has been. The cave man had 
the habit of cleaning himself and all about him in the spring time. Back 
of his custom lay the customs of his ancestors; back of the customs of 
the ancestors lay the instinct of the animals; back of this lay the laws of 
nature. 

The groups of women who in the spring of this year will be organizing 
clean up movements are not illustrations of De Vries' "Mutations" or 
"Sports." They are in harmony with the eternal fitness of things. They are 
links in a chain that reaches back to Noah and his ark laws, to Adam, to the 
cave man, to dumb animals, to nature itself. 

The beginning is with the house. All winter long the waste has accumu- 
lated there. The housewife has done her best. She has cleaned each day, 
each week, but the task has been too much. The sun had a short day and 
could not kill all the offensive matter in all the rooms. The air was cold 
and could not be allowed to sweep through and do its full share of cleaning. 

Therefore each week the standard of household cleanliness has gone back 
just a little. If it were 1,000 in October, in November it had fallen by easy 
stages to 990 and so on until easily and gradually it became imperceptibly 
lower as the winter went on. 

Now May comes and by one prodigious effort it must be brought to the 
normal again. 

The shutters are thrown wide open; the rooms are bathed in sunshine; 
the windows are thrown open; the rooms are bathed in air. 

However, more than that is required to make up for the sins of the 
winter. So up come the carpets and out they go to a vacant lot where 
some poor fellow beats them. He stands in a cloud of dust striking away. 
It is too bad that the principle of vicarious sacrifice should be carried so far. 

Statistics show that janitors and carpet beaters die from consumption 
like flies in autumn. Though it cannot be shown by statistics they revel 
in colds during the spring cleaning season. How could one expect anything 
else? There they stand, day by day, breathing in the germ laden dust, the 
dust that the housewife knows she must get rid of if her family is to keep 
well. 

The scoffer says : "Have you not told us that sunlight and air kill germs ; 
that drying makes harmful things harmless ?" Yes, they do. Given a million 
germs and admit these agents would kill five hundred thousand of them, there 
is still danger to the rug beater. 

The danger of carpet dust, though, lies in the fact that not all janitors 
die from it, and none of them drops dead as he beats. If they did carpet 
beating would stop at once. 

If the babies all died, or if babies died instantly, from bad milk, bad 
milk would be a matter of no imoortance to the community. Everybody 
would stop using it. 

Cannot a better way be found ? 

If there is something to be said against the prevailing practice in carpet 



SPRING CLEANING 



1137 




cleaning nothing can be said against washing and scouring the walls and 
floors, the closets and pantries, the sinks and ice boxes. 

Spring cleaning assumes a rather broad scope. It has for its object not 
only cleanliness but the laying plans for protection against disease that comes 
with the approach of summer. 

The doors and windows of the average home have usually been kept closed 
during the cold, bleak days of the winter. The air in many such homes is 
more or less foul; dust and dirt have accumulated. The attic and closets 
have been overworked by the accumulation of useless wearing apparel, old 
papers, paper boxes and odds and ends. 
The ceilings, especially of the closets, 
have become dust and dirt laden. In 
smoky neighborhoods particularly the 
paper on the walls is dirty and greasy 
from coal soot. 

During the last days of the win- 
ter the good housewife and the good 
husband have planned for a spring 
cleaning. They have faced the problem 
of cost and combined their best judg- 
ments in arriving at conclusions as to 
what shall and what shall not be done. 

Unfortunately, all of us cannot 
step to the phone, call the vacuum 
cleaners to take an order to clean 
apartment at No. — or home at such 
a location. While it is the ideal method 
of cleaning it is too expensive for most 
people, and necessitates their resorting 
to soap and water and hard labor. 

When the wife and husband 
planned their spring cleaning they 
were not wholly influenced by selfish 



Board or \ 
pfafe J/&SS 
io SO" h/g/? 
fie/o/jbyc/eafc 

Michigan Public Health. 
Fig. 481. — Ventilating by Means of Win- 
dow Lowered at Top, Raised at Bot- 
tom, With Deflector. 




s . 



motives. They might leave some 
things undone. They might get along 
without such extensive cleaning. But 
their neighbors have rights. They do 
not want to maintain a menace to the 
health, comfort and happiness of their 
neighbors. Hence they have endeavored to be more liberal in their calcu- 
lations. 

There is no better way, no more economical way, no more effective way 
to spend money than in maintaining a clean, hygienic home. 

The best way to clean a house is to begin with the closets. See that they 
are thoroughly cleaned and put in order before anything else is undertaken. 
Next, empty and clean bureau drawers, take down curtains and portieres, clean 
and put them aside until the cleaning and decorating has been completed. 
Bric-a-brac and pictures should be cleaned and placed where they will be pro- 
tected until the carpets and rugs are laid. 



1138 THE HOME 

House cleaning, as usually referred to, has regard only for the dusting of 
pictures, bric-a-brac and books, wiping the dust from the walls, beating the 
carpets and upholstered furniture and rugs, hanging the mattresses and 
bedding in the sun all for a few days each year. 

However, house cleaning should have for its object a little mere than this. 
It should mean getting the house and its immediate surroundings into a hy- 
gienic and sanitary condition. 

Insects are carriers of infection. They are responsible fcr many epi- 
demics. They may carry the germs of typhoid and typhus fever. 

The mosquito carries the germ of malaria, the bedbug carries the germs 
of relapsing fever, fleas may carry the germ of many diseases. The damage 
that the common house fly does by carrying disease laden tilth on its feet 
is pretty generally understood. 

The necessity for thorough spring cleaning seems to be only too apparent. 
Every corner, every niche should be thoroughly cleaned and freed of vermin. 

Cockroaches and all fields which oiler good breeding places for them 
should be destroyed. Containers to foods should be provided to bar their 
entrance. 

These pests may have paid a recent visit to some outhouses where they 
crawled over disease laden feces, only to return hastily to your kitchen and 
crawl over your bread, cake and other articles of food. They are kind and 
considerate enough to leave the germs of typhoid or typhus fever. 

Eoaches have an especial liking for dark, dirty, damp corners in the 
kitchen and about the pantry. For this reason extra care should be used when 
cleaning and repairing in the kitchen and pantry to provide against the pos- 
sible invasion of the cockroach. 

In rural districts the houses may not contain so much dirt as the homes 
in the great cities but there are outhouses such as barns, chicken houses, pig 
pens, cow pens, stables, smokehouses and wagon sheds which need thorough 
cleaning. 

In the spring cleaning season they should all be carefully gone over. 
All the debris and waste which favors the breeding of vermin must be 
destroyed. 

It should not be forgotten that rats, mice, flies and fleas are especially 
partial to fields of filth that are located in and about such areas. They 
are all carriers and spreaders of disease; and if the home is to be free from 
disease breeding vermin their habitations must be destroyed. 

It has been known for some time that the mosquito is the carrier of the 
malarial poison. No disease so insidiously and secretly undermines the 
constitution and decreases physical efficiency as malaria. 

To do away with the mosquito it is important that cesspools and mosquito 
breeding habitations be destroyed. Mosquitoes breed in water tanks, tin 
cans lying about the yard, barnyard, in the street or road, in barrels used 
to catch rain water or that for some other reason contain water, and in cisterns 
and flush tanks in toilet rooms. 

The water tanks, cisterns and flush tanks should be covered to keep the 
mosquitoes out ; tin cans or other receptacles containing water and lying about 
the yard, barnyard and streets, should be gathered up and carted away to the 
dumps. 



SPRING CLEANING 



1139 



To prevent the development of mosquitoes in dumps the rubbish should 
be treated with crude petroleum or coal oils. 

Where swamps exist within a given radius of a home, they should be 
drained. Where there are filthy cesspools they should either be filled up or 
treated with some sterilizing agent, as lime. 

It may be necessary to treat the swamps with crude petroleum or coal 
oil. If it is necessary, it should be done. 

Flies carry disease germs on their feet, gathered from feces, sputa, dead 



Virginia Health Bureau. 




Fin. 4S2. — Window Ventilator. 



animal matter and infected discharges. The germs they deposit on the 
food over which they crawl or the moist surfaces of the body are often the 
starting point of a serious epidemic of some one of the many contagious 
and infectious diseases. 

Spring cleaning then should ha^e regard for placing the home and 
outhouses in such condition as will reduce the fly-breeding places. All garbage 
cans or containers should be thoroughly cleaned, repaired and equipped with 
an appropriate and practical cover. This will make it easier for the housewife 
or other person wno wishes to deposit garbage or other waste material therein 
and insure proper protection of such waste material against exposure to 
flies. 



1140 THE HOME 

Manure boxes may become a serious menace to public health, as they 
furnish an ideal place for flies to breed. In their construction, therefore, re- 
gard should be had for the exclusion of flies, insects and rats. 

Manure bins should be carefully cleaned and in the rural communities, 
manure piles should be hauled away, since they are often within the field of 
some watershed from which the family well may draw some of its water 
supply. 

Where it is possible and practical the manure boxes, cellars, pig pens, 
chicken houses and the inside of outhouses should be whitewashed. Lime 
should be sprinkled freely about the area. 

Flies and mosquitoes must especially be guarded against as they are 
the most common carriers and dispensers of disease producing germs. After 
the house has been thoroughly cleaned and refuse containers thoroughly 
sterilized and rendered sanitary flies and mosquitoes should be further 
guarded against by proper screening of the house. Dr. Eosenau has said : 

"When the matter is generally understood it will be a greater reproach 
to the housewife to have mosquitoes and flies in the house than bedbugs." 

House Doctor Needed. — M. L. H. writes: "Our house contains a living 
room and three bedrooms on one floor, an attic above, and a basement 
containing a dining room, kitchen, and two rooms used for storerooms. In 
one of these shoes in a short time are covered with blue mold and in the 
other room tins and pans rust quickly. The dining room and rooms above 
have been decorated twice in three years. A whole side of paper and putty 
coat will come of together. The decorator says it is on account of the 
dampness. A furnace heats the rooms very well except in severe weather, 
but it does not heat the kitchen, where we have a gas range for cooking 
and a coal range for heating. The floor always strikes up through the feet 
cold and clammy, although there are rugs all over it. The grandmother 
puts on alaskas to go to the kitchen. A jelly-like substance oozes up 
through the cracks of the hardwood floor in the kitchen, so the decorator 
said he had better give it two coats of paint. That was during the ex- 
tremely hot weather last summer. It was over three weeks before the sec- 
ond coat could be put on, and that was even longer in drying. The dec- 
orator said the boards were so wet on the other side they could not absorb 
the paint. In the corner near the sink the floor seems so cold we have 
boards on the floor and covered with carpet. We thought the pipes must 
leak, but the plumber says that is impossible. Could we require the land- 
lord to take up the floor and examine conditions below f Is it unhealthy 
to live in such a house, and are we laying the foundations for rheumatism?" 

Eeply. — Yes, you are laying the foundation of ill health, and probably 
of some infection like rheumatism. 

Your house needs a house doctor — first to diagnose and next to cure. 
At the beginning it should have had a house doctor to prevent, for pre- 
ventive house medicine is as much better than curative house medicine, 
as preventive medicine is better than curative medicine for folks. 

The jelly-like substance which oozes up is mold. Molds are certain to 
grow in such a house. Continuous sunlight would be required to prevent 
it. 

The trouble with the house is that the walls and floors are not insulated. 
Ground water travels up the walls. A six-inch cement basement floor 
with a hard finish, a layer of impervious material — slate, lead, vitrified 



THE HOME 1141 

brick — above the ground in all walls which reach the ground, deadened 
floors and room walls in which there is deadening and on which there is a 
hard finish — such would be a correspondence course diagnosis and treatment. 

Space in Tenements. — J. I. F. writes: "Referring to your article on 
housing, I venture to suggest that in addition to sanitarians, architects, 
and political economists, whose counsel is to make effective committee 
work for letter homes, the advice of several practical women would he 
of invaluable aid. My own experience in poor neighborhoods, as a 
settlement resident, visitor, etc., tell me that from the house (home) 
keeper s point of view several things besides light and air and good plumb- 
ing are essential. 

"I believe it necessary and practical to have a certain amount of shelv- 
ing in the kitchen, and, as I know that every inch of space is paid for by 
the tenant, this shelving need not take extra space, but can be made sightly 
by corresponding to the plate rack in costlier homes, and hooks can be 
attached. 

"Above the second floor, the home that has not some little porch where 
a baby buggy may be placed, or a little child, properly guarded, may play, 
is by that much incomplete for the mother. She must hold the little one 
or give her time by taking it to the ground floor, or else intrust its care, 
frequently, to some one too young for that responsibility. 

"The wall space in many new buildings could be better arranged by plac- 
ing windows and doors in juxtaposition, so that currents of air could cool 
the rooms on hot days and purify them in all seasons. 

"Finally,! believe that, through agitation, it might be possible to induce 
some builders of tenement property to put up buildings as we see them on 
modest streets in the Humboldt Park and Logan Square neighborhoods, 
on the checker board plan — one or two houses at the rear end of the lot 
and the next touching the building line. This arrangement secures light, 
air, and garden space, and I believe is capable of much improvement, so 
that the landlord can be assured of a fair return on high-priced property. 

"While conditions are not so bad as in New York, they are in great need 
of improvement, and I hope we shall soon see some tangible results and 
that women will be allowed to help in solving these problems/' 

Eeply. — This letter contains many valuable suggestions. It is pub- 
lished in order that they may be more widely circulated. 

Safe but Wasteful. — R. C. writes: "Will you kindly tell me if a sta- 
tionary porcelain tub. not in a basement, is a safe ice box, when kept abso- 
lutely clean? Should the stopper be left out?" 

Reply. — It is safe enough. The stopper may be kept out. It will waste 
ice. Much of the cold will be used up in chilling the air of the room. 

Sunlight in Bedrooms. — E. M. writes: "Are bedrooms with northern 
exposure, that never have the sunlight, any less healthy than those that do, 
provided they are well ventilated from the outside?" 

Eeply. — Bedrooms which get no sunlight are not as healthful as those 
which do. If the ventilation and cleanliness standards are raised high 
enough the harm from lack of sunlight is negligible. If the sunshine 
standard goes down and the ventilation and cleanliness standards do not go 
up to a compensating degree the harm is material. A bedroom getting no 
sunlight will be safer if it has plain walls without moldings or shelves, 



1142 THE HOME 

doors and windows without projecting frames, rounded corners, hardwood 
floors and simple furnishings. The windows should be thrown up and the 
room aired out during some part of the daytime. They should be open 
during the hours of sleeping. 

Poor Lighting in Hotels.— Mrs. TT 7 . J. G. writes: "1. Are there laws in 
Illinois governing the amount of light to he furnished guests in rooming 
houses and hotels? A man not long ago complained of his head aching and 
eyes feeling strained on account of the poor light in his room while read- 
ing (studying) evenings. The lights in the parlor and office, he said, were 
better, but these places were too noisy for one to read or study in. 2. Is it 
not a fact that such conditions need to be remedied?" 

Reply. — 1. There are no such laws. The laws of competition do not 
even cover the case. One of the prominent monthly magazines had an 
article on this subject a few months ago. It was written from the stand- 
point of the traveling man. One of the complaints was of the universally 
poor lighting of hotel rooms. The lights, he said, are never where they 
are needed. 

2. Yes. 

Cleaning the Sink. — E. T. W. writes: "Kindly inform a young house- 
keeper how to keep the sink and toilet always clean and what to use. Some- 
one says to dissolve a little copperas and pour down twice a week. Is that 
good?" 

Reply. — I do not think copperas would help much. The first necessity 
is that outside parts be kept as clean as possible. For this purpose hot 
water and soap, particularly the soaps having an excess of alkali, suffice. 
Pipes from sinks clog with chilled grease and dirt. What is needed to cut 
this is heat and alkali — hot water and lye soap or some of the other very 
alkaline soaps. If any part of the clogging is from the growth of moldy 
slimes strong ammonia cuts it. Clean out the grease and dirt and anti- 
septics will not be needed and their use will not help. Some precipitates 
composed of grease and salts from the water can be cut best with a sand 
soap. For bath tub stain a cloth moistened with kerosene works very well. 
For toilet discolorations alkali soaps and ammonia are usually efficacious. 
Sand soaps are frequently needed ; sometimes plenty of alkali soap applied 
with a stick or an old case knife will be necessary. If the flush is not force- 
ful enough or the traps do not keep full and odors result the plumber must 
be called in. 

No Sunlight in Bedrooms. — S. J. writes: "That new idea that perfect 
health cannot be had without sunshine in bedrooms is incorrect. If you 
are not healthy do not blame it on account of having no sunshine in the 
bedroom. I know a family who had sunny bedrooms, but the members were 
sick and consulted doctors and used all kinds of medicines. Then they 
moved into a building where they had no su?i in their bedrooms, and at the 
same time bought a book called 'The Nature Cure,' and also read the Chi- 
cago Health Report, written by Dr. W. A. Evans, and are still reading Dr. 
Evans' writings, and not only reading but living thereafter, and the result 
is perfect health without doctor and medicine. How did the members of 
.said family cure themselves without sunshine in their bedrooms and with- 
out doctor and medicine? They sleep with their windows open at top and 
bottom all the year round, without heat in the bedroom, and, as they get 



THE HOME 1143 

out of bed they throw the bedding over the back of the bed and leave the 
room with the windows still open for hours, and dress in a heated room. 
After the bed is well aired they close the windows and open the door to 
the heated room, and when the bedding is warm the bed is made up. In 
the summer the bedding is brought out in the sun a couple of times a week. 
And they drink plenty of water at about the same temperature as the body 
the first thing in the morning and the last at night, get plenty of regular 
sleep and bathe at least once a week, and only eat and drink what agrees 
with them three times a day, and sparingly at that. Laugh heartily the 
first thing in the morning and the last at night, and don't kick or grumble; 
it hurts. It is said cleanliness is next to godliness, and I believe it. Be 
good to yourself and you obey God." 

Reply. — The plan is most excellent. 



CHAPTER LXI 

Ventilation — Heating — Humidity 

VENTILATION 

VALUE OF FRESH AIR 

Ship stokers, iron and steel workers, furnace men, and some others 
must do their work in places where the air is sizzling hot. Bakers and 
cooks work where the temperature is higher than is healthy. Such men 
suffer from heat exhaustion and heat cramps, sometimes one feature pre- 
dominating and sometimes the other. 

The affected man seldom has the high fever of sunstroke. On the other 
hand, the temperature may be below normal and the skin pale. The muscles 
are unable to get rid of the waste — lactic acid — and they spasmodically con- 
tract or become sore. The usual attack lasts a few days and then recovery 
ensues. Rarely is it fatal. Most men who suffer from it feel lassitude, a 
muscular soreness — "a touch of muscular rheumatism" — whereupon the man 
loafs on his job for awhile and gets well about as mysteriously as he got 
sick. 

No workman can afford to work in a hot place where there is no provision 
for keeping him well. Just as certainly no employer can afford to work his 
men in a place where the air is hot and wet and still. 

I have sometimes wondered why iron is made in sheds and why foundries 
always have broken windows. There's a reason — and the small boy goes free. 

It has been found that besides heat two other qualities of engine room 
air are harmful — high humidity and stillness. A wet bulb temperature above 
85° F. causes the workmen to have fever. It is important to watch the 
ordinary or dry bulb thermometer. It is more important to watch the wet bulb 
thermometer. 

I wonder how many foundries, rolling mills, engine rooms, kitchens 
and bakeries have wet bulb thermometers. And yet the readings of this 
instrument will furnish a good index of how much work a man will do in 
a day as well as some sort of a rough index of how many sick days he will 
have and how many years' labor. 

If the air is both hot and wet its harm still will be decreased if it is 
kept in circulation. If the air next the workman's skin and nose, after it has 
taken up as much heat, moisture, and bodily waste as it can, is replaced 
however by fresh air ready to take up its load the workman will suffer less 
harm. 

Surgeon Fiske of the United States Navy told the Congress on Hygiene 
that in our haste to build the White Squadron we forgot these things and that 
our sailors suffered heavily. Now our battleships are being provided with 

1144 



VENTILATION 



1145 



ducts and fans capable of throwing a great volume of air into the hold and 
the efficiency rate of the sailors has risen. 



VENTILATION AND EFFICIENCY 



Not long ago the chief surgeon of a certain railroad (who is the only 
employee with any information on sanitation) came in to see me with blue 
prints of the division superintendent's office at a certain point on his road. 




I- = :=G 



Fig. 483. — Diagrammatic Sketch of Various Provisions for Ventilation. A, Sash win- 
dow with Hinckes-Bird's arrangement. B, Hopper sash-light falling inwards. C, Louvred 
outlets. D, McKinnell's ventilator. E, Sheringham's valve. F, Tobin's tube (showing 
valve open). G, Ellison's conical bricks. H and I, Grid ventilators below floor joists. 
(From "Hygiene and Public Health," by Drs. L. C. Parkes and H. R. Kenwood, London, 
H. K.. Lewis, Philadelphia, Blakiston, 1911.) 



What was originally one large room on the second floor had been cut up into 
about a dozen smaller rooms. 

Incidentally I want to say that a large part of the insanitary premises to 
be found everywhere is the result of making over a house so that it can be 
used for a purpose not contemplated when the house was designed. 

These rooms each have 2,000 to 3,000 cubic feet of space and each is 
occupied by three or four men. Each room has outside windows and those 
on the corner have outside windows on two sides. The use of "tissue" makes 
it necessary to keep the windows down both summer and winter — that is to 
say, strong currents of air blow "tissues" around and the men solve the 
current question by keeping the windows down. 

On the east side of the building are the toilet rooms and these communi- 



1146 



VENTILATION— HEATING— HUMIDITY 



cate with the hall by a door and transoms. When the wind is from the 
east the odors are carried into the offices. 

The rooms are heated by steam which circulates in pipes arranged along 
the outside walls below the level of the window sills. The amount of air 
space per person is 400 feet in some instances and 800 in others. In this 
estimate no allowance has been made for the space occupied by furniture 
and fixtures. 

There are no records to show the temperature or humidity of the room 





Fig. 484. 



-The Position of Inlets and Outlets, and Their Relation to the Air Currents 

in a Room. 



or any part thereof at any time. The men complain quietly that they are 
uncomfortable and logy and they think the ventilation conditions make 
against health though they could not say just what proof they had of their 
conclusions. 

The above condition is so commonplace that it is scarcely worth while 
using the white paper needed to print it on. There are thousands of similar 
places. Having started the recital, I may say there are hundreds of thousands 
of men and women who could have supplied the details and wound up by 
saying : 

"We know all about such places ; we work in them." 

Had I said then that the employer loses money on every person forced 
to work in such a place the multitude probably would have replied that 
they gave honest service and they could not see where they could have ac- 
complished more — which is just the point, 



VENTILATION 



1147 



A full day's work cannot be done and the man who falls short cannot 
see how he could have done more. He could not. The heavy, still, hot, 
humid, foul air took the snap and eagerness out of him. He did less and was 
satisfied. The (say) 5 per cent clipped off of efficiency by bad ventilation 
bulks larger than any other loss suffered by the railroad. 

The problem of ventilating exists by reason of the problem of tempera- 
ture. When there is no temperature problem there is no ventilating problem. 
Under a few circumstances the problem of ventilation is complicated by the 
problem of cooling; under most circumstances, and particularly in the winter 
time, the problem of ventilating is a problem of heating. 

In the summer time the maximum comfort is secured by raising the 
windows. Thus without thought or special planning ventilation takes care 
of itself. As a result colds 
are few, pneumonia is at its SB 
lowest, scarlet fever, diph- 
theria, measles and smallpox 
inconsequential as compared 
with the winter — the season 
of poor ventilation. 

In the cold weather, un- 
less there is planning, the 
maximum comfort is secured 
by closing the windows. 

The principal reason for 
heating a room is to heat the 
air. The people are makers 
of heat, not users of it. They 
make enough heat to heat 
their bodies and to heat all the air breathed in. 
good stoves for the air of the room. 

The inside walls are just about neutral. They sometimes feed a little 
heat to the room; they sometimes take a little heat from the room; but they 
never affect the temperature much one way or the other. 

If the house has a snug basement the floor soaks up a little heat from the 
room. If the boiler is under the floor the floor is a source of some heat. 
Nevertheless, the floor is just about neutral. 

The outside walls lose much heat on cold days. They stand midway 
between the cold of the outdoors and the warmth of the indoors. On the 
outside the air is trying to cool the wall down and on the inside the air is 
trying to warm it up. 

How much of a tax the outside wall is to be on the heat of the inside 
air will depend upon its thickness and the material of which it is composed. 
The parts made of glass will be a great tax; the parts of brick, mortar 
and plaster will be less so. But much more of a tax than the outside wall 
is the incoming air. 

In a room (from the heat standpoint) you have the floors, ceilings and 
inside walls as about neutral, the people as credits and the outside wall and 
the incoming air as debits. The problem of heating is to add enough steam, 
hot water, hot air heat or direct radiation to balance the account. 




Fig. 485. — Window Ventilator with Deflector. 



In addition, they are fairly 



1148 VENTILATION— HEATIN CI— HUMIDITY 

It is important that the heat should be applied where it is needed. Above 
all it is needed where the cold air comes in. Second in importance is that 
it is needed where the cold walls are. As outside walls always leak some 
and usually leak a great deal the heat is needed near the outside walls. 

As the windows are the coldest part of the wall it is proper that the heat 
should be under the windows. So far our railroad friends are right — they 
string their heat in pipes around the walls. 

However, the chill that comes from the walls is of small consequence as 
compared with the chill from the incoming air. Therefore the really im- 
portant point is so to place the heat that the incoming air is warmed before it 
comes in contact with the people. 

Nor is it necessary that all of it should be thus heated. If 80 per cent of 
it be heated it will rapidly warm up the small amount that comes in cold. 

Cold air is heavy and warm air is light, Cold air falls to the bottom 
two feet of the room. 

It happens that that part of the room is inhabited by that part of the 
body which has least cold resisting power. 

The legs are masses o^ muscle. Most of the heat of the body is made 
up of muscle. When a person is' walking the legs are the twin stoves. When 
a person sits quietly the legs are cold stoves. When one sits quietly at a desk, 
studying or keeping books, much of the blood is short circuited out of the 
legs and the cold stove becomes colder still. Now, when cold air pours in 
through the windows and falls on the lowest two feet in the room we have 
cold, almost bloodless feet, bathed in cold air. 

I have seen as much as ten degrees difference between the temperature 
of the air up next the ceiling and that next the floor. A difference of six 
degrees between the temperature of the air around the head and that around 
the feet is not unusual and that adds to the short circuiting to which allu- 
sion has just been made. 

If the room is cold all over it may not be uncomfortable but there is 
no escape from discomfort when one's head is in a temperature of 70° and 
one's feet at 60°. 

We hear a lot about drafts. About all there is to the draft proposition 
is indicated in the above idea. Moving cold air is somewhat more chilling 
than still cold air. 

In the series of rooms the amount of air space per person is ample if 
there is provision for supplying them with plenty of air properly warmed. 
Ten times as much space would not be enough with no provision for supplying 
fresh air. A tenth as much space would be enough if the provision for 
supplying fresh air were perfect. 

It is better, of course, that people should not be closely crowded to- 
gether. If they are not badly crowded the ventilation can be rather poorly 
provided and not much harm result, whereas if they are jammed up close and 
the ventilation is poor the harm is great. 

As space costs money why would it not be good business judgment to 
provide a good air supply and put ten people in a room uncomfortable and 
unhealthy under present circumstances when four occupy it? 

So far as this particular office is concerned the plan would be to conduct 
the cold air from the window to the coils along the walls and to discharge 



VENTILATION 1149 

the air in such a way that it would have to pass over the coils before it escaped 
into the room; then to have some electric fans somewhere to draw the foul 
air out of the rooms. 

The best place in that suite of offices is in the windows of the toilet 
rooms. Exhaust fans located at those windows would make the toilet rooms 
an area of low pressure and would induce a flow of air from the offices to 
them. 

To supply the low pressure thus induced in the offices air would flow 
into the rooms from the outside, thence over and through the heat coils. 

Perhaps one set of exhaust fans would not be enough. That is a point 
for the fan man to work out. It would have to be determined by how well 
the house is shielded against the wind, how free is the communication between 
the rooms and such questions. 

A better arrangement still would be fans to exhaust the foul air and 
other smaller fans at the inlet windows to pull in the air and send it just 
where it is wanted. With the force that the small inlet fans develop the 
incoming air could be both warmed and cleaned before it is discharged into 
the room — a point that is worth considering in a railroad office. 

Under such a plan the air down near the floor would be but a few 
degrees lower than the air next the ceiling. It would be but a degree or 
two lower than at the head zone. In consequence the room would be com- 
fortable. 

Of more consequence is the fact that the men would be less liable to 
colds, coughs, neuralgia and rheumatism. They would do more work in a 
day and the number of men to each room could be increased. 

From time to time the windows can be thrown open and the rooms blown 
out. Nothing takes the place of that. When it is done several times a day 
the men feel better, are healthier and can do more work. 

To chill and freshen all the air in a room, the occupants meanwhile 
standing up or otherwise exercising for a few minutes, is a different matter 
from the constant letting in of a little cold air which immediately falls to the 
floor and stays there. 

Whatever method of ventilation is employed there must be arrangement 
for periodic blowing out. If any system does not allow of this procedure there 
is no further need of discussing that system. This one point alone is 
enough to condemn it. 

Finally, these offices should be equipped with thermometers and hy- 
grometers. The chief clerk should arrange to have an hourly humidity and 
temperature record kept. This record should be placed on the desk of some 
responsible official every morning. This bit of bookkeeping is essential. 

ERRORS IN VENTILATION 

The first ventilation laws were based upon the cubic feet of space per 
person without any regard to air changes or the condition of the air. 

The next step in the evolution was that requiring a certain volume 
of air per person per hour. 

The next step is to combine the space requirement with a volume of air 
requirement and to add other provisions such as that the temperature shall 



1150 VENTILATION— HEATING— HUMIDITY 

be kept within bounds, the humidity within limits, the carbonic acid 
gas below a certain percentage and the dust under control. 

It is because ventilation practice has not applied these last provisions 
that it has failed. 

One of the most frequent statements which we hear of ventilation 
jobs is : "We put in 2,000 cubic feet of air per person per hour." A number 
of years ago the British Parliamentary Commission on Ventilation reported 
that it did not make so much difference how much air you put into a room 
as it did how and where you put the air in. And now the Chicago Com- 
mission on Ventilation comes forward with this: 

"Besolved, That the putting of a given volume of air per hour per 
person into a room does not necessarily constitute ventilation." 

The demand that a given volume of air must be put in a room for 
each person was arrived at by mathematical calculation as to the amount of 
air needed to dilute the carbonic acid gas produced by the occupants to a 
point less than what was supposed to be the harm point. 

The ventilating engineer discovered a long time ago that when he had 
to remove odors or excess of heat or steam he must remove it as directly 
as possible; and he devised all his apparatus on that basis. But carbonic 
acid gas was supposed to be different somehow and instead of trying to remove 
it directly the effort was to dilute it. 

Almost as an essential part of the plan of dilution there came the loca- 
tion of the outlets at the floor. However, this last provision was largely 
based upon an error in physics. 

The ventilating engineers were told to take the foul air out of the room 
low down because carbonic acid gas was heavier than air and settled to the 
floor. Thirty years ago books on physics made this statement. They in- 
stanced foully ventilated rooms in which dogs toppled over while men sur- 
vived, the reason being that the dogs were breathing two feet from the 
floor while the men took their air from five feet up. Such statements 
found their way into books on hygiene and then ventilating engineers based 
their practice on them. 

The fact is that gases do not settle out. Carbonic acid gas tries to diffuse 
evenly. When men are breathing in a room the carbonic acid gas is slightly 
in excess of the ceiling and near the outlets wherever they are. But remove 
the men from the room or stop all air currents and within ten minutes the 
carbonic acid is evenly distributed. 

Now, having the outlets near the floor does keep the floor warmer 
and does keep the coal bills down, other things being equal. But bad ventila- 
tion is too high a price to pay for warm floors and lowered coal bills, 
especially as there are other and better ways of getting these results. 

It is essential that the public should understand that the present method 
of ventilation is both inefficient and unnecessarily expensive. 

Now I shall explain the reason for this last statement. If one were to 
write a ledger account of room heat he would enter the occupants and heating 
as large credits, the floors, ceilings, and inside walls as very small credits, or 
even as small debits. The large debit item is air, though windows and out- 
side walls are of some consequence. 

It costs to heat 2,000 to 5,000 cubic feet of air per person per hour but 



VENTILATION 1151 

when the principle of dilution is abandoned the quantities required are 
lessened. Winslow says 700 cubic feet per person per hour is enough. The 
new Chicago ordinances in some instances call for as low as 350 feet. In 
addition a good mechanical engineer will arrange methods of using the 
surplus heat of the outgoing, hot, vitiated air to warm the incoming air. 

When the principle of dilution is abandoned and the effort is made 
to remove the foul air as directly as possible the amount of air required 
will drop to less than half of what it now is and the cost of ventilation will 
drop proportionately. 

If the quantity of air used is not the test of efficiency, what is ? The per- 
centage of carbonic acid gas, the temperature, the humidity and possibly 
its harmfulness as determined by the method used by Eosenau of Harvard — 
the quality rather than the quantity of air. 

For the next shortcoming of ventilation the hygienist is less respon- 
sible; that is the stillness of the air — its freedom from drafts and currents. 
Some hold that "draft cranks" are responsible for the demand that ventila- 
tion shall be free from any appreciable air movement. It would be fairer, 
however, to say that the public sentiment responsible for this requirement 
is due to insufficient study of the problems of temperature and velocity of 
the air at the inlets. 

As a result of this demand ventilating engineers strove to produce a 
morguelike stillness, only to learn that "still air" is dangerous. What they are 
now told is that the air must be kept on the move; that where fans are 
needed in summer they are needed in winter; that moving air is com- 
fortable provided it keeps within a certain number of degrees of the tempera- 
ture of the human body. 

The stock statement as to ventilation is: "We introduce so many thou- 
sand feet of washed and tempered air and the room is free from drafts." 

As to washing the engineer has made good. He can and does reduce the 
dust and bacterial content of the air in a very satisfactory manner. In- 
cidentally I may say that when he is called upon to remove the dust within 
the room made by manufacturing processes located therein he succeeds. 

If tempering means humidifying or drying the air the people have so 
recently begun to think of humidities that the engineer has rarely planned 
to control them. 

But "conditioning" is the term usually applied to humidity, and "temper- 
ing" is used as meaning heating or cooling. 

So much for the past. What of the future? 

It is bright, of course. Given the proper principles by the sanitarians 
the mechanical points will be solved without great delay; given proper stand- 
ards in law and public sentiment mechanical ventilation will be better done; 
and when better done it will be more universally employed. 

The following principles are now pretty generally accepted by sanitarians : 

1. Air which moves with force enough to be felt is as necessary for health 
as it is for comfort, both in warm and cold weather. 

2. Air which is higher in temperature than 70° is always harmful except 
when it is kept in active motion. 

3. Air which is above 10 relative humidity is uncomfortable when either 
hot or cold. When above 85 and the temperature is high it causes the occu- 



1152 VENTILATION— HEATING— HUMIDITY 

pants to have fever and later heat prostration. Air which is lower than 50 
in humidity is both uncomfortable and unhealthy. 

If-. Dusty air is to be avoided. The dust in air is harmful chiefly by rea- 
son of the bacteria found therein. Inorganic dusts are more harmful; organic 
dusts less so. 

5. When reasonable efforts are made to prevent admixture of foul and 
fresh air the amount of air per person per hour can be lower than 1,000 
cubic feet with comfort and safety even when the occupants are engaged in 
manual labor. 

6. Carbonic acid gas is quite harmless in any quantity ordinarily liable 
to be found in air. The amount in a room is to be considered as a measure 
of the pollution of air in the room rather than as a source of pollution. 

7. The foulest air in a room is in those sections toward which the 
currents of a room are flowing but within a few minutes after the air becomes 
quiet its composition is uniform in all parts of the room. 

8. That there are substances in air which do harm, possibly through 
an anaphylaxis, certainly through some generalized intoxication; but these 
substances have not been discovered any more than the poisonous substances 
in other excretions have been. 

9. That within certain limits sunlight, air and space are compensatory. 
We are sometimes justified in lowering the standards of one provided simul- 
taneously we elevate the standards of the others. 

WHY VENTILATION FAILS 

Winter is the season when interest centers in the bad air diseases in every 
part of this country where there are marked seasonal changes in tempera- 
ture. More than half the people are intermittently suffering from colds. 
At least one out of ten has a cough; many are sick from pneumonia and 
large numbers are contracting consumption. 

About one-third of Chicago's deaths are due to bad air diseases — 
almost 10,000 a year — and whether they come from Omaha, Fort Wayne or 
rural Iowa the figures tell the same story. 

These deaths in one way and another are brought about by foulness 
of the air. At that, the story told by the deaths from bad-air diseases 
leaves a large part uncovered. There must be added the figures of inefficiency 
and secondary costs as well as the indirect contribution from bad air to 
the disabling forces of other harmful conditions. 

It has been said that the drinking of bad water does three times 
as much harm in indirect ways as it does directly in causing typhoid. It 
would be no exaggeration to say that bad air does five times as much harm 
indirectly as it does in bringing about deaths from pneumonia and consump- 
tion. 

The air problem is a big one — big in the harm which it does and big in 
the measures which are demanded that it may be met. 

There is need for pure outside air. This is being met by anti-smoke 
campaigns of many different sorts. 

But outside air is about uniformly bad at all seasons of the year. There- 
fore so much of the rate from bad air diseases as is represented by fluctuation 



VENTILATION 1153 

between seasons must be the result of circumstances which fluctuate. 
This brings us to ventilation, for "inside air is good in summer and bad in 
winter. 

So many places are poorly ventilated that a man can count himself 
lucky if he goes a week without getting into some uncomfortable and un- 
healthy air. The ordinary man at the very best will get into some such place 
for a part of each day. The farmer who reads this statement no doubt thinks 
it true enough of the city man but not of himself. On a below-zero morn- 
ing the ventilation is just a little worse in the farmhouses of Iroquois County, 
Illinois, than in the tenements of Chicago for the former are snugger and 
warmer. Certainly, the ventilation of the average working place in Wis- 
consin is worse than in Chicago, for the air campaign is working better 
here than there. 

I am sure that conditions are better than they have been and the 
promise is for a steadily progressive improvement. The Chicago deaths from 
bad air diseases were 750 fewer in 1911 than in 1907 in spite of a gain of a 
quarter million in the city's population. 

If good ventilation could become universal the bad-air disease deaths 
would be cut to less than half of what they now are — say a saving in Chicago 
of 5,000 a year, a greater saving than has been accomplished by the campaigns 
against yellow fever, malaria, plague, smallpox and typhoid fever combined. 

From hotels, stores, offices, factories, schools, churches, and homes, from 
one end of the line to the other the same story is coming back — a mechanical 
fulfillment of requirements with usually a gain in comfort, though there are 
many exceptions and usually a loss in health and efficiency — mechanical 
figures which show results but balanced by an almost universal public opinion, 
founded on experiences, that the results are not good. This public opinion 
is confirmed by chemical and statistical data. 

Plainly, those theories about ventilation which work out when they are 
being tested do not in practice bring about healthy conditions. The fact is 
that the ventilating engineer has not made good. To say this baldly will 
not accomplish as much as will analyzing the reasons for the condition and 
putting on each party concerned his share of the blame. 

Conditions must be quickly righted, for the public and legal demand 
must be met. The hope for speedy righting lies in careful analysis rather 
than in unthinking condemnation. 

The combination which passes on ventilation is about as follows: the 
people, demanding that houses be heated and ventilated; the sanitarians, lay- 
ing down certain health requirements and setting certain ventilation stand- 
ards; the heating and ventilating engineers under the control of architects, 
sometimes in accord and sometimes in rank discord, trying to meet those 
demands. 

The first trouble came from the people. They knew almost nothing 
about ventilation but they had pretty definite ideas about heat. The pro- 
fession to which they appealed was known as "heating and ventilating engi- 
neers" and, quite naturally, thought was concentrated on heating to the 
neglect of ventilation. 

There is no more exact science in practical operation than that of heat- 
ing. A heating engineer can tell to the third decimal point about evapora- 



1154 VENTILATION— HEATING— HUMIDITY 

tion, radiation, conduction and convection and can install a plant and obtain 
the results on which he has figured. 

Eadiation is placed in a room to keep it warm, not to heat the radiator, 
not even to heat the corner in which the radiator is located; therefore, one 
would conclude that methods of dissemination of heat would have been one 
of the earlier research studies of heating engineers. 

When we learn that they have not comprehensively studied air currents 
as a means of getting efficiency from radiation we are quite prepared to learn 
that they have not so studied them in relation to ventilation. 

The second part of the responsibility for the poor development of ventila- 
tion rests on the architects. Houses should be as artistic as possible; they 
should be built of proper material and along proper engineering lines; they 
should have their interior space divided in such a way as to preserve the 
economies; they should be properly drained. But infinitely of greater 
importance than any of these is the necessity that they should be properly 
lighted and ventilated. 

Certainly the architect has not given these values to the different points. 
I am sure every other feature has had the right of way over ventilation. 

He has allowed the sewage ducts to crowd the air ducts into such 
twists and turns that efficiency was impossible. He has sacrificed air to art, to 
beams, to everything. 

In his office there is a well developed art corps and a large retinue of 
structural engineers but a poor ventilation equipment — of men and materials. 
And yet buildings are made to live in and good air is much more important 
to life than those things which the architect has given right of way over it. 

Architects must assume a large part of the blame for abandoned or useless 
ventilation systems and for houses without provisions for Ventilation. 

The third party of the quartet of responsibles are the sanitarians. The 
ventilating engineer- has been told to put a certain volume of air into a 
room at a certain temperature and he has done so. As a general proposi- 
tion he has solved the problems which were put up to him. Then why is 
it that the places in which he has installed ventilation are not ventilated ? 

The answer is that the problems put up to the engineer were not proper 
problems, or were based upon inexact or misleading information. On his 
mechanical side he has made good. His work fills the specifications as set forth. 

The principle of dilution of bad air as a means of ventilation; the plan 
to hold carbonic acid gas below one part in 1,000 by dilution procedures; the 
2,000 to 4,000 feet quantity standard; the high temperature level; the dis- 
regard of humidity; the incorrect ideas about drafts; the wrong teaching 
about variation in temperature; all these are basic points responsibility for 
the error of which must be laid at the door of the sanitarian. 

The ventilating engineer, being in a sense a sanitary engineer and in 
addition being the capstone of the structure, has been hurt the worst. That is 
to say, he has suffered because there is not the demand for ventilation that 
there should be. 

VENTILATING OFFICES, SCHOOLS AND STORES 

Some time ago a correspondent wrote that a group of men occupied 
an office in which the air, for purposes of ventilation, came in through a 



VENTILATION 1155 

transom. The air was cold and one of the five objected to the cold air on 
his head and wanted the transom kept closed. Such a situation is one 
of great difficulty. On the one hand, here are four men who want fresh air 
and, on the other, one is harmed by the cold air striking him. 

First, as to the claim of the man who wanted the transom closed. 
Cold air coming in contact with the body takes heat away from it. Especially 
is this true if it strikes the skin with some force. If the person affected is 
a good heat maker, with a skin not oversusceptible to cold, no particular harm 
is done. 

People vary, though, so much in these particulars. Some are cold — 
neurasthenics who can get up a shiver over any sort of draft. Most of 
their trouble is imaginary and springs from their generally self-centered 
and selfish makeup. However, there are people who are genuinely harmed 
by cold air blowing on them in such a way as to abstract heat faster than 
they can make it. When men are quiet they will get uncomfortable if 
the air which strikes them at a low velocity is lower than 50° or if that which 
strikes them with a higher velocity is colder than 60°. 

This means that where a room is fairly well filled with men and women 
the air which enters must be somewhat warmed . before it strikes anybody — 
that is, in any climate north of Memphis. 

Transom ventilation will not work unless there are lights enough close to 
the opening to warm up the air before it gets to anybody. 

A few years ago Mr. Mitten of the Street Eailway Company of Chicago 
put an opening in the front of the car roof. Theoretically it was all right 
for it provided air enough; practically it did not work because the air was 
too cold. On the same principle deck sashes (the side. window lights near the 
ceiling) usually seen on street and railroad cars are of little service. Usually 
they do not ventilate at all. When they do the air is so cold that nobody 
tolerates it. 

So in this particular office the man who objected to the transom had 
much of right on his side. But the other men had more of right on 
theirs. 

Either the air must be warmed before it gets to the occupants of the 
room, the occupants must move around enough to keep warm by making heat 
or else they must dress differently. 

Some way must be found to satisfy each group, for each is right. 

The proper way to ventilate an office is to draw air through the outside 
walls by means of ducts leading to radiators placed under the windows — 
cleaning, warming and moistening the air as it comes through. Fans 
located in the attic should be used to empty the foul, warm air from the 
rooms through openings at the ceilings on the inside walls. This is effi- 
cient as well as cheap to install and cheap to operate. 

But offices are as they are and most people who occupy them must do 
the best they can with a bad situation. If the room is ventilated by present 
systems what can be done in addition to setting different standards? 

1. The windows must be well stripped. 

2. Storm sashes must be used. 

3. The room must be blown out several times a day, at least one window, 
and better more, having been arranged so as to make this possible. 



1156 VENTILATION— HEATING— HUMIDITY 

4. Fans must be employed to keep the walls and windows warm 
and the air agitated. 

5. The air must be cleaned by air washers or cheesecloth. 

6. Steam must discharge from the radiators into the air of the room. 
If the rooms are ventilated by windows: 

1. Deflectors must be used. 

2. The radiators under the windows must go at full head. 

3. Fans must be used to keep the floor zone warm. 

4. Steam must blow into the room. 

5. The air must be cleaned by cheesecloth. 

6. The room must be blown out several times during the day. 

7. A ventilating fan connected with a window intake and discharging 
through the radiators is highly desirable. 

In all schools and offices the following requirements must be met: 

1. The temperature must keep below 70°. 

2. The difference between the temperature 1 foot and that 6 feet above 
the floor must not be greater than 2°. 

3. The humidity must be as high as 50. 

4. The air must be kept moving. 

5. It must feel fresh. 

6. It must be clean. 

The methods which apply to offices apply equally well to schools and 
dry goods stores. 

REMEDIES FOR POOR VENTILATION 

The great majority of us must continue to live and work in places 
which are poorly ventilated. Is there anything which can be done without 
much cost or change in method to improve things? 

The first thing to do is to find out what the conditions are and then 
to discover means of remedying those which are most objectionable. The 
temperature can be taken at several different places in the room ; the humidity 
can be measured likewise in different places. A fair idea of the amount 
of dirt can be had from noticing sheets of white paper after exposure. 

If the air as it is taken into the intakes is dirty the best method of 
cleaning it is by washers; but when these are too expensive fair results 
can be had from cheesecloth used as an air filter. The cloth should be fitted 
into wooden hoops like those used in embroidering and can be changed as re- 
quired. 

When air is heated it must be humidified. This will require from two 
to 200 gallons of water according to the space ventilated. It is a small 
room which requires so little as two gallons a day in cold weather. Steam 
from the radiators, hot water coils in pans of water, large flat pans on 
radiator coils or on top of hot-air heaters are required. 

The temperature of the water must be kept over 120° ; there must be 
square feet of evaporating surfaces instead of inches if the humidifier is to 
rise above the level of fakedom. Large wet sponges placed in the air cur- 
rents give results. So do growing plants if they are plentiful enough. 

If the floor zone is cold, warm it by throwing warm air into it with 
a fan. If the incoming air is more than 100° use a fan to mix it with the 



VENTILATION 1157 

cool air of the room. Above all cool it by blowing it against the cold windows 
and walls. 

When the air is heavy and the occupants begin to grow drowsy and list- 
less open the windows and blow out the room. 

TEMPERATURE OF INCOMING AIR 

Whenever the temperature of a room is over 68° and the space is fully 
occupied by lightly dressed people the temperature of the incoming air must 
never be lower than 60° and it is wisdom to heat it several degrees higher — 
say to 63° or 64°. 

Nothing is more common than to see an elaborate ventilating plant with 
openings so placed as to give the workers an abundance of cool, fresh air, 
but so plugged that they give no air, hot or cold, good or bad. The men 
who were chilled by the cold incoming air plug the openings, sometimes with 
boards as in the Chicago postoffice, but more frequently with wadded news- 
papers. 

I remember one basement corner in which the temperature of the room 
was over 90°. A man stood there without a shirt, his bare body covered 
with sweat. The ventilating duct had an opening right over his head but 
he had plugged it because the air at 60° chilled him. 

He was right. It was safe, as well as more comfortable, to take his 
chances in that basement without air. 

When cold air flows into a room it rolls to the floor and the warmer 
the room the straighter it goes there. 

When radiators are having difficulty in keeping the room warm or the 
foot zone is cold the best way to increase the efficiency of the heating ap- 
paratus is to have fans blow the warm air from around the radiators to those 
parts of the room most in need of heat. Many of the failures of mechanical 
ventilation arise from the fact that the ducts deliver cold air into a warm 
room, repeating the very shortcoming which in the first place caused the owner 
to supplant window ventilation with mechanical devices. 

If there are boilers or machines near the ventilated room causing it to 
heat to more than 75° the temptation is to use cool air to ventilate and to 
cool. Such a plan is wrong. 

A wiser plan is to insulate the boiler rooms so that they do not heat 
near-by workrooms ; or else to give the hot rooms a separate outlet system and 
to run the inlet ducts along this in such a way as to save heat. 

On the other hand, the temperature of the incoming air should not be 
higher than 80° when it strikes the occupants unless it is blowing with 
considerable force. 

A large part of the complaint against hot-air systems is because they 
deliver air in the room in cold weather at 118° to 130° — and that is cer- 
tainly unhealthy. To be at its healthiest air should flow into the room 
between 65° and 75°. 

LIMITATIONS OF GRAVITY VENTILATION 

What is gravity ventilation? When ventilation is done without fans, 
the moving force being differences in the temperatures of inside and out- 



1158 VENTILATION— HEATING— HUMIDITY 

side air, the system is called gravity ventilation. The usual illustration 
is ventilation by means of open windows. 

Warm air is lighter in weight than cold air. Whenever the air in a 
room is at 70° and that outside is at zero strong currents will blow in and 
out. When there is 70° difference the force is considerable; but when the 
difference is but a few degrees the ventilation declines until there is but 
little air movement. When the atmosphere gets warmer than 50°, the room 
being 70°, open windows do not give much air. If on the other hand 
the room temperature falls to 50° or below (as in sleeping rooms at night) 
windows do not take in much air unless the atmosphere is below freezing 
temperature. 

Further limitation is put on gravity ventilation by the force of wind 
currents. Of course, it is gravity which causes winds; but there is a wide 
difference between the warming agencies of a room 12' x 12' and those of 
1,000,000 square miles of ground. A current flowing in through a window 
at a rate of two miles an hour would be called speedy. A wind of less than 
six miles an hour is not much wind. 

When the wind is blowing more than ten miles an hour into gravity 
outlets such openings always will act as inlets. When such a wind is blow- 
ing into gravity inlets they will carry enough air to chill the room. If the 
wind blew steadily from one direction it might be possible, with moderate 
winds, to adapt inlets and outlets to them; but anyone who has watched the 
steam and smoke of a city knows that the winds eddy and swirl without 
regularity as to force or direction. 

And, finally, the chief limitation of window or gravity ventilation is in 
the uneven temperatures in different parts of the room, especially at different 
levels above the floor. If the cold air as it came into a room would mingle 
freely the difficulties would be lessened — but it does not. It settles near the 
floor and (as human legs below the knees are easily chilled) complaints are 
numerous and insistent. The attention of occupants is diverted, they waste 
time and energy; eventually, they put down the window and gain comfort, 
even though it is less healthy for them. Window ventilation is not adapted 
to factories, schools or offices where there are many employees — certainly not 
when the weather is very cold. 

EFFECTS OF WIND ON VENTILATION 

Houses are most ventilated and most uncomfortable on windy days. 
When the wind is blowing thirty miles an hour it is exerting a pressure of 
4.5 pounds a square foot. In consequence every crack on the wind side of 
the building takes in cold air at a high velocity. This air blows out the dirty, 
foul air and simultaneously it blows out the heat. On a still day the windows 
and walls warm the air next them but on a windy day the warmth is blown 
away and cold air takes its place. 

It is for this reason that rooms cannot be heated satisfactorily on windy 
days. 

Winds affect ventilation so much that no plan will work that is not 
adapted for changes in wind force and direction. When the air of a room 
is 68° and the outside air is 28° the difference in temperature will pull air 



VENTILATION 1159 

into the room with some force but it is inconsiderable as compared with the 
force of a thirty mile wind. 

It is for this reason that open windows on the lee side of the building will 
act as outlets on a windy day — the outside area is one of low pressure. An 
ordinary ventilating fan delivers air with sufficient force to overcome wind 
pressure under ordinary circumstances but even using them outlets will some- 
times act as inlets. All in all, on windy days houses take in a great deal 
of cold air on their wind side and but little on their lee side; and even heat- 
ing and airing requires careful planning. 

VENTILATION BY WINDOWS 

The gravity method of ventilation or, in other words, ventilation by ordi- 
nary windows, is excellent for sleeping rooms in a northern climate during 
January, February, and March. It is all right for living rooms where there 
are but few occupants. For instance, in a 12' x 12' room ventilated by 
windows a woman can sew or read with comfort, since she can change her 
position to such parts of the room as are comfortable. It is all right for 
rooms where the occupants can be warmly clad — and the best example is 
sleeping rooms — but it is not adapted to workrooms where the workers must 
work without wraps, overshoes and gloves. 

Because much of the school work can be done thus clad it is fairly well 
adapted to that. About 10 per cent of school children gain more from 
studying in rooms with open windows and the temperature at 55° than they 
lose from having to wear wraps and heavy foot covering and work with hands 
encased in mitts. 

It is not adapted to offices, ordinary schools, stores, workshops, churches 
or theaters. 

In fact, in the Chicago climate in midwinter gravity ventilation is of 
limited use. 

Since differences in atmospheric temperature, difference in the direction 
and velocity of the wind (to say nothing of lesser agencies such as sunshine 
and cloud) make such a difference in results a broad margin must be left 
when window ventilation is used. This means inefficiency. A room in which, 
with proper ventilation, there is space enough for forty people cannot be 
occupied by more than ten people when there is window or gravity ventila- 
tion. Every feature spells waste — waste of space, waste of equipment, waste 
of effort, waste through inefficiency. 

And yet, mechanical ventilation of offices, factories, and stores is usually 
so unsatisfactory that window ventilation is the lesser evil. Certainly in all 
mechanical systems there is need of periodic flushing by opening the windows. 

The cure for this bad situation, leaving aside bedrooms and a few such 
places, will not be through window ventilation. It will be through more scien- 
tific and at the same time more practical mechanical ventilation. 

THE PHILOSOPHY OF FANNING 

Scientists, trying to find what caused the ill effects of air, have con- 
ducted many experiments along many different lines. None is more inter- 



1160 VENTILATION— HEATING— HUMIDITY 

esting and conclusive than those of an Englishman, Leonard Hill. Most 
of Hill's writings have been issued within the last five years, so his conclusions 
are not out of date. 

Hill placed small animals in a sealed box with no port holes, no venti- 
lating ducts — just solid walls of glass. Small electric fans were so placed 
as to keep the air well churned. No fresh air could come in, no foul air 
could get out. 

You remember the alarming stories in our school physiologies about 
badly ventilated rooms, where the carbonic acid gas gradually increased until 
all life was snuffed out — the Black Hole of Calcutta, the ships in storm and 
all that grewsome lot? 

Well, these observations of Hill shot these stories full of holes for he put 
men in sealed rooms and kept them comfortable and healthy without ventila- 
tion by using plenty of fans. He duplicated the box conditions on a large scale, 
using a room instead of a box and men instead of small animals. 

There are other factors to be considered besides air movement but Hill 
did a valuable piece of work in showing how necessary it was that the air 
around us be kept on the go. 

Now anything that works practically is right theoretically. We some- 
times hear that a thing may be right in theory but not in practice — which' 
statement is untrue. If a thing is wrong in practice its theory is wrong 
and vice versa. 

What is the theory that accounts for the wholesome effect of mov- 
ing air? 

The human skin keeps at about 98° Fahrenheit, the air in touch with the 
skin at about 95°. The air in a room is usually in the eighties and seldom 
passes 92°. Therefore, fanning blows the hot air away from the skin and puts 
cooler air in its place. When room temperature gets to 96°, if it ever does, the 
next the skin air gets to 98° or over. The human body is a furnace. 

The statement is about true that the weather is never so hot but that 
the use of a fan feels pleasantly cool. 

In addition, the skin sheds body waste into the air that lies against 
it. Hence fanning blows away chemically dirty air and replaces it with chemi- 
cally cleaner air. Therefore, there is philosophy in fanning — all varieties, 
from electric to palm leaf. 

For the same reasons a drafty room is a healthy room — a windy city is a 
healthy city. 

OZONE 

Clean, fresh, circulating air is a great purifying agent, one of the best 
known. Health authorities are agreed on that point. About one-fifth of the 
air is oxygen and oxygen is powerful in changing the character of the things 
with which it comes in contact. 

Air that is all oxygen is a better oxidizer than air one-fifth oxygen. 
Again everybody is agreed. Ozone is an especially active form of oxygen, 
about three times as active as ordinary oxygen. This is an established fact. 

Every health authority advocating better ventilation drums these facts 
into the people. Certain manufacturers of ozone machines twist these known 



VENTILATION 1161 

facts to convince people that ozone machines should be installed in offices to 
purify the air therein. 

The most dangerous of all fallacies are those which are founded on estab- 
lished and recognized facts. A man must be extremely well informed to know 
at what point in the twist the fact ceases to be a fact. 

In consequence, ozone machines are found in many offices. In fact, a 
.few years ago one was installed in the Chicago city hall and it took a 
fair amount of testing by the health department to prove to the chief of 
the department in which the machine was that the apparatus was of no 
value. 

About all that was investigated then was whether the machine did any 
good. The conclusion was that it did not. The money which it cost was 
wasted. 

Eecently the ozone machines as ventilating devices have been studied by 
Professor Jordan of the University of Chicago and independently by the Cali- 
fornia Board of Health. They came to the same conclusions. 

Ozone will kill typhoid, pneumonia, diphtheria, consumption and other 
germs out it will not hill these germs until the percentage of gas in the air 
is so strong that it will Tcill guinea pigs. In fact, in the experiments the 
guinea pigs died long before the germs did. 

They did not try it on men because that would have been murder. But, 
having found out the strength that kills germs and guinea pigs they cut way 
below that at a point where germs would not be disturbed and had men 
breathe air containing those strengths. 

Some of the men got drowsy; some went to sleep while at work; some 
had headaches; some had colds; some got sore throat. 

Air containing a moderate amount of ozone is unfit to breathe. It makes 
the breathers sick long before it kills disease germs or destroys odors. 

On the other hand, the odor from the machine hides the odors of the air 
foulness; and in modern times intelligent people bathe rather than dope with 
perfume. 

LIVING ROOMS 

In a house heated by fireplaces it is easy to decide what shall be called 
living rooms. In a house heated by steam, hot water or hot air people sew, 
do light housework and read all over the house. Comfort determines where 
the occupants stay. 

In the winter the room must be warm enough to be comfortable for a 
person doing light physical work and lightly clad. This means a temperature 
of 65° to 70°. 

Living room temperatures are usually too high. Seventy-five degrees is 
almost an accepted standard. An excellent wet and dry bulb thermometer for 
determining humidity has 65° to 75° marked as the limits of proper room 
temperature. 

Ninety per cent of the flats in Chicago at 6 o'clock in the evening have 
a temperature during the winter months that is higher than 80°. 

When the outside temperature is below 30° the ventilating air in an 
ordinary living room should not blow directly on the occupants of the room. 
It will take heat from their bodies faster than thev can make it when sitting 



1162 VENTILATION— HEATING— HUMIDITY 

quietly. The first necessity is that the wind be deflected. On some days this 
is all that is required ; on others it must be warmed somewhat. 

Eadiators should be placed in front of windows. It is advisable to have 
the bottom of the window below the top of the radiator or else provide a 
separate opening below the window leading air through the radiator. 

Living room humidity should be somewhere around 50°. 

Probably the reader never saw a humidity measurer and yet a measure 
of humidity is just as necessary for comfort as a measure of temperature. 

Most of the condemnation of flats by those who think of causes is due 
to the dryness of the air in them. When air is heated it must be watered or 
harm comes. If the steam radiator blows steam into the room the humidity 
will be raised; or there are many types of water cans made to hang against 
the radiator coils. 

Pans of water set on the radiator or elsewhere in the room are of great 
service. 

FOR FRESH AIR DUCT 

The Federal system of heating and ventilation, after laying down its 
Federal heat unit as a standard of computation for the heating of houses, 
proceeds to cite standards for the more usual of the unusual conditions. Of 
such are the variations to be made to provide for the heating requirements 
made necessary by windows already noted. 

Another standard of variations has been worked out for climates that are 
unusually cold or unusually warm. When the wind blows from the north 
or west at the rate of twenty-five miles an hour the demands on the heating 
increase 20 per cent. Nothing is added to the needs by an east wind blowing 
fifteen miles an hour and south winds blowing five miles an hour and less 
actually help the heating 5 per cent. 

In a more general way wind blowing thirty-five miles an hour increases 
the heat needs 40 per cent, and forty-five miles an hour 60 per cent. 

All this information will be of value in making people comfortable. 
What will be of greater value will be the detailed instruction on those points 
that have more to do with their health. 

For instance, there is this injunction : "No furnace should be installed 
without a fresh-air duct." 

The weight of the system's authority is thrown against recirculation of 
air. A fresh-air intake is provided. This is equipped with a dust screen. 

The air then passes under one baffle and over another and then into ducts 
leading to the combustion chamber. 

The intention is that the duct be eliminated by the screens, baffles and 
dust collectors so that the air as it reaches the heating chamber, is cleaned 
and somewhat warmed. 

Around the chimney from the furnace is a second, or air, chimney. 
The heat of the smoke heats the air in this chimney and thus foul air is 
drawn from the house as the air chimney receives the foul-air ducts which 
lead from the rooms. 

The dust filter screens in the fresh air inlets are accessible, removable 
and cleanable. 

In order to cure the usual dryness of old style furnace heat insistence 






VENTILATION 1163 

is put on humidity standards, and furnaces are equipped with humidifiers. 

The standards provide for a relative humidity between 50 and 70. 

On the practical side instructions are given as to the amount of water 
to be evaporated to accomplish these results. 

VENTILATION OF THE BEDROOM 

Whoever thinks the agitation for bedroom ventilation ends with the win- 
ter time is mistaken. When the outside temperature is higher the air rushes 
in through every crack. When the temperature outside and inside is the 
same or within twenty degrees of the same the window openings must be 
large to get results. 

To get high grade air, sleeping out and special ventilating arrange- 
ments are needed in the summer as well as in the winter. As a further 
consideration, some of the people who shrink from the cold of outdoor sleeping 
in winter feel like going out when the spring time comes on. 

The toggery for sleeping out differs a little from that for sleeping in. 
The art of sleeping out differs a little from that of sleeping in. 



1. Sew a layer of building paper on the springs and over it a strong piece 
of unbleached muslin or canvas. This not only prevents the cold from com- 
ing up underneath but also keeps the paper in place. 

2. Place an unbleached muslin cover over the mattress and a pad on top 
of it; then cover with a white cotton sheet tucking it in at the head and 
sides. 

3. Cover three-fourths of the bed, lengthwise, with a heavy woolen 
blanket, part of it extending over one side; put another one in like manner 
on the other side of the bed. Place pillow at the head. 

4. Place a double flannelette sheet, five and one-half or six yards in 
length, over the bed with the closed end at the foot. Turn in the sides of 
this sheet (allowing enough room to sleep between) and letting the under 
part of the sheet extend over and around the pillow. 

5. Fold over the flaps of the two blankets and tuck them in. 

6. Place one or two double blankets over all, tucking in well at the sides 
and foot of the bed. Fold back the upper part of the flannelette sheet over 
the blankets. 

7. Place a khaki or canvas cover over the entire bed. 

The windows should be raised from the bottom and lowered from the top 
when you are retiring. If there are two raise one and lower the top of another. 
The one raised should be toward the side from which the wind is blowing. 
The lowered one should be on the other side of the room. If the room has 
a window or windows on only one side at times ventilation will have to be 
assisted by leaving the transom open or by leaving the door open a few 
inches and providing an open window either on the wind side or on the 
lee side elsewhere in the house. 

The temperature of the occupied sleeping room should not go above 60° 
Fahrenheit during the winter time. There must be an appreciable air move- 
ment through the room. This is necessary in the winter. It is absolutely 



1164 VENTILATION— HEATING— HUMIDITY 

necessary in the summer. When the outside temperature is so great that the 
sleeping room can no longer be kept below 65° it becomes necessary to have 
"blowing" air in the room — air moving enough to be felt by the occupants. 

The water of condensation in the radiators is liable to freeze during 
cold weather. There are two ways to prevent this. One is to keep a head 
of steam during the night and to turn the radiators on full enough to 
keep the water cleared out. The other is to have a vacuum return system 
and then to shut off the radiators at night. This is the cheaper plan 
in the long run. 

If the radiators are turned off the room gets its heat from the bodies 
of the occupants and from warm walls, floors, and ceilings. In cold weather 
deflectors throw the air in a window in such a way that it does not strike the 
bodies of the occupants with an unpleasant force. 

We have given some details as to bedroom methods because we think the 
main thing is that the bedroom should be a cold room and the main thing 
in a cold room is to know how to be cool and comfortable. 

Put Up Windows. — B. T. writes: "I occupy rooms near the center of 
the city. These consist of a bedroom, bathroom., and large sitting room, 
the cubic contents of which is about 7,500 cubic feet. During the day the 
rooms are unoccupied and always have plenty of air circulating through 
them, and, in the winter months, the temperature rarely rises above 68 to 
70 degrees. Owing to the noise, it is impossible to accustom myself to sleep 
with the windows open. The window area, both front and rear, is very 
large, and, even when the windows are closed, a great deal of air comes 
through, and I fancy much more than I breathe. Will you kindly inform 
me whether, provided at the time of retiring the air is thoroughly fresh 
and new, any serious injury will result from the continued practice of 
sleeping in quarters of that size with the windows closed, all the rooms 
being thrown into one? The writer takes a great deal of open-air exercise, 
but must confess he does not sleep at times quite as well as he would like. 
Is not the theory of the necessity for absolutely fresh air one which can be 
carried to an extreme in some cases?" 

Reply. — You must either raise your windows in your present location 
or move where the noises will not disturb you so much. You must not sleep 
in rooms without some window opening. Evidently your rooms are in 
good condition when you go into them at night. The old idea that you can 
dilute still air enough to make it harmless is pretty generally abandoned 
now. 

The volume of air which you describe in the second paragraph of your 
letter — to wit: 7,500 — would not be particularly harmful during the first 
three hours of occupation. The authorities who based their calculations on 
dilution said 3,000 to 4,000 cubic feet of air an hour was required. 

You are correct as to the large amount of window leakage, especially 
during cold weather. Your windows are scarcely loose and leaky enough 
to supply more than half the deficiency. If you make use of storm sashes 
you will not get much aid from window leakage. 

Fresh air does harm when it abstracts heat faster than the body can 
make it. Under all other circumstances it does good. Put up your win- 
dows if you have to move. 

Deflectors for Open Windows. — P. B. K. asks a definition of deflectors 
spoken of for open windows. He asks how they are made and used 



VENTILATION 1165 

Reply. — The ordinary window ventilators are deflectors. There are 
many of these on the market. If you wish to make one proceed as follows : 
Take a piece of glass as long as the window is wide. The glass should be 
twelve inches wide and one-quarter inch thick. A board of these dimen- 
sions can be used instead of glass. Make a frame for this deflector. Set it 
just inside the sash on the window sill. The frame should be so built that 
the deflecting glass or board can be set parallel with the window pane — that 
is, perpendicular — or that it can be moved out at the top for a space of four 
inches. The deflector then can be set parallel to or at an angle to it. The 
space on the sill between the window and the deflector should slant out so 
that rain would drain out of and not into the room. 

Suggestion on Ventilation. — W. B. L. writes: "1. 1 Relieve that the best 
way to heat and ventilate a room is to use indirect radiation, taking cold 
air from the outside, passing it through a radiator underneath the -floor 
and having the radiator as low and as wide and long as they are made, to 
give the required amount of radiation; placing a water pan on top and 
admitting heated air to the room by an opening in the floor in front of the 
windows; the air to be taken out of the room by openings in the walls at 
floor level on the outside wall of the room. In this way the heated air 
would enter the room, rise along the outside wall, traverse the ceiling to 
tlie bach wall, descend along that, cross the floor to the outside wall, and 
go out, giving thorough circulation to the air. The natural draft could be 
used or electric fans; the latter would, of course, give a positive action. 
2. Please refer m& to several of the best modern works on heating and 
ventilating." 

Reply. — 1. The ventilating method suggested by you would be moder- 
ately well adapted to offices and schoolrooms. To try to carry the air back 
to the outside wall would be a mistake. Air in the open can only be made 
to do a few simple things. In the installation suggested by you there 
should be these modifications: 

The air should enter at several places. 

A large part of it should enter near the outside wall. 

The outlets should be on the outside wall. 

The outlet ducts should have openings near the ceiling and also near 
the floor. 

An exhaust fan would be necessary to care for the rooms on the lee 
side of the building. 

To take the air through the walls and let it flow through the radiators 
would be cheaper, simpler and more effective. 

The floors are warm in buildings several stories high. The radiation 
underneath the floor would fit a one-floor school building. 

2. Heating and Ventilating Magazine, 1123 Broadway, New York; Car- 
penter, Hoffman, Raber and Allen. 

Special works : Wilson, "Air Conditioning" ; the British Parliamentary 
Reports ; MacFie, "Air and Health" ; Shaw, "Currents" ; Parkes and Ken- 
wood, "Hygiene." 

A magazine giving much space to ventilation is Human Engineering, 
Cleveland, O. 

Sleeping Room Regulation. — R. M. B. writes: "Will you please advise 
the proper method of ventilating a furnace-heated sleeping room occupied 
by two adults and a six months old baby. As the baby sleeps alone in his 



1166 VENTILATION— HEATING— HUMIDITY 

crib we are anxious to know if it would be injurious to him if the tem- 
perature got down to 1+0° ." 

Reply. — Furnace heat delivers air in the room at a temperature of 118° 
to 130°. When the windows are thrown open the hot air goes straight out 
without heating very much. Fasten a twelve to eighteen inch board 
across the bottom of the windows so as to deflect the incoming air upward. 
Raise your window about one to two feet from the bottom. Leave the top 
up. In this way you should succeed in keeping the temperature at 50° to 
55°. Forty degrees is too cold for the baby. 

Regulation Is Necessary. — J. H. writes: "Will you kindly tell me what 
kind of heat you think the better for health, hot water or steam? We live 
in a steam-heated apartment, and my baby has had bronchial trouble all 
winter. I have been told it was due to the steam heat, and that hot water 
would be better for him, as it is more regular. Our apartment gets too hot 
when steam is put on, and if we shut off the radiators we freeze before 
steam is put on again. It is cold during the night. On the very chilly 
nights baby took an extra cold each time." 

Reply. — Practically, there is not much difference between them. Hot 
water heat is more even, but with steam heat it is easier to humidify. 
Properly regulated with thermometers and humidifiers and aided by wise 
use of windows either can be made satisfactory. Without such regulation 
and aid neither can be made satisfactory. 

Ventilate Room. — B. B. R. writes: "I have been accustomed to an un- 
usual amount of fresh air in my bedroom, but since my baby came, being 
obliged to have her sleep in the same room, I have had only one window 
open about three inches. The baby is 5 weeks old and healthy. What is 
the lowest temperature she could stand?" 

Reply. — The baby can stand as much cold as the mother. She should 
be warmly wrapped. Ventilate the room better and the baby will thrive. 

Sleeping Out of Doors. — Miss M. R. is in perfect physical condition. 
She started sleeping out of doors last summer and wants to know whether 
she shall keep it up through all sorts of weather including rainy and damp 
nights. 

Reply. — Yes, if the sleeping place is properly arranged so that the 
sleeper is comfortable. Otherwise, no. If the porch is deep enough or 
screened or if the bed is covered by a rainproof covering dampness of the 
air or rainy and snowy nights should not deter. 

Window- Ventilated Office. — R. G. works in an office that is ventilated 
by windows. He says that the warmer the room gets the colder his feet 
get. Why is this? 

Reply. — Cold air goes to the floor. The warmer the air in the room the 
more quickly the cold air gets to the floor. The more quickly it gets there 
the warmer it is when it gets there. The hotter the air is where the head 
and shoulders are, say five feet from the floor, the colder will one's feet and 
legs be in air one foot from the floor. When the room ventilation is 
through windows and the room temperature is 78° one's feet will feel 
colder and the air near the floor will be colder than when the temperature 
of the room is 68 °, 



VENTILATION 1167 

How to Make Deflector. — J. E. L. writes: "In your article today on 
ventilation you say windows in ~bedrooms should be supplied with deflectors. 
Kindly explain how to make and how to put them on properly. Also, is it 
sufficient ventilation in winter to let in the air by having the lower sash 
closed on a board, thus allowing fresh air to come in between the two 
sashes, as is often done?" 

Reply. — There are many deflectors on the market. To buy one of these 
is usually more satisfactory than making your own. To make one take a 
piece of glass or a piece of board twelve inches wide and of a length equal 
to the width of the window. The thickness should be one-quarter to one- 
half an inch. 

Make a frame for this. The frame fastens at the bottom of the window 
frame inside the lower sash. The inside of the deflector should be three 
inches from the wood of the window sash frame. The top of the deflector 
should have four inches of play. It should be arranged to catch with the 
perpendicular of the deflector parallel with the window pane and about 
four inches therefrom. It should also be arranged to catch with the de- 
flector at an angle with the window pane, its top being eight inches there- 
from. 

Closing the lower sash on a board allowing air to come in between the 
two sashes is satisfactory in unoccupied rooms. If one or two windows in 
a room can be so fixed and the number of people in the room is below five 
it will be satisfactory in cold weather. In warm spring weather or medium 
weather in spring and fall there is not enough difference between the room 
temperature and the outside temperature to pull in air in sufficient quan- 
tities. The opening is too small. 

Sleeping in a Draft. — Mrs. E. E. writes: "Should one sleep or sit in a 
draft? My husband claims one cannot get a- change of air in a sleeping 
room without a draft. He and I have had many arguments about sleeping 
in drafts. I am against it." 

Reply. — Everyone should sleep in moving air. When air moves strongly 
enough it is called a draft. If the air is cold its movement is felt when it 
is going only a few feet a second. When the air is warm its movement is 
not felt until it gets much faster. No two people call the same thing a 
draft. A force of air movement which one person objects to is pleasant to 
another. A force which in the summer is a most pleasant breeze in winter 
is a horrid draft. A force of wind which one exercising in the open air 
thinks exhilarating is unpleasant to the same person sitting in a room. 

The rule is : Sleep in air which is moving just as much as you can 
stand without being chilled. Do not stay in any air current which chills 
you. If you chill easily try to train yourself by exercises, cold baths, 
massage and exposure to stand more draft without chilling. It is fine for 
you if you can stand it. It is bad for you if you cannot. 

Both of you are right — he in his theory and you in your custom. But 
you had better change your custom gradually. 

How to Ventilate a Room. — "Salutaris" writes: "Are the effects on 
health deleterious where there is no way to cause a current of air to pass 
through a room, no transom or door on the other side? Can you suggest 
any method for proper ventilation for such a room?" 

Reply. — I take it that you have a window on one side of the room. 
If you will raise the lower sash two feet from the bottom and lower the top 



1168 VENTILATION— HEATING— HUMIDITY 

sash two feet from the top you will get good results in weather below 40°. 
When the atmospheric temperature rises much above 40° the house tem- 
perature will not move much air. 

Ventilation. — N. B. G. writes: "If the occupants of a furnace-heated 
building, having inside air supply drawing in part from rooms occupied by 
a tuberculosis patient 'are in no danger/ it is reasonably assumed that this 
method of furnace air supply is not unhealthy. Were it unhealthy the oc- 
cupants would be in danger. How then can the foregoing be reconciled to 
the definite statement that 'recirculated air is unhealthy' when dealing out 
advice on furnace installation?" 

Reply. — If you will refer to the letter in question you will see that the 
writer was asking whether consumption germs would be dried, picked up 
by the air currents, carried from one part of the house to another and then 
infect healthy people. The reply was that there was no danger. There is 
a difference between the carrier action of air and the unhealthfulness. Air 
is frequently unhealthy when it is not a transporter or carrier of disease 
germs. There are two tendencies in the country as regards ventilation 
view. One is a lessening fear of air as a germ carrier ; the other, a growing 
fear of bad air as a producer of unhealthfulness. These tendencies are not 
contradictory. 

Outdoor Sleeping. — Earnest Inquirer writes: "1. What is your opinion 
on sleeping out of doors? 2. Do you believe it is good or bad to sleep on a 
north porch, exposed to the lake in cold weather or damp weather? A 
member of my family is a crank on the subject and it worries me ex- 
ceedingly." 

Eeply. — 1. I believe in it. 

2. Depends on the party and on the facilities. Some people are bene- 
fited by sleeping on a north porch in Chicago without effective wind shields ; 
others are not unless they have facilities for shielding themselves against 
winds, storms, light, and noises. The outside sleeping cranks are nearer 
right than the draft cranks. 

Open Windows in Winter. — S. T. T. writes: "It is time to write 
something about leaving windows open at night so as to sleep in brisk, 
fresh, early winter air." 

Reply. — You are right. I begin by publishing your admonition. 

Drafts and Colds.— E. P. N. writes : "Some 'fresh-air fiends' and 'draft 
cranks' are having a tug of war in a certain club as to whether, during the 
cold season, the windows are to remain open or be closed. An answer to 
the following questions would be appreciated : 1. How does impure air cause 
colds, coughs, et cetera? 2. How do drafts cause colds, coughs, et cetera? 
3. When a window is open six inches at the top and bottom is the resulting 
cold air really a draft? I believe I have heard of some methods of warm- 
ing the air before it enters the room, but in every room I have been in so 
far (as in the case of the clubroom in question) it is simply a case of 
choosing between open windows, fresh air, and a draft (if it be true that 
in a room without the method mentioned you are bound to cause a draft 
by opening the window) and closed windows, impure air without a draft. 
I have never yet opened a window in the winter time when three or four 
persons were in the room without someone crying out, 'Where is that 



VENTILATION 1169 

draft coming from?' Then the poor window is discovered open and imme- 
diately closed. If. In case you must have draft in order to get fresh air 
in the ordinary buildings at present are not the colds, et cetera, caused by 
drafts in order to get fresh air less severe as well as less frequent than those 
caused by impure air the result of closed windows? 5. In a room twenty-five 
feet by fifteen feet, with twelve people in it is the opening of one window 
six inches from the top and six inches from the bottom too much, too little, 
or about right? I wish to get an idea of about how quickly the room 
becomes actually dangerous. Of course, some are so fond of fresh air that 
they aim to sleep, study, and work in rooms with the air as nearly as 
possible like that of outdoors. But, on the other hand, there are some who 
admit the force of the fresh air arguments, but open the window about 
1-1,000,000 of an inch and contend that that much is sufficient to keep 
the air from being poisonous." 

Reply. — 1. Colds and coughs are due to infections. Impure air (a) 
transports bacteria, (b) lowers resistance. 

2. By chilling one portion of the body drafts lower resistance. 

3. In cold weather, yes; in warm weather, no. Every man is his own 
judge of drafts. A current of air strong enough or cold enough to be 
objected to is called a draft by the man who objects to it. The speed of 
the air, its volume, the difference between the temperature of the air of 
the room and the incoming air — all these are factors, but .the determining 
factor is the man who is passing judgment. 

4. (a) If all the air is heated as it enters the room it can be introduced 
in large quantities without causing complaint of drafts, (b) Yes. 

5. Too little in warm weather; too much in cold weather, especially if 
the window faces the wind. A room 25' x 15" inhabited by twelve people 
cannot be ventilated by windows in cold weather without complaint. The 
"fresh-air fiends," as described by you, are exceptionally well off. One 
can get on with less air without being greatly harmed. This is as 
definite as I can be in the space available. 

Kitchen Air. — J. D. S. of Kewanee writes: "Is it healthy to take air 
from the kitchen of a dwelling where all the work in cooking and other 
housework is done and pipe it to the furnace in the basement, and thence 
to the sleeping and other rooms?" 

Reply. — Kitchen air is about as healthy as any inside the house. It is 
too hot and too moist and that makes it bad for cooks but these conditions 
can be rectified before it reaches the living rooms. Kitchen odors are not 
unhealthy but the family would object to having them sent all over the 
house. 

For Well- Ventilated Cars. — W. B. R. writes from Shermerville, III: 
"I wish to suggest that one car on each suburban train should be a 'fresh- 
air car for men and women. It should be sufficiently ventilated to keep 
the air pure and supplied with no more heat than the other cars. When any 
of the numerous persons who now object to seeing a few ventilators open 
happen to get into this car they can be invited to move into the next car 
instead of interfering with the proper ventilation, as they usually are able 
to do under present conditions" 

Reply. — The suggestion is good. It would take the railroads several 
years to change their cars so they could be properly ventilated. In the 



1170 VENTILATION— HEATING— HUMIDITY 

meanwhile they might have one car that was healthy and comfortable for 
some people and uncomfortable for others and the remainder of their cars 
unhealthy and comfortable for some and uncomfortable for others. Cars 
can be ventilated so as to be both healthy and comfortable for the great 
majority of people. 

The present railroad car ventilation is about the limit of pigheaded- 
ness. Nearly four years have elapsed since the Master Carbuilders' Asso- 
ciation published a report showing the inefficiency and unnecessary cost of 
present methods and suggesting new methods. One railroad, the Penn- 
sylvania, acted on the report. Up to date it has made no impression on 
the general run of passengers. 

More Ventilation. — F. C. writes: "For years I have had a weak throat 
and difficulty in talking at any length. Last winter I lost my voice for six 
weeks. Have had many colds which always terminated in severe coughs. 
I have no cold now, but cough at intervals. 

"I do not have long coughing spells, but cough a little at times in 
order to clear my throat. The entire trouble seems to be in the throat. 
Is there any danger of tuberculosis? 

"I am and have been a stenographer for years. I have no other symp- 
toms, good appetite, and am not losing flesh. I am always extremely tired 
in the morning and never feel normal until after breakfast. I walk to and 
from the office, one and one-half miles each way." 

Reply. — People who are tired in the morning have usually slept too 
much or slept in a badly ventilated room. If you sleep in a well venti- 
lated room you ought to have fewer colds. Your letter suggests that you 
have an area of chronic infection in your nose or some sinus leading 
from it and that this infection occasionally spreads to your nose and 
larynx. If this is true your colds will recur until this focus is cleaned 
up. Your letter does not suggest tuberculosis. 

Ventilating a House. — W. B. writes: "I should like to have you describe 
a common-sense, practical method of ventilating thoroughly an ordinary 
two-story, six-room, hot water-heated residence, during the winter months. 
We have two boys, 5 and 2 years old respectively, who must spend some 
time indoors during the day in bad weather, and the problem is to give 
them the best hygienic conditions and still not subject them to the danger 
of colds through drafts from open windows, etc. If plenty of outside air 
is admitted is the humidity sufficiently high or would you advise using 
water pans through the house? Would 60 on the hygrometer be a good 
point at which to keep the interior humidity and, say, 68° tempera- 
ture?" 

Reply. — I do not think you will be able to get the humidity of your 
house up to 60 except in the cold bedrooms. 

Throw the windows of the bedrooms wide open. Fasten a blanket 
across the foot of the bed or use a screen so as to keep the wind from 
blowing straight on the boys. Keep the temperature at 45° to 55°. The 
humidity will keep at 60 or over without any help from humidifiers. 

Have them dress in the bathroom with the thermometer at 75°. Pay 
no attention to the humidity in this room. 

Keep the temperature of the living room at 68° and the humidity 
as near 60 as possible. You probably cannot get it higher than 40. Use 
pans of water and every other aid possible. Four times a day have the 



VENTILATION 1171 

boys play some lively game and while they are doing so throw open the 
windows and drop the temperature to 60°. The humidity will come up to 
50 for a short while. 

There are few days bad enough to make it advisable to keep the boys 
in for all the day. Even babies over three months of age should be out at 
least two hours practically every day in the year. 

Air the House Well. — G. H. F. writes: "Please advise me what liquid 
of strong, pleasant odor will counteract the smell of varnish, still not in- 
juring or affecting its properties or ingredients" 

Reply. — Varnishes are sometimes dissolved in wood alcohol the fumes 
of which are poisonous. Get rid of the odor by opening the windows and 
airing the house well. 

To Insure Pure Air. — W. N. K. writes: "Is there any device or appli- 
ance which one can wear while traveling to reduce the intake of con- 
taminated air, etc.?" 

Reply. — I know of no such device nor would one be practicable. 

The better way is to build and operate railroad and street cars so as 
to facilitate the outflow of contaminated air and the ingress of fresh air. 
Cars are generally badly ventilated. Agitate for ordinances and laws forc- 
ing better car ventilation. 

Method to Be Avoided. — H. J. B. writes: "What is your judgment as 
to installing a hot air furnace with two registers in each room, one to take 
the air from the room and the other for hoi air to return? These jobs are 
frequently put in without talcing cold air from the outside. The claim is 
made that there is great economy in not talcing the air from the outside." 

Reply. — The practice is one of recirculating the air. It saves money, it 
is true, but in my opinion at the expense of health. Some recirculation is 
compatible with health but no research work has determined just how 
much* and certainly in practice no effort is made to adjust the recircu- 
lation on the basis of health. 

-My advice is, until this matter is fully determined, to avoid recircu- 
lating hot-air furnaces as « one would avoid a man with smallpox. 

Bad Air in a Basement. — T. R. says he is employed in the basement of 
a wholesale house where the air is bad. He asks, "Will a five-mile walk and 
deep breathing while walking 'overcome' the bad air absorbed in the lungs 
during the day?" 

Reply. — A five-mile walk and deep breathing will overcome much of the 
effects of bad air absorbed during the day, by reason of working in the 
basement of a wholesale house where the air is bad. At the same time 
it is doubtful if it will overcome it all. My advice to you is to find 
employment in a better ventilated place. 

Coughing in Theaters. — J. H. R. writes: "Every time I attend a theat- 
rical performance I am annoyed by persons all through the theater who 
cough incessantly. I never am troubled this way, and so I write to ascer- 
tain the cause of it. Perhaps it is the imperfect ventilation." 

Reply. — The reasons are several. In the first place the ventilation is 
poor. Several hundred people crowded together in one room make a lot 



1172 



VENTILATION— HEATING— HUMIDITY 



of heat. The illumination makes additional heat. The audience gathers 
quickly and disperses quickly. This adds to the troubles of the manage- 
ment. All in all, theater ventilation is usually a poor job. There is a 
tendency to cough engendered by hearing others cough. Much more im- 
portant than the last is the coughing excited by laughter. A farce comedy 
is a better cough stimulator than a mild melodrama. Until we recog- 



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Fig. 486. — Influence of Closed Windows on Room Air Current on a Cold 
Day. Hot-Air Heat. 



nize colds as contagious and preventable a person will be a little better off 
if he will stay away from the theater from January to May. The coughing 
prevents him from hearing, so what's the use? 

Church Ventilation. — L. C. F. writes: "Kindly print something in 
regard to ventilation of churches. Ours is a small church with windows 
close to the pews on either side and at the back of the choir loft. The 
windows are always let down from the top on both sides, or on one side and 



HEATING 1173 

back of the choir, thus making everyone in the congregation sit in a 
druftr 

Eeply. — About the only thing you can do is to warm the air before it 
gets to the people. One way to do this is to put deflectors on the windows 
so that the air goes to the top of the room and is partly warmed by admix- 
ture with the warm air before coming in contact with the people. This 
method works fairly well on moderately cold days. A better plan is to 
place deflectors and ducts so that the fresh air is sent through the 
radiators. This can be fairly well done without electric fans but the 
service is much more efficient when small electric fans (one-eighth horse- 
power, for instance) are used. Drafts of themselves are not harmful. The 
temperature of the air in a draft may be so low that it robs the body of 
heat a little faster than the body makes it. Under those circumstances, a 
draft does harm. 

HEATING 

Those who contemplate reading this series of articles will do well to 
remember that the ends sought and the methods used must vary with the 
season, the climate, the business and with special conditions. 

In writing them I have had in mind the usual conditions which pre- 
vail in Chicago during the cold weather of midwinter. It follows that they 
will not fit so well when the weather gets warmer nor can they be applied 
without adaptation when the proposition is to ventilate a house in a climate 
which is much warmer or more humid than that of Chicago. 

In the main the principles involved vary widely according to the at- 
mospheric temperature, the amount of wind and its velocity and the rela- 
tive air humidity. 

I cite some illustrations: In very cold weather the air is too dry; in 
warm weather it is too wet. In cold weather the house temperatures are 40° 
to 80° higher than the air temperatures; in warm weather they are 20° 
less. In cold weather fans are used to create drafts of warm air; in warm 
weather, of cold air. In Mississippi the woodwork swells in winter and 
shrinks in summer; in Illinois the reverse is true. Effort is necessary to 
humidify the air of schoolrooms and flats; on the other hand, laundry, 
bakery and packing house ventilation requires that the air be dried. 

The most important point, however, for the reader to bear in mind is 
that individual problems require individual treatment. Correspondence ven- 
tilation is like correspondence medicine in that it becomes harmful when it 
is carried beyond its limitations. A given ventilation problem must be care- 
fully studied and the remedy devised to suit the conditions found. 

The general principles laid down form the basis upon which to build. 
They do not constitute the whole of the building. 

HEALTHFUL HEATING OF HOUSES 

Before winter begins the shop windows have displayed rows of trained 
batteries in the nature of stoves, ranges and heaters of all kinds announcing 
the battle royal to be fought with Old Man Winter. Gradually these bat- 
teries, Shiny Black, Lustry Bright and Batter Big Chest, are distributed to the 



1174 VENTILATION— HEATING— HUMIDITY 

houses of our citizens. Once more mere man asserts his superiority, mounts 
a step ladder to prove it, gets the stove piped and confers upon himself a sooty 
mark of distinction while the real master, the lady of the house, watches 
it all with a directing eye. Outside is heard the heavy trudging of horses 
pulling a wagon brimful of coal. Last but not least, the janitor is becoming 
more officious. Everything shows preparedness to fight with heat and 
fervor the onslaughts of Winter. 

There are many methods of heat each having its advantages and dis- 
advantages. The great advantage of heating by open fires is that ventilation 
is added. The disadvantage is that it heats the room unevenly. The outside 
walls are always cold and the floors are usually so. The fire must have air, 
and the incoming air is necessarily cold. Arrangements can be made to 
deflect it but none can be made to heat it. Open fireplace heating is adapted 
to rooms occupied by a few people — for example, sitting rooms. 

Open fireplaces in which gas is burned are open to another objection. 
Frequently rather ornate gas logs are used. The gas flows from a small pipe 
into a larger space and there escapes from many openings. Frequently 
these openings are more or less obscured by asbestos. In consequence un- 
burnned gas nearly always escapes and in a short while the odor in the 
room is appreciable. 

The remedy is easily applied. Gas logs should be simple and plain with 
a small number of openings and those in such plain view that a point 
from which gas is escaping into the room could not be overlooked. Occa- 
sionally heating is done by a gas burner which has no chimney or flue 
attached. This is always to be condemned. When gas burns it is not 
destroyed. It is merely changed into other gases and these are almost as 
harmful as the original gas. 

And finally those who make use of open-fire heating whether they use 
coal or gas should remember that unless the windows are raised or the 
ventilators are opened the air of the room speedily gets into a harmful 
condition. This happens more quickly than where there is steam or hot- 
water heating and lack of ventilation. 

The conclusion is that for rooms occupied by but few people and with 
ventilators and windows sufficiently used open-fire heating is excellent. In 
the milder climates, say south of a line through Memphis and in the South- 
west, its advantages are great enough to overcome its discomforts. This 
is true of its use in houses and small halls. It can be adapted .to school 
use in California, the Southwest and in the South beyond Montgomery, Ala- 
bama. 

HEATING THE HOUSE 

Heating by hot water has its advantages and disadvantages. It is an 
economic method of heating' as compared with heating by open fireplaces. 
In fact, it is easy to demonstrate that the saving is great enough to more 
than pay for the cost of installation and upkeep in the lifetime of the plant. 

It is to its disadvantage that it does not make ventilation a necessity. 
As we have seen, however, this advantage of the open fireplace is not what 
it seems, since there is no way of warming the cold air and in the effort 



HEATIXG 1175 

to stop the stream of cold air along the floor, doors and windows will be closed 
and cracks will be chinked. 

As a means of keeping the floor warm, hot-water heating is midway 
between hot-air heating and open-fire and stove heating. 

In hot- water heating the temperature of the coils is never so hot as 
steam coils get at times. This is something of an advantage though not a 
great one. 

To my mind, the great drawback of hot-water heating is the difficulty 
of humidifying. To remedy this defect three methods have been employed. 

Pans are placed on the radiator. These do not evaporate enough 
moisture. By the use of wicks, towels and evaporating bricks the amount of 
evaporation may be materially increased. 

Fountains are employed to throw a fine spray of cold water into the 
air. Steam evaporated in a special vessel in the firepot is discharged at some 
advantageous point in the room. 

The satisfactory humidifier used by Dr. Bryce discharges steam into 
an air intake. 

Heating by steam has the economies of hot-water heat. It allows 
the placing of the heat under the windows and against the outside windows. 
Thus wall chill as well as window chill is provided against. The leaking 
air is promptly warmed. The temperature of the chilled air is raised. 

Its advantage over hot-water heating is in the greater ease with which 
humidifying is done. Steam from the radiators can be used to moisten 
the air in the room. 

Direct-indirect heating: This term is employed to designate heating 
where fresh air is taken into the room behind the radiator coil and, having 
been warmed, is discharged into the room. It is. therefore, a method of 
heating combined with a method of ventilating. As a heating method 
it has the great advantage that the incoming air distributes the heat through- 
out the room. 

PROBLEMS OF HEATING 

An important question to decide is whether it pays to keep a building 
heated all the time or to let the heat die down when the building is not being 
■used. On this subject there are a multitude of opinions. Many of the men 
holding opinions have investigated or observed conditions to some extent and 
base their opinions on what they have observed. That they should hold such 
contradictory opinions points to the probability that under certain circum- 
stances it pays and in others it does not. 

The opinions are determined by the point of view of the holders. The 
man who has to hustle out of bed on cold mornings to make the fires no 
doubt would advocate keeping the house heated all the time. Those who 
stay in bed until the house warms up might think differently about it. 

The problem is one of heating both the walls and the air. The air with 
efficient heating methods is quickly heated, but it must be promptly changed. 
The walls heat slowly but when once heated if they be well made they 
remain warm. 

The time required to heat a building depends on its exposure, the snug- 
ness of its walls and windows, the materials of which the walls are composed, 



1176 VENTILATIOX— HEATIXG— HUMIDITY 

and some other items. A large building with thick walls may require twenty- 
four hours to heat up. That the time required can be accurately calculated 
is shown in two articles in the Heating and Ventilating Magazine, one by 
Tea and the other by Donnelly. 

If the fires are to be allowed to die down, for example, in schools on 
Saturday and Sunday or in churches during the week the heating plant must 
be built larger than where the fires are to go all the winter. Wolf says this 
excess should be 10 per cent for a sheltered building heated in the daytime 
only; 30 per cent if the building is greatly exposed. The increase must be 50 
per cent in churches cold for several days on a stretch. 

Mr. Mackay, a ventilating engineer, says : "It takes more coal to raise the 
temperature in a building than it does to maintain it." 

Professor Allen says that at the University of Michigan they burn 100 
tons of coal a day in a 3,000-horse-power plant. As the result of experiments 
they found it took about one ton more of coal to maintain heat in the buildings 
over Sunday than to allow them to go cold and then reheat them. In 
discussing Professor Allen's paper Mr. Weinshank said that in designing the 
heating for a building he always added an excess of 30 per cent in radiation if 
the building was to cool down at night. He thought a church saves coal by 
keeping its building warm all the week and as proof he cited two churches — 
one heated on Wednesdays, Saturdays and Sundays and the other heated 
all the time. The one heated all the time used less coal than the other. Pro- 
fessor Allen's method of comparing was much more accurate than that of his 
critic. But one point made by Mr. Weinshank must be taken into account. He 
said: "Any heating apparatus operated intermittently also suffers greatly 
from wear and tear." 

TYPES OF HEATING 

Gas Heaters. — A bathroom should be a little warmer than the average. 
In order to make this possible, small gas heaters are in common use. The 
same type of heating apparatus is used to a limited extent in bedrooms in 
cold climates for a short while morning and night in the spring and fall. In 
the gulf states such heaters are used in bedrooms for an hour or two morning 
and night during the warmer days of midwinter. 

Gas heaters of this type are generally without any chimney or pipe to 
carry the colorless, odorless smoke to the outside air. Where built in this 
fashion they are just about as vicious a device as is known in civilized 
society. 

By a rough sort of calculation, when a foot of gas is burned two cubic 
feet of oxygen, that is ten cubic feet of air, is used up and three cubic feet of 
carbonic acid gas is made. One can readily see that a gas stove running a few 
minutes in a closed bathroom makes the air unfit to breathe. As the tempera- 
ture of the air quickly gets over 80° and as the water in the tub evaporates 
rapidly and soon brings the humidity of the room to 70 an impossible com- 
bination is brought about. Fat men, men with bad hearts, men disposed to 
faint, presently become dizzy. Unless the window is raised or something else 
is done the man faints. If he faints and falls in the water he drowns. 

When this type of heater is used in a bedroom the conditions are not so 
bad. The room is larger, the walls are less snug, the humidity and the 



HEATING 117? 

heat are less. Such use kills nobody outright and used for a few minutes to 
moderate the temperature does no material harm. 

In many cities the ordinances require that such heaters shall have a stove- 
pipe leading to the outside air. Such pipes carry off much of the carbonic acid 
gas and prevent some of the overheating. Let us say they cut the danger in 
half. 

For use as bedroom heaters a gas stove is made with some water carried 
in pipes in the back or baffle plate above the flame. The statement of the 
selling agent is that this water moistens the air in the room. As a gas heater 
rapidly adds heat to the air and does not add moisture the air in the room 
speedily becomes very dry. Whenever heat is added to air a proportionate 
amount of water must be added or the air becomes unfit. 

The need is present but the remedy offered by the selling agent is no 
remedy at all. By what magic water in closed pipes can become water in air 
deponent sayeth not. As the water in the pipes cannot be heated much above 
212° and the carbon flame is much above that figure the net result of the use 
of this type of apparatus is the precipitation of solid particles from the un- 
burned gas as soot, some of which goes to soil the walls and curtains and some 
to soil the lungs. 

If the manufacturer will provide an escape valve so that the steam from 
the coils will escape into the air of the room there will be some gain from 
the coils — enough to offset the harm from the increase in soot. 

Gas heaters without stovepipes in bathrooms should be made unlawful 
everywhere. Gas heaters with or without pipes are allowable in bedrooms 
where they are in use for not to exceed fifteen minutes on condition that the 
room be aired soon afterwards. 

The height of folly is represented by the gas logs with asbestos whiskers. 
I suppose this monstrosity was devised by some poetic soul who thought 
it pretty. They are sold to esthetic souls who think they are esthetic. To 
my mind they are gas exuding, dust catching monstrosities and punish- 
ment for installing one should be hanging. 

Gas flows from a small pipe into the wider logs, thence it issues by a 
hundred holes. Through some it goes with force and volume and burns 
readily ; through others it oozes too feebly to flame. As the openings are 
covered with asbestos the only available proof of the air pollution is the odor. 
If the asbestos were absent the leaking pores could be detected and the flame 
be turned higher or off entirely. On the other hand, gas logs without asbestos 
whiskers would fall into disuse at once. Xobody who knows that customarily 
a quarter of the holes "do not burn" installs them or uses them. 

Open Fireplaces. — Heating by open fireplaces is inefficient and most un- 
economical. It is advocated because it carries with it automatically ventila- 
tion that is fool proof. The ventilation afforded by open fireplace heating 
is not good ventilation — in fact, it is bad ventilation- but bad as it is no fool 
can make it horrid. If the windows are leaded in, the doors chinked, the 
walls made impermeable and no ventilation ducts are open the fire will not 
burn. In that sense, the ventilation attendant on fireplace heating is fool 
proof. The same cannot be said of the prevailing school, church, factory and 
office ventilation. 

The old fireplace burning great wooden logs did well enough when fuel 



1178 VENTILATION— HEATING— HUMIDITY 

cumbered the earth and the more you burned inside the house the less you 
had to burn when you cleared the new ground. The coal grate is not so 
wasteful but it is wasteful enough. Much of the heat goes up the chimney. 
The fireplace is located on the inner wall and that part of the room is nearly 
warm enough without a fire. On a cold day a good hot grate fire may warm 
a room for a distance of about ten feet. The balance of the room will be too 
cold for comfort. Persons in the outer two-thirds of this zone will be warm 
on one side but the rest of their bodies will be chilled beyond all comfort 
by the cold air flowing from the outside toward the fire. Especially will 
the occupants surfer from cold feet. 

Obviously, fireplace heating is not adapted to schools, offices, factories, 
stores or other rooms where the floor space is fully occupied. The heating 
is not good enough. As the fresh air pours in in cold streams and flows 
in such streams along the floor, not getting comfortably warm until it gets 
ready to leave the room by the chimney, it cannot be said such ventilation 
is or can be satisfactory. The best that can be said is that ventilation such 
as it is cannot be wholly done away with. 

Stoves.— Stoves have some advantages and some disadvantages as com- 
pared with open-fire heating. They are less cheery ; and I suppose that every- 
body will agree that something is lost there. A bright, glowing fire has 
stimulated many a bright fancy and cheered many a drooping spirit. 

Stoves tlo not stimulate room ventilation as much as open fires do. On 
the other hand, they have certain advantages. Being placed, as they usually 
are, toward the center of the room they heat much more efficiently than 
do open fires. They are much less wasteful of heat, particularly when 
the stovepipe is used to heat other rooms or other portions of the same room. 

They do not heat the outside walls and the floors as well as do proper 
steam and hot water heating apparatus but they heat them better than open 
fireplaces do. As the fire in a stove is located inside the room they make for 
ventilation more than does hot water, hot air and steam heating. If the air 
is let in the room the fires burn better and thus in an indirect way, stove 
heating if properly managed helps ventilation. 

If, however, the cold air is unpleasant to somebody and the air intakes are 
closed stove-heated rooms speedily become nuisances beyond compare. 

There is another objection to stove heating which is of consequence 
enough to require some emphasis. It has been found that when iron gets 
red hot the combustion gas is in part changed from the slightly harmful 
carbonic acid to the very harmful carbon monoxid. This is partly the 
cause of the burnt odor of some bad air. 

Therefore when stove heating is employed the stove should not be al- 
lowed to get red hot unless the windows are opened wide enough to permit 
the poisonous gas to escape easily to the outside. Who of us has forgotten the 
red-hot stove, the burnt odor, the feeling of drowsiness, the soon-coming 
headache? 

For rooms occupied by a moderate number of persons stoves are fairly 
well adapted, even as far north as Minnesota. The one-room school probably 
will have to stick to stoves. 

Can they be installed so as to make them more satisfactory than they 
now are? Yes, 



HEATING 1179 

As at present run they cannot heat the outside walls, they cannot 
heat the incoming air and they overheat the near-by air. This is more of 
a load than they can carry. 

The remedy is to conduct at least one-half of the ventilation air through 
ducts under the floor and to discharge it into the room under and around 
the stove; to take in some fresh air through the windows; to let out the foul 
air at the windows; to use the windows on the wind side of the building 
for an accessory air intake and the windows on the lee side of the room for 
air outlets. Thus will the disadvantage of stove heating be overcome. The 
stove will not overheat. The temperature of the air next the walls will be 
increased, wall chill will be lessened, the air for ventilation will be warmer 
and more tolerable. 

If the air is freshened by opening the windows periodically small 
schools, small halls, railroad stations, farmhouses and small homes in towns 
and cities can be ventilated by stoves without discomfort and harm as far 
north as Canada. 

Stove heating is much more economical than open fireplace heating. 
It takes less coal and is more easily cared for. The first cost is small. 
The fire using less coal than the open fireplace likewise uses less oxygen out of 
the air. 

Having the fire in the center of the room is an advantage as compared with 
a fireplace on an inside wall. A pan on the top of the stove will evaporate 
a good deal of moisture. It is somewhat easy to carry the stove-pipes through 
upstairs rooms and in this way to get a good part of the heat out of the smoke 
before it is discharged to the outside air. 

The disadvantages of stove heating are several. It heats the outside 
walls poorly. In consequence the air in the room is liable to be too hot and 
the walls too cool. The desk space next the walls is liable to be too cold ; that 
close to the stove too hot. The iron stove wall gets red hot at times. It is 
well established that dusty air coming in contact with red-hot iron becomes 
scorched. The dust particles are charred. Some ammonia is formed and 
some excess of a poisonous gas called carbon monoxid is formed. 

Some of the effects of ordinary stove heating are overcome in certain 
systems by jacketing the stove and providing evaporation pans. The jacket- 
ing lessens the overheating of the space near the stove and circulates the air 
around the room. 

Stove heating does fairly well for county schools and other places where 
the requirements are full occupation of the floor space and slight cost of 
installation. If fresh air can be brought into the room into the jacket 
and warmed somewhat before it is distributed it stands to reason that more 
of it will be allowed to enter than if it comes in at zero or thereabouts. 
In such schools there should be hourly registration of the temperature and 
humidity. 

Hot-Water and Steam Heating. — The great advantages of these 
types of heating are efficiency and economy; and yet there are disadvan- 
tages. It is possible to heat well with these methods and have no ventilation 
at all. 

Our ideas of heating and ventilation have been inherited from the old 
days of fireplace heating. In those days the heating of a room by an open 



1180 VENTILATION— HEATING— HUMIDITY 

fire started currents of incoming air which, without planning for it, gave 
a moderate amount of ventilation. The more loosely the house was con- 
structed the better the involuntary ventilation. We are prone to carry 
over our ideas of heating and ventilation into our modern quarters. 

Heating with steam and hot water can be done without any ventilation, 
and the more ventilating done the more expensive heating becomes. In fact, 
speaking broadly, in our modern, closely built houses heating is needed to heat 
the air for ventilation, the outside walls and the windows. The occupants 
make more than enough heat to heat themselves, the inside walls, floors, 
and ceilings. Therefore the temptation always is to reduce the size and 
number of windows, to cut down the outside wall space and especially to limit 
the air taken in. 

Until better ventilation practices prevail these should be held as legiti- 
mate arguments against steam and hot-water heating. This is doubly true 
since heating engineers and manufacturers of heating apparatus have so 
signally failed to do their duty toward the ventilating side — for in trade 
and professional parlance "heating and ventilating'' are coupled. 

Another disadvantage of heating by these methods is that the air is 
too dry. This can be remedied by allowing steam to escape from the radiators 
into the dry air. It can be accomplished less well with steam or with hot 
water by using the radiators as evaporators. 

A great advantage of these methods is that they allow the heat to be 
radiated at those places in the rooms where it is needed, that is, near the 
windows and otherwise along the cold walls. 

Another point which with a little planning could always be taken 
advantage of is that the ventilation air could be introduced into the room as 
moderately warmed air. This is especially necessary if the room is to be 
occupied to its full capacity. 

The advantage claimed for hot-water heating is that the air is more 
moist than in steam or stove heating. In hot-water heating the air comes 
in contact with coils that are 170° Fahrenheit and below. Fluegge demon- 
strated that when dust was heated to more than 160° it became offensive. 
It was singed and distilled and there resulted some ammonia, some carbon 
monoxid and some other substances less harmful but more offensive. This 
cooked odor and feel some people try to avoid by keeping the heating ap- 
paratus free from dust, while others adopt the less troublesome procedure of 
putting in hot-water heating. 

A great advantage of hot-ivater heating is that the air leaves the heating 
surface at a fairly low temperature. The authorities are generally agreed 
the air should not be brought into a room at a temperature higher than 160°, 
and some of the bed of them say the temperature should not be higher than 
104°. Hot-water heating meets this requirement well indeed. 

We commonly hear it said the air in hot-water heating is less dry than 
with other methods of heating. A part of this opinion is purely psychological ; 
a part of it is based on material differences. If the air contains a certain 
quantity of moisture, enough to give a relative humidity of 70, the relative 
humidity can be dropped by raising the temperature of the air. The amount 
of water in the air remaining the same, the air would be comfortably moist 
when it was cold and uncomfortably dry when it was hot. 



HEATING 1181 

Another advantage of hot-water heating is that the heat coils can be 
placed under the windows and around the outside walls — locations where 
heat does the most good. 

So much for the advantages of hot-water heating. Now for its dis- 
advantages. 

One, and the most important one, is that it is not a ventilation pro- 
cedure. Hot-water heating can be well done without ventilation. Most people 
do not know that heating and ventilation are two procedures which are 
frequently combined but which, nevertheless, are two procedures. The average 
man thinks that when one is attended to the other is also. 

A system of heating that does not necessitate ventilation sometimes 
leads to bad conditions. When a room is heated to 70° and the outside air is 
at zero there will be some ventilation regardless of what is done to prevent. 
In spite of thick walls, air space and heavy wallpaper, air will filter through. 
The saying is "Walls breathe." In spite of well-made windows the cracks 
leak. But this is not sufficient ventilation to keep the air right. When the 
heat is by hot water the ventilation cannot be made fool proof. 

Another objection is the difficulty in evaporating enough water to keep 
the humidity at 50 in hot-water-heated rooms. In hot-air heating the evapo- 
rating pan can be set over the firebox; in steam heating steam can be 
discharged into the room from the steam coils. But I know of no way 
to evaporate enough water in hot-water coils to hold the humidity at or 
above 50. 

Those who advocate steam heat claim that it is highly efficient; that it 
saves coal and thus saves money; that it heats all parts of the room so 
well that desfcs can be put next the windows as well as elsewhere and that thus 
it saves money; that it heats thoroughly, heating the walls as well as the air; 
that the heating is so thoroughly done that the people are willing to ven- 
tilate, which means that more people can be put in a room and that thus also 
money is saved. 

These claims are quite true; and yet some of the worst ventilation 
of which I know is in steam-heated places, as with hot-water and hot-air 
heating the heating can be pretty well done without any ventilation at all. 

It is true that when a room is hot and the outside air is cold lots of air 
will leak in and out even when every window is shut. It is also true, as the 
Furnace League men say, that it is easier to heat where there is some ventila- 
tion than where the air is altogether befouled. 

Nevertheless, none of these considerations gives ventilation that measures 
up to the standards of human needs. It has always seemed to me that the 
steam-heating men were foolish to have done no work on ventilation since 
poor ventilation so frequently is found in steam-heated places and causes so 
many people to "get down on" steam heat. 

The hot-water heaters say that the air next the coils in steam heating 
gets too hot and smells cooked. The hot-air men say that the air in the 
lower two feet of a steam-heated, window-ventilated room is too cold; that 
six feet from the floor the temperature will be 78° and six inches from the 
floor it will be 68°. 

Both these statements are founded on existing conditions. Yet how 
easy it would be for the steam-heater men to provide that air be sent 



1182 VENTILATION— HEATING— HUMIDITY 

between the coils of the radiators, thus lowering the temperature round about 
to a proper level and raising that of the air flowing out over the floors and in 
this way to overcome these objections ! 

Again, how easy it would be for the steam-heater men to provide for 
noiseless discharge of steam into the air and thus stop that other group that 
complains that steam-heated apartments are too dry. 

Hot- Air Heating. — The advantage of hot-air heating is that it warms 
the floors better than any other method. It is an effective method of heat- 
ing. Furnace-heated houses are usually well heated. In many furnace- 
heated houses there are several objectionable features: First, the air is very 
dusty; second, the air is very dry; third, the air is recirculated; fourth, the 
air enters the rooms at too high a temperature; fifth, the air as it came 
through the furnace was in contact with iron that was too hot and in con- 
sequence it smells and feels scorched. 

These are the objections commonly urged against furnace heat. I 
have insisted upon them more than once. They are valid as against the 
usual job of furnace heating, yet I have before me a booklet on furnace 
heating which shows that they are not necessary evils and that no one need put 
up with them unless he wants to. The furnace men have found a way to cor- 
rect them. This book convinces me all that is needed for good ventilation is 
for the sanitary engineers to say what should be done and for the public 
to demand that it be done. The heating and ventilating engineers will find 
a way to do it. The name of the book is the "Federal System of Heat- 
ing and Ventilation." It is a trade publication written by Dr. W. F. 
Colbert. 

The leading furnace manufacturers of the United States compose the 
membership of the Federal Furnace League, which has been organized and 
will be maintained not for the purpose of attempting to regulate the selling 
prices of furnaces but to work logically and persistently for the accom- 
plishment of five objects among which are standardization of methods and the 
education of the public in heating and ventilation. They begin by establish- 
ing a heating standard which they term the Federal Heat Unit. 

The writer favors hot-air heating over other methods, as he says, 
whenever occasion offers; but the information given will be of great value 
even though the reader does not wholly subscribe to some of the conclusions. 

From it we learn that a house of a certain cubic papacity should have 
a furnace installed of a certain Federal Heat Units capacity with ducts of a 
certain size; that in calculating the chilling effect of wall space 20 per cent 
should be added for glass exposure facing north and west, that nothing be 
added for east glass exposure and that 20 per cent be subtracted for south 
glass exposure. In addition to the total wall exposure is added one-sixth of the 
square feet of glass. For example, if a north wall was 10' x 20' and had two 
windows 5' x 3' the wall space for heating purposes would be figured as 
follows: 170 feet of wall space plus one-sixth of window space equals 175 feet; 
window area, 30 feet plus 20 per cent equals 36 feet. This added to the 
total wall space equals 216 feet. 

Hot-air heating and -ventilation is a form of indirect heating. It is 
nicely adapted to the heating and ventilation of homes and when certain 
changes are made it will meet the partial approval of sanitarians. Ordinarily 



HEATING 1183 

the woman whose house is heated by hot air compares her comfort with 
the great discomfort of the stove heating which it displaced and it will 
take a good deal to get the contrast out of her mind. About as much as 
she will admit is that the air is too dry and that the apparatus does not 
work well on windy days. Occasionally she complains that the children are 
paler and have had more headaches and colds than they did in the old, un- 
comfortable days. 

Hot-air heating has the great advantage of heating certain rooms well, 
of holding down wind leakage and of keeping the foot zone warm. The 
manufacturers have given much thought to their heating and little to their 
ventilating. Their furnaces heat fairly well but ventilate so poorly that they 
scarcely deserve to be called heating and ventilating methods. 

The objections to this method are: 

1. In many instances the foul air from the rooms is carried back to the 
furnace, heated and sent back into the rooms — recirculating it is called. 

2. The air at the inlets is too hot — from 100° to 130° according to the 
atmospheric temperature. 

3. It is too dry. 

4. The gravity force is not strong enough to work in the teeth of a 
wind. 

5. The heated air flows most readily in the vertical pipes and least 
readily in the horizontal pipes; therefore certain rooms are well heated and 
others poorly. 

Some of these defects can be remedied. For instance, the reason for re- 
circulating the air is to save heat. A more sanitary method would be to run 
the intake tubes within the outlet tubes, saving its heat but allowing its 
foulness to escape. 

The humidity can be raised by placing pans on top of the furnace large 
enough to evaporate five to ten gallons of water a day. It is not feasible 
to keep the windows continuously open where heating is with hot air. For 
this reason periodic blowing out of the rooms is absolutely necessary. 

It is to be hoped that the manufacturers will study their subject so that 
they can ventilate as well as heat in a manner which sanitarians can ap- 
prove of. 

Direct-Indirect Heating and Ventilation.— When radiators or other 
heating devices are placed in a room the heating is said to be direct. When 
the radiators are placed in air ducts and the hot air is blown into a room 
the heating is said to be indirect. When radiators are placed in a room 
and air is drawn into the room through the radiators the heating is said to be 
direct-indirect. 

Direct-indirect ventilating requires fewer ducts and fewer fans and 
therefore costs less to install than do the more elaborate mechanical sys- 
tems. They are likewise more cheaply and easily maintained. There is not 
the interference with floor joists and beams and sewer pipes that makes 
the usual mechanical systems so difficult to install. As the effort is to 
keep the fresh and foul air as much apart as possible the quantity of air per 
occupant per hour can be reduced to one-half what is required in other 
methods of ventilation. 

The cost of ventilation, in the main, is due to the heating of the air and 



1184 VENTILATION— HEATING— HUMIDITY 

any suggestion which promises to lower the quantity to be heated and which 
gives results will be in great demand. 

There are a few places where the direct-indirect method has been em- 
ployed; but without much success. Why have these installations failed? 
They have placed the air outlets near the floor. The direct-indirect method 
depends on difference in temperature to move the air. This is force enough 
on a wind free day provided the warm air is allowed to leave the room 
at the ceiling. It is not enough if the warm air from the ceiling must 
come back to the floor to get out. The system will work if the foul air is 
taken out at the ceiling and fan power enough is used to overcome wind 
obstacles. 

It is difficult to make air do complicated things after it has found 
its way into the free space of a room. The systems which depend upon 
the air in a room taking certain directions do not work in practice. An 
advantage of the direct-indirect system is that the air moves from inlet to 
outlet along simple lines. 

Central Plant Heating 1 . — Heating from a central plant is economical. 
In this particular, heating by isolated units, such as stoves and fireplaces, 
cannot compare with heating from a central plant. It is also very much more 
comfortable heating than that by isolated units. As the object of heating is 
comfort it follows that central plant heating represents efficiency. 

The question always is, How large should the house be to make the greater 
economy of the central plant more than offset the cost of installing it and 
the provision for maintaining it? 

There are, though, some advantages outside the first cost. Fire in an 
open fireplace or a stove will not burn well unless there is air. Where 
heating is done by steam or hot water or hot-air radiation the heating may 
be perfect and the ventilation unspeakable. The fire in the basement may 
be getting a splendid supply of air while the people upstairs are suffocating. 
If the stove and the people are in the same room they have to take pot luck 
together. 

There are three kinds of central heating — hot air, hot water and steam. 
Hot air, as compared with steam and hot water, has some advantages and 
some disadvantages. It has provision for circulating the heat throughout 
the room and that is a great advantage. 

It has two marked disadvantages. They are remediable and no man 
should tolerate hot-air heating unless they have been remedied. The air is 
frequently recirculated. That is to say, no provision is made for taking 
in fresh air. Some leaks in and some old air leaks out but the quantities 
are inadequate and in the main the bad air goes back to the people and 
round and round in a vicious circle. 

The other is that the air is heated but not moistened. It is low in 
humidity. 

Lesser disadvantages are these: The heat is put in on the inside wall 
and in consequence the inside wall is too hot and the outside wall is too 
cold. The air as it comes into the room on cold days is too hot to be fit to 
breathe. The system does not lend itself readily to periodic blowing out 
of the rooms by throwing open the windows. 

Most of these disadvantages can be overcome. A hot-air heating plant 



HEATING 1185 

that has corrected them represents a good type of heating and permits of 
good ventilation. 

Bather than put up with the harm of these things it is better to tolerate 
the discomforts of stove and open fireplace heating. 

USING HEAT 

The temperature of a room not equipped with fans must not he allowed 
to go over 70°. When the machinery makes it impossible to maintain a tem- 
perature below 72° conditions can be made fairly harmless by using fans 
enough to keep the air in active motion. 

A bedroom must not be allowed to go over 60° and 55° would be a 
better maximum. An infant's sleeping room should be kept at 65° until the 
child is three months old. The bedroom of an infant three to twelve months 
old should be 55° ; after a year 45° to 50°. 

Adults should dress in a room 70° to 75°. 

A living or sitting room should be 65° to 70°, according to the humidity. 
If the humidity is under 30 a temperature of 70° is required; if the humidity 
is 50 to 70 a temperature of 65° is proper. 

The same conditions apply to offices and schools. I have nothing to say 
about factories because factory heating and ventilation are another subject. 

Street cars should not be heated above 60° and a 55° temperature is 
better; day coaches not above 65°; sleeping cars not above 68°. 

It will be noticed that the temperatures advised range from 45° to 75°. 
There is a reason in each instance. 

The influence of humidity, of physical activity and weight of clothing 
must each be considered. Individuality cannot be forgotten. Some have 
coddled themselves until they have greatly reduced their heat making powers. 

Anyone reading this section so far would be justified in concluding that 
a given type of room should be kept uniformly at the temperature set for it. 
Uniformity of temperature is harmful. 

One of the few advantages of open fireplace and stove heating is the lack 
of uniformity. Men and women who work in offices where the temperature 
is evenly maintained slow up and presently get sleepy. About once in 
so often they get headaches. 

The human body needs the stimulus which comes from having changes in 
temperature. This is one of the great advantages from having the room 
judiciously blown out from time to time. This, not overdone, will make 
everybody feel better and the work will show the effect. 

GET THE THERMOMETER HABIT 

In any town there are thermometers displayed here and there in 
front of stores. The people would be wise if they noted the temperature 
from time to time. But the thermometer habit which would be most useful 
would be the indoor thermometer habit. Ten years ago we had a genus 
called the draft crank. The collapse of this industry must have left a 
lot of people who are interested in their surroundings, acute-minded people 
who want to do the right thing and who need something to specialize in, 



1186 VENTILATION— HEATING— HUMIDITY 

without a hobby. What better than to get the thermometer habit? Why 
should they not insist on knowing the temperature of the rooms into which 
they go? 

It has been proved that high temperatures, over 68°, are harmful. 
As the temperature rises above that the air around the body cannot clean 
itself. This being so, should not every house have one or more ther- 
mometers and should we not get in the habit of noting the temperature several 
times a day? Should not every schoolroom have a thermometer? Could 
a teacher do better by the students than by teaching them to read the ther- 
mometer and then having an hourly temperature record made by some pupil ? 

Our employers have put in registering time clocks. Every employee 
punches the clock as he goes to work and as he leaves. But there is a 
difference between sitting at a bench and working. Good ventilation is the 
speed boss. Cool air is the essence of good ventilation. Employers would 
make more money if they would spend less on time clocks and more on 
thermometers. They, too need to get the thermometer habit. 

Thermometers Inaccurate. — P. C. S. writes: "I have heen making a 
few experiments to ascertain the humidity in my living rooms. I have 
two thermometers that read alike in the same room. On one of them I 
have put a silk wick. The bulb shows through the mesh of the wick. The 
wick is about four inches long below the bulb. I have hung this ther- 
mometer so that it comes about one inch from water, the wick being in the 
water, which goes up the wick and moistens the bulb of the thermometer. 
This thermometer in the room with the dry thermometer at 70° will register 
from 61° to 63° and will maintain nearly this distance from the dry one, 
if this one rises or falls six or eight degrees. I wish to inquire what degree 
of humidity I have in my rooms with this reading. Is it enough for good 
health at this time of the year? I have hot-water heat. As I took these 
two thermometers out of doors on a very damp day, the wet one registered 
35° above zero and the dry one 31/.°. Have you any tables that I can tell 
just what humidity I have with a given reading of these wet and dry. 
thermometers? If so, will you please send me some?" 

"Since writing the above I have been evaporating about one quart of 
water per hour, or fifteen quarts in fourteen hours, by means of pans in my 
radiators with blotting papers in them. Can put four in each radiator. I 
have twelve in two rooms. I now find my thermometers are registering 
64° wet and 68° dry, or within four degrees of one another. This would 
show too much moisture. Is there any danger with so much moisture — that 
is, are we more liable to catch cold in this damp atmosphere, or what will be 
the effect? I can and have reduced the number of tanks in radiators, for 
I was not running the furnace hard when I got the above evaporation. The 
rooms are 30 x 18 and llf x 15 feet, two of them with large halls connected 
with them, ivith open stairway." 

Reply. — A dry bulb reading 70° and a wet bulb 62° means 64° relative 
humidity. A dry bulb reading 35° and wet 34° means 99° relative humid- 
ity; 68° and 64° respectively means 78°. I feel certain, however, that your 
apparatus is not accurate. The amount of water evaporated will not give 
so much humidity. My guess is that the meshes of your wick are not coarse 
enough. The Taylor Instrument Company and the Schaeffer-Beudenberg 
Company, both of Chicago, get out humidity tables. 



HEATING 1187 

Care of Thermometer. — Sanitary writes: "Bo you deem it advisable for 
everyone to have his own clinical thermometer? The reason I ask is that 
in a great many cases that have come to my notice the doctor simply rinses 
his thermometer off in a glass of water, dries it with his handkerchief or 
towel, and puts it back in the case. You no doubt are familiar with the 
manner in which the average physician handles his thermometer. He 
generally rinses it off in a glass of water just before using and directly 
after, and in a great many cases that is all the sterilizing the thermometer 
gets. Now, then, isn't it possible, knowing as we do that typhoid germs 
lurk in water, for the thermometer to infect the patient from being rinsed 
off in the water? In case there were no germs in the water, suppose the 
patient had a contagious disease of any kind? Isn't it possible that the 
thermometer would carry the germs and transmit the disease to the next 
one using the thermometer when said thermometer is cleaned in the man- 
ner described above?" 

Reply. — An individual thermometer is safer but the risk is not great 
except in contagious diseases, including typhoid. In such cases, the ther- 
mometer should at least be washed in formalin solution, bichlorid solution 
or carbolic solution. 

Stove Is Explanation.— 8. H. B. writes: "Apropos of your remarks 
recently on the use of gas stoves for heating, could the constant use of 
a ten-jet heater as the only means of heating a room used day and night 
account for chronic headaches of the occupant? The extremely severe 
weather necessitated having the stove lighted all day. A window was kept 
open at night for ventilation, but in the day time an open fireplace fur- 
nished the only ventilation, if any. After about three weeks my head 
began to ache, and almost never ceased, until with the spring weather the 
stove was no longer used and the windows were kept open day and night. 
The headache has now almost ceased. Is this situation sufficient to explain 
the headache?" 

Reply. — It could. It did. It is. 

Answered in three ways to prevent any misunderstanding. 

Treatment of Furnace Heat. — E. M. writes: "Nearly all hot-air fur- 
naces are supplied with cast or wrought iron pans near the hottom of the 
hot chamber for the purpose of supplying water for condensing purposes, 
the idea being that this vapor will be carried into the rooms. Few people 
know about this or realize the importance of keeping the pan filled. 

"1. These water pans are not in the right place and are not efficient. 
They should be placed inside the hot chamber. 

"2. Beople who live in furnace-heated houses should place a pan of 
clean water under the registers every day. 

"3. Outlets inside the inlet incoming pipes will warm the air and 
interfere with circulation. The outlet pipes should go down separately 
from the inlet pipes and end in the cold air box, so the outgoing air will 
help in the draft and pass off into the chimney instead of coming back 
into the rooms. 

"Jf.. It is customary to supply cold air for the firebox from the front 
hall, but I have found it improves matters to have a cold air pipe dropped 
from the attic instead." 

Reply. — 1. The water pans should be placed on the furnace inside the 
hot chamber as suggested by E. M. 



1188 VENTILATION— HEATING— HUMIDITY 

2. The temperature of water in pans placed in the registers would not 
be high enough for effective evaporation. To place them in the hot-air 
chamber on top of or close to the furnace is the ideal, to place them in the 
register ranks second, on the register face, third. 

3. To warm the incoming air by placing the intake pipes close to the 
outlet pipes will save in heating but will decrease efficiency. The colder 
the incoming air the more rapidly will it come in. 

4. The plan of taking the cold air from the attic has the advantage of 
doing away with variation in the force and direction of the wind to a cer- 
tain extent. The plan of running the outlet back to the firebox has some 
disadvantages. It will be difficult to make warm air go back down to the 
basement, and any plan that is based on such a mechanical idea will be 
found difficult to work. Furnace heating represents a great improvement 
over grate heating so far as comfort is concerned. 

Keeping Off Frost. — W. S. writes to Tcnow why grocery stores have 
fans in their windows. Why do some hinds of stores have more frost 
on their windows than others? 

Reply. — Grocers want their windows to display their goods. This they 
cannot do when the windows are frosted. Throwing hot air against the 
window keeps the temperature of the air next the glass above the dew point ; 
therefore the windows sweat but little and frost less. When windows are 
chilling a room the same procedure will remedy the difficulty; when win- 
dows are leaking cold air the same procedure helps though not as much 
as proper stripping. 

Those stores where the humidity is high have frosted windows unless 
the windows are fanned or there is a good deal of radiation just below the 
windows. 

Lunch rooms and laundries are at the head of the list. Then come 
florists' shops and groceries. Butchers' shops are near the top. Dry goods 
stores and drug stores are low in rank as humid places. Hardware stores 
are lower still. 

Furnace May Lack Capacity. — E. C. B. writes: "I have lately had in- 
stalled in my new residence an underfeed hot-air furnace. It has given us 
much trouble during the recent cold weather. When the first and second 
floors were heated to 70° the basement would be up to 90° and 100°. 
In other words, any degree of comfort in the living rooms was the result 
of superheated metal below — so hot that the outside jacket of the furnace 
would be hissing and sizzling. Does not this process lessen the life-giving 
oxygen? There is no provision for humidity. The furnace does not have 
the usual water pan in the casing. Our hardwood floors and furniture 
show the effect of excessive dryness. What remedy do you suggest for 
greater humidity, more oxygen, and freer air circulation with less heat in 
the basement?" 

Reply. — Probably your furnace has not capacity enough. Relief may 
come through storm windows, doors which fit snugly, storm doors, papered 
walls, and carpeted floors. If this fails a larger furnace should be in- 
stalled. Air which comes in contact with red-hot iron is unfit. Water 
inside the hood is the best means of humidifying. Water below the register 
face in the floor or on the register is a poor substitute but better than 
nothing. You must blow out your house several times a day. 



HEATING 1189 

Would Save Heat. — G. C. writes: "There is an idea that always hobs 
into my head when I consider the problems of humidifying indoor air, 
heating, and ventilating. When outside air is cold and inside air warm 
and moist, the moisture is lost by condensation upon the cold window 
glass. This condition prevents proper humidification and absorbs a lot of 
coal. Storm windows are objectionable, as they restrict ventilation, can- 
not be kept clean, are expensive, unsightly , and considerable bother, both 
in winter and summer. Why not fit the ordinary window sash with double 
glass, leaving one-quarter of an inch or one-half an inch of airspace as a 
thermal insulator between the two panes of glass? If this space were 
made airtight the glass surface within it would remain clean and the 
indoor surface would not act as a condenser and heat absorber. The sav- 
ing in fuel would, I think, more than offset the expense. Also in extremely 
hot weather the outside heat could be more effectually shut out." 

Reply. — The method would save heat. It would not help much with 
humidity. 

Keeping Warm at Night. — Athber writes: "I am 61 years young and 
in robust health. I occupy a large room on the second floor at the south- 
west corner of a detached house. There are three large windows in the 
room, one at either side of my double bed and one below the foot of the 
bed. The last window I use for ventilation at night. My habit is to have 
the lower sash up as far as it will go, which gives an opening of four feet 
wide by three feet high. The last two nights I have been miserably cold. 
The first of these nights I had it open the full measure, and the last about 
halfway up. The room has a polished oak floor. The bed is made up as 
follows: Upon a box frame mattress is a forty-pound hair mattress, a 
layer of heavy manila paper between the two mattresses, two four-pound 
single blankets, a padded cotton comforter, two sheets, a six-pound blanket, 
a wool-filled comforter, and another six-pound blanket. Last night I placed 
a rug on the floor under the bed so as to prevent the wood floor from 
drawing the heat out of the bed. Seldom do I use all the top covering 
above named, but during the last two nights all of it did not keep me warm. 
I have always been under the impression that I required less bed covering 
than is usual. Each morning upon waking the thermometer was about 
35 degrees in the room." 

Reply. — A man sixty-one years old cannot stand cold as well as when 
he was younger however well he may feel. I suggest that you raise the 
temperature of your room to 40°. You can do this by having more heat 
in the surrounding rooms and the room below. You might hang a com- 
forter on the bed posts between you and the window so as to stem the wind. 

I notice that you have a paper blanket between your mattresses but 
none over you. Put a paper blanket between the comforter and the top 
blanket. You can add a third blanket if necessary. 

When the temperature outside is below 15° always put a hot-water bottle 
or electric heater between the sheets ten minutes before you go to bed. 

If these suggestions do not suffice get a sleeping bag. The larger 
drygoods stores carry them. 

Outside Air Necessary. — Reader writes: "We are advised by a furnace 
man in order to save fuel, to have both fresh air intakes to the furnace 
come from inside instead of one from outside, trusting to opening doors and 
windows each day to air off the house. He cites hot water and steam heat 



1190 VENTILATION— HEATING— HUMIDITY 

as having no direct outside air. Is it right from a health standpoint as well 
as economical?" 

Reply. — The air supplying the furnace should be taken from the out- 
side. To run the intake pipes through the basement so as in some measure 
to preheat the air is proper. But the air as it comes to the furnace must 
be outside air. Recirculated air is unhealthy. "Whether the heating is 
done by hot air or by steam heat there must be air from the outside. 

Storm Window Problem. — A. F. P. writes: "Do you think it wise to 
put on a storm window that has an opening in the framework of only about 
2x6 inches? My bedroom has the lake exposure, being two blocks from 
the shore, and the wind has full sweep. The question arises whether I 
should have the window put on or suffer on some bitter cold nights which 
we are likely to have. I contend it is better to be able to throw open 
wide the window, but, because the room is small, it is less easy to get 
away from the breeze than if the room were larger. There is an outdoor 
transom in the room, but the air from the top strikes me more than from 
the bottom, and, again, the size of the room makes it impossible for me to 
be far removed from the direct breeze. On the other hand, some winter 
nights are so cold that a storm window would afford considerable protec- 
tion, but the landlady will provide only the one with the small slide." 

Reply. — A bedroom should not have storm windows. The heat should 
be turned on and the windows should be left enough open to keep the 
temperature of the room during sleeping hours at or around 50°. The 
humidity should be around 70. A humidity anywhere between 60 and 
80 is proper for a bedroom during the night hours. 

So much for the use of the room for sleeping purposes. If you can 
sit in some other room in the house the problem of your sleeping room is 
easy. If you must use it as a sitting room I suppose you will be com- 
pelled to have the storm sash and the small opening but do not have the 
sash put on until Christmas and have it taken off by March 1. If you 
keep your room temperature as high as 70° on days when the outside tem- 
perature is lower than 10° above a lot of air will come in through the 2' x 6' 
opening except when a strong west wind is blowing. I judge your room is 
on the east side of the house. A strong west wind will always cause your 
transom to act as an inlet and your window as an outlet. 

If you are employed during the day and spend no more than four 
waking hours a day in your room again the problem is easy. Equip your- 
self with a good warm wrap, woolen stockings and slippers of wool-lined 
sheepskin. Use these and do without the storm window. 

Cold Sleeping Quarters. — W. B. J. writes: "Is a lower temperature 
than 30° not as good as from 30° to 50°? For instance, the writer 
had constructed a room or inclosed porch at the rear of his residence 9x9 
feet exposed on three sides, containing two windows on each of the three 
sides 2x5 feet, which are on hinges and can be kept open any distance 
desired. Naturally the temperature in such a room is the same as it is in 
the open air. Would you consider such a room in which the temperature 
goes below zero at times injurious to the occupant?" 

Reply. — The sleeping arrangements described by you are most ex- 
cellent. The room will not be injurious. On the contrary, using it will 
make you sleep better, feel better in the morning and do a better day's 
work as well as make you less susceptible to colds, pneumonia and con- 



HEATING 1191 

sumption. A lower temperature than 30° to 50° for a person prop- 
erly equipped is advised unless there are individual difficulties. 

Have Fresh Air Enter. — W. G. writes: "Some months ago you cau- 
tioned your readers not to have a gas water heater in the bathrooms, 
unless it is connected with a chimney, saying that there had been deaths 
traced to that practice. 1. I wish to know if it is not equally true that the 
burners of a gas range would be also unhealthy, unless there was a hood 
over tjie burners and connected to a chimney. 2. Does the contact of the 
hot gases with the cold water pipes generate a by-product, different from 
that which arises from the fire of an open range? If so, what is it? I 
know of some recent instances when people were made sick and one of them 
fainted from using a hot-water heater not connected with the chimney. 
Hence I wish to know about the gas range, so as to take whatever precau- 
tions are necessary to be safe." 

Reply. — 1. Yes. The danger is not as great because the room is better 
ventilated. 

2. It prevents complete burning of the gas. Thus the air of the room is 
fouled by some unburned gas, some little soot (or unburned carbon) ; the 
oxygen is used up and carbonic acid and a little carbon monoxid are poured 
into the air. Use a stove with a flue or chimney. See that fresh air 
enters through the windows. 

Proper Heat for Flats. — W. A. N. of Urbana, III., writes: "Will you 
kindly inform us what is considered the proper temperature for a steam- 
heated fiat building? We keep our house from 70° to 7-4° from 7 a. m. to 
10 p. m. and some of our tenants complain of being cold. I tell them that 
most doctors advise 68° to 72°. Am I about right or not?" 

Reply. — Sixty-five to 68° is right for all the rooms except the bathroom 
and the dressing room. These should be at 72°. Bedrooms after 10 o'clock 
at night should be kept below 55° and better still below 50°. If your ten- 
ants complain of cold when the temperature as shown by a wall thermome- 
ter is at 74° two conditions exist — either the air is too dry or the room air 
six feet from the floor is 74° or over with the room air six inches above the 
floor under 70°. 

Recirculating System Bad. — J. M. R. writes: "Which is the best heat- 
ing system — steam, hot-water, or hot-air furnace? You said in one of 
your articles that the humidity of steam-heated rooms is too low, and the 
air is too dry, which is correct? Is hot-water heat any better? What do 
you think about a hot-air furnace properly installed and with two cold-air 
returns, one for outside air and one for inside® The inside should be used 
when we have stormy weather." 

Reply. — Most of these questions have been answered in this chapter. 
The hot-air recirculating system is bad. 

Keeping Warm Problem. — L. W. L. writes : "Can out-of-doors sleeping 
and living in cold rooms be carried to such an extent that the body cannot 
supply sufficient heat?" 

Reply. — Sleeping and living out of doors does not interfere with the 
heat producing functions of the body. If anything, these are stimulated. 
The problem of keeping warm while outdoors or sleeping outside resolves 



1192 VENTILATION— HEATING— HUMIDITY 

itself into one of muscular activity during the day and sufficient covering 
during the night. The body will produce more heat when sleeping out in 
the cold well covered than it will in an overheated room indoors. 

Correcting Furnace Trouble. — A. E. P. says that E. C. B.'s furnace 
trouble was due to an improper arrangement of the cold-air intakes. Last 
winter he had trouble keeping his house warm. He studied the air intakes 
and this winter readjusted them. In consequence he has had no trouble 
keeping his house at 68° to 75° this winter in spite of the cold weather. 
- Last winter he used twelve tons of hard coal, this year (to February 15), 
seven, to heat a twelve-room house. He thinks a water pan inside the hood 
of the furnace will rust it. 

Reply. — A way can be found to keep up the humidity and prevent 
rusting. Inside the hood is the best plan for the water pan. 

Not As Healthy. — F. J. W. writes: "Please state whether in your 
opinion the heat from a gas stove is as healthy as the heat from a coal 
stove where there is not any steam heat, ventilation being secured by 
open windows at the top and bottom?" 

Reply. — As they are usually built, no. If there is a pipe to the out- 
side and there is never any gas odor it will do. 

Steam Heat Itch. — 8. H. writes: "I have lived in steam-heated flats 
for the last eleven years. Every year, as soon as the steam is started, I 
have the most intolerable itching and burning of the skin. My 3-year-old 
boy is affected in the same way. It does not seem to be hives — at least, 
there is no breaking out. Bathing seems to make it worse. I have rubbed 
myself with olive oil and cold cream, without any benefit. Of course, I 
suppose it is due to the excessive drying of the air by the radiators, which 
are nearly all low, and putting pans of water on them is out of the ques- 
tion. Lately I have been putting wet blankets on them. Will you suggest 
something for me to put on my skin? You have mentioned an instrument 
for measuring the humidity of the air. I have forgotten its name. I 
should like to get one. What I cannot understand is that, of all the people 
whom I know who are living in steam-heated flats, I have never heard 
anyone complain of suffering as I do." 

Reply. — Several have written to me complaining of itching of the kind 
described by S. H. We know that it is a disorder from which many 
people suffer. It begins in the autumn and keeps up until the heat- 
ing of flats is stopped the following spring. Frequent bathing is of 
service but nothing is of much avail except to get out of steam-heated 
quarters. 

S. H. is right. It is due to low humidity. The average relative humid- 
ity of a steam-heated flat after the weather gets cold will not be far from 
25. At 75° F. each cubic foot of air wants about 10 grams of water. It 
has about 2.5 grams. In trying to get the balance it dries the skin so as 
to produce this itching. What is of more consequence, it dries the throat 
and lungs so as to produce a proneness to colds, sore throat, pneumonia 
and consumption. It does no good to use oils. The remedy is : 

Change climate so as to get rid of the need of artificial heating, or 

Change quarters by finding a living place where the air is more 
humid, or 



HUMIDITY 



1193 



Change the temperature of the room to say 60° when the air will not 
be so thirsty for water, or 

Change the humidity by having a stream of steam blowing into the 
room or by having evaporating devices on the radiator. 



HUMIDITY 

FROSTED WINDOWS 




As you go along the street in winter you will notice that some of the 
windows are clear and others covered with frost. Some of those which are 
clear are so because of fans which blow the warm air of the room against 
them, others because of large radiators beneath them, others 
because of double windows with a clear space between them, 
and still others are free from frost because the air in the 
rooms is so dry that it has no moisture to deposit. 

Nothing is more frequent than to have janitors object 
to humidifying the air of the rooms because it makes the 
windows sweat and frost. That may be all right from the 
janitor s point of view but it is all wrong from the point 
of view of the woman who is to breathe the air. And 
whose say should go? 

When air is at 72° and has 50 per cent humidity it 
is not far from right. If anything chills it to 52° the dew 
point is reached and the water of the air precipitates on 
the cold surface. On a cold day the window glass is far 
below this temperature and it follows that if there is not 
water on the glass there was little in the air — too little 
for the health of human beings. 

Of this you can be certain: the house where the win- 
dows do not sweat and frost is not fit for human habitation. 
The school with clear windows is wasting the taxpayers' 
money, the teachers' time and the pupils' health. The 
office with clear windows is a place where employees have 
more than the average of colds, pneumonia and minor 
infections. 

When the weather gets warm sweating windows have not the same 
significance. At that season they mean humidity which is too high for 
comfort and, in some measure, for health. In midwinter beware the house 
that has not frosted windows. 

And what is the objection to frosted windows? None that I can see. 
They soften the light and make it even better for purposes of illumination 
than the direct rays of the sun. I have never heard any objections to sweat- 
ing windows and walls that had any force to them. Of course, if the 
moisture on the walls is so extreme as to cause the paper to loosen, that is 
a different matter. But walls which chill enough to sweat like that are 
too cold to be sanitary. 




Fig. 487. — Hygrom- 
eter Composed 
of Wet and Dry 
Bulb Thermom- 
eters. 



1194 



VENTILATION— HEATING— HUMIDITY 



METHOD OF HUMIDIFYING 

Recently Dr. Peter Bryce of the Canadian interior department de- 
scribed for me a method of humidifying a house heated by hot water. 
He has used the method for several years in his own home and has had no 
difficulty in maintaining a humidity of 50 and even a little above. Incident- 
ally he has had no difficulty in keeping the ferns growing in the house in 
healthy condition. 

In his hot-water heater there is an evaporation chamber. This is fed 
from a tank located a few feet from the heater. The tank is of the type used 
in toilets. 

It is provided with a float valve of the type used in toilet tanks. This 




pIT^" 



flocr^? Cold Air Inlet 



lafTl 







City Water 



-Suppty Tank 



^Inlet tc Reservoir 



Heater 



Hepterv 



■:>:jr: - ;,\<^ 



--.-•/-; 





■Section through fresh 
. Air Inlet and Ducts. 
Expansion Pipe 
utlet For Steam 



Point where/ 
fresh Warmed 
Air and 5team 
Mingle on Way 
to feqister 



t ;fF^r?f' : --.^7r -_ ^--T^-r-TT^^-v--',^-^- ,<t^ ; - 



Fig. 488. — Bryce Method op Humidifying a House Heated by Hot Water. Steam is gen- 
erated in the firepot of the water heater. The steam is discharged into the air intake. 
The steam discharge pipe runs for some distance in contact with the air pipe before discharging 
into it. ('Domestic Engineering.") 



valve regulates the feed from the tank to the evaporating pan. From this 
pan there is a duct which carries the steam to the rooms. 

Somewhere along the way this duct is joined by the fresh-air duct. 
The fresh-air duct lies on top of and in contact with the steam duct. The 
fresh-air duct is divided by a vertical partition into two ducts except for 
a short distance. One of these ducts we will call A, the other B. 

The fresh air flows along a duct to the end of the partition, then around 
the end into duct B, then along duct B to an opening into the steam duct. 
The object of this arrangement is to warm up the fresh air before it mixes 
with the steam. 

If the ducts are long enough to warm the air in the length of a single 
tube the partition can be omitted so that the air is not carried around 
a sharp curve with the consequent mechanical difficulties. The mixture 
of steam and warm air then flows directly into the rooms. 

It is to be understood that this is a ventilating arrangement. The 
heating is done by hot water in coils. As a ventilating arrangement it 
does not do away with the possibility of using the windows to freshen the 
house air from time to time. 

In 1887 Dr. Bryce read a paper before the International Congress 



HUMIDITY 1195 

of Medicine on the harm done by dry house air. At that early date he 
recognized that ordinarily heated house air dries out the mucous membrane 
whereupon these structures permit the germs of colds, pneumonia and con- 
tagion to get by. 

Since he devised this method of humidifying he has checked its efficiency 
with an hygrometer. His opinion that it furnishes a solution of the prob- 
lem of humidifying a hot-water-heated house is worthy of belief. 

Sometimes we are told that humidifying the air will save coal. This is 
not true. Kimball says: 

"A simple calculation will demonstrate that, approximately, four times as 
much fuel is required to evaporate the water required to produce 50 per 
cent humidity at 68 degrees as is saved by reducing the temperature from 
76 to 68 degrees." 

WHY FLOWERS DIE 

When a woman has bought a nice fern in a pot of good, black dirt 
she wants to have it live. She places it in her sitting room and takes pride 
in its care. Presently she is distressed to find it dying. In her eagerness 
she may visit a florist to discover how he succeeds in keeping his plants alive 
while she fails. 

If she goes to his greenhouse she will find the temperature around 70° ' , 
the humidity around 90, the ground fairly moist, and the plants getting some 
sunlight every bright day. When she goes back she finds that her plant is 
in air which is at 80° , with a humidity of 20, and maybe sunlight does 
not strike it. If she modifies the conditions her plant will live; otherwise it 
will not. She can bring the temperature as low as 70° . She cannot bring the 
humidity up to 90 but she can bring it up to kO or 50 and she can give her 
fern some sunlight on days when the sun is shining. 

Now people should have flowers in their offices and living rooms. They 
are esthetic and pretty and add to the charm of one's environment. Deep 
down in the heart of man there is a desire to see things live and grow. But 
these are of small importance as compared with the next three points. 

Where there are animals plants are needed to maintain an atmospheric 
equilibrium ; a city in a garden, a factory in a park, a house with flowers repre- 
sent wisdom from the health and efficiency standpoint as well as from the 
esthetic. 

Plants take up moisture from the ground and feed it to the air through 
their leaves; they condition the air for human occupation; and, finally, 
whether they thrive or die is a gauge by which the fitness of rooms for 
habitation can be determined. When rooms are so bad that flowers will 
not live in them wise people will move out. It is said that when rats 
are seen leaving a ship it is time for the passengers to get on rafts — when 
flowers die it is time for the occupants to get wise. 

WET BULB THERMOMETERS 

The humidity of the air is measured by an instrument called a hy- 
grometer. The instrument advised consists of tivo thermometers set side 
by side. The bulb of one of these is surrounded by a loosely woven wick. 



1196 VENTILATION— HEATING— HUMIDITY 

This wick draws water from a near-by cup so that from the surface of thisi 
bulb water is evaporating continuously. 

This thermometer is called the wet bulb thermometer and its companion 
the dry bulb. 

From the difference between the reading of these two thermometers the 
humidity of the air is found on a table attached to the instrument. There- 
fore, when one uses this kind of a hygrometer he has two thermometers at 
his service — one of the ordinary kind called the dry bulb and one of a kind 
new to him, the wet bulb. 

Under ordinary office conditions in January he will find that the dry 
bulb thermometer registers about 16° higher than the wet bulb, say 72° 
and 56° respectively. 

In talking about temperatures we always speak of the temperature shown 
by the dry bulb thermometer. Now, a group of physiologists are saying 
that the thermometer we ought to go by is the wet bulb. If we do we shall 
have to get new notions about temperatures altogether. Their argument 
is that the human body is a wet bulb and not a dry bulb. A man evaporates 
one or two pints of sweat from the skin every day. Therefore he is a 
wet bulb. 

On this basis the temperature of the room is 56° instead of 72°, as he 
thought. Somehow he felt a little cold but it could not be — the thermometer 
read 72°. 

If a man were to fall in a pond and go around with his wet clothes 
on he would be a wet bulb. As it is he is only a slightly moist bulb. Tc 
figure him on the same basis as the wet bulb is to overstate the case. 

A compromise somewhere down the line, say about half way, would hii 
it off — such as to say that the temperature of the room for anything that is dry 
is 72° and for anything that is wet 56°, while for everything about as moist 
as a man it is 64°. 

There is no doubt at all that the discomforts of extremes of temperature 
are better measured by the wet bulb than the dry bulb thermometer. 

It is when the wet bulb thermometer shows over 70° that men keel over 
in laundries, in kitchens and in some factories. It is when the wet bulb ther- 
mometer shows under 56° that the throat dries out and colds are contracted, 
that the skin dries out and winter itch develops. 

If a person can only afford one thermometer a wet bulb will tell him 
more than a dry bulb; yet he ought to have a dry bulb as it is what every- 
body refers to when they speak of temperatures. 

The fact is, everyone should have both. It would pay to save in some 
other direction. 

A PRACTICAL SUGGESTION 

The suggestion relates to a method of humidifying air in a room 
heated by steam. On the market there are several devices which are to be 
attached to the radiator for the purpose of allowing steam to escape. The 
practice is to attach this device to the far end of the radiator, the end at which 
the steam leaves the coils. 

One objection to these devices is that when several of the coils are 
filled with water, as often happens with poorly installed heating plants, 



HUMIDITY 1197 

water escapes from the humidifier. The far end of the radiator is the water 
end. When the water condenses in the coils that end catches most of it. 
When the steam is turned on it blows the water from the forward coils to 
those at the far end. 

The suggestion is that the humidifier be attached at the front end — 
the end where the steam enters, the end where you turn the steam on, the 
dry end. Generally the radiator coils have a plugged opening in this first 
coil. It has threads ready for the threads of the humidifier. By attach- 
ing the humidifier at this end water will not leak from it. 

Professor Shepherd of the Chicago Normal College and a member 
of the Chicago Ventilating Commission reported the results of his investiga- 
tions to the International Congress of School Hygiene. He found that proper 
humidity was most essential for the welfare of students and that ordinary 
schoolroom ventilation methods do not give proper humidity. In fact, 
schoolroom air generally is well below 30 per cent humidity, less than half 
of what it should be. 

The comfort zone of the pupils under investigation was found to be 
fixed by temperature and humidity. One end of the comfort zone was 64° 
Fahrenheit and 55 per cent humidity. The other end was 70° Fahrenheit 
and 30 per cent humidity. 

With a close, snug house we cannot have a humidity higher than 20 
on a cold day without some form of humidifier. Humidifying a room heated 
by a stove, hot air or steam is not a difficult matter. How to do it is 
now generally known to those who are manufacturing heating appliances. 
It is up to the consumer to see that he gets proper apparatus. 

DRY AIR 

Now is the winter of our discontent 

Made glorious summer by this sun of York. 

Shakespeare tells us that Richard III (Act 1, Scene 1) thus expressed 
himself after the triumph of the White Eose faction. Converting winter into 
summer did not stop with the days of Eichard III. Suns of York, now called 
radiators, hot-water pipes and hot-air flues, are converting winter into summer. 
Most people spend the greater part of the day in winter in hot air — air 
that is hotter than room air in summer. 

In summer they take their warm air in the open. In winter they take 
it in closed rooms. In summer the hot air was heated while in contact with 
lakes, rivers and wet ground. In winter it is heated while in contact with 
iron pipes and dry walls. 

The following figures are taken from an article by McCurdy in the 
Heating and Ventilating Magazine: 

"With atmospheric pressure at approximately 30 ins. and the tem- 
perature at degrees Fahrenheit, a cubic foot would hold 0.481 grains of 
moisture; at 32 degrees F., it would hold 2.113 grains of moisture; at 60 
degrees F. it would hold 5.745 grains; and at 70 degrees F. it would hold 
7.98 grains. 

"Vapor or space at degrees F. and 50 per cent relative humidity would 



1198 VENTILATION— HEATING— HUMIDITY 

contain approximately 0.2-1 grains of moisture per cubic foot. This vapor, on 
being heated to 70 degrees F., would still contain its absolute humidity 
of 0.24 grains of moisture per cubic foot, but its relative humidity would 
drop from 50 per cent to 3 per cent, except as the air passages and skins of 
pupils became water jugs which were continually emptying water from 
the bodies of the pupils into the air of the room. 

"Air at 32 degrees F. and 50 per cent relative humidity would con- 
tain approximately 1.056 grains of moisture per cubic foot. This air, on 
being heated to 70 degrees F., would then have a relative humidity of 13 
per cent unless moisture was added from the pupils, walls, or fixtures in the 
rooms." 

This summer air in winter time is drier than the air of Arizona or any 
other dry region in this country. It dries out the skin causing winter 
itch; it dries out the hair causing baldness; it dries out the nose causing 
colds; it dries out the tonsils causing enlarged glands; it evaporates mois- 
ture from the skin so fast as to make us feel cold even when the air is over 
70°. 

If we are to have this summer in the winter time let us duplicate the 
entire process. Let us have some rain; or by some sort of device bring the 
humidity of the room air up to the summer standard. 

The first step is to know. To have thermometers exposed here and there 
is an excellent idea, To have hygrometers exposed just as abundantly is 
just as good an idea. 

For several years I have advocated hygrometers in the schoolrooms. 
I have not heard of anybody putting the plan in practice but somebody will 
before long. In time it will become universal. 

When the people learn the facts they will proceed to remedy the bad 
conditions. Humidifiers are on the market. They are not so well developed 
as heaters but the engineers have not been working on the problem so 
long. At the present time there are several types of humidifiers on the 
market. 

The man who insists will get a humidifier in his hot-air furnace. The 
indifferent man will not. The man who insists will get humidifiers on his 
radiators. 

Not until the air is properly humidified will the winter of our discontent 
be made glorious summer. 

GET THE HYGROMETER HABIT 

If you will turn to the weather report on the first page of almost any 
newspaper you will find the temperature and the relative humidity among 
the items of information. By a relative humidity of 90 is meant that the air 
contained nine-tenths as much moisture as it would hold at that temperature. 
In hot weather when the humidity is over 90 the days seem much hotter 
than the temperature shows they are. In cold weather with the same relative 
humidity the days seem colder than they are. 

When the relative humidity is around 70 conclusions drawn from your 
feelings jibe with what the thermometer says about it. The discomfort of 
the climate of the lake cities is due to their high humidities. It is by reason 



HUMIDITY 1199 

of better humidities that inland cities — for example, Minneapolis, St. Paul, 
and Denver — have the advantage of us. 

But the purpose of this section is to tell of indoor humidities. The 
Commission of Labor of New York has found that the following trades usually 
work in places with a harmfully high humidity: Printers, clothing makers, 
bakers, pearl button makers, cigar makers and laundry workers. The list is 
incomplete. Discomfort, harm and lowered efficiency come from working in a 
place with a high humidity. Artificially heated schools, offices, some stores 
and all living rooms have a harmfully low humidity ranging from 50 down 
to 10. 

So while we are getting good habits let us get the hygrometer habit. Hy- 
grometers are cheap and almost as easily read as thermometers. Bedrooms 
should have them but they are more needed in living rooms. Schoolrooms- 
certainly should have them. Offices are much more in need of them than 
of registering clocks. All factories and workshops should be equipped with 
them. 

Then, when they are installed, somebody should make a record of what 
they show. The manager of a factory or large office should have the records of 
temperature, humidity and absences from sickness placed on the desk every 
day. In larger and better organized plants these records should be supple- 
mented by efficiency data. 

RAIDING THE HUMIDITY 

Much the best thing to do to raise humidity is to have a steam jet dis- 
charging steam into the room. This can be done by removing the small vent 
and substituting for it a tube long enough to discharge the steam away from the 
wall and to prevent water from blowing into the room. Steam discharging in 
this way makes a noise and, occasionally, results in odors. If the radiators are 
so arranged that the condensation flows back to the basement the tendency to 
squirt water is reduced to a minimum. 

Ordinary pans of water on the radiators help but little. The evaporation 
from them cannot possibly raise the humidity more than ten points. Humid- 
ifiers help but little. The water surface exposed to the air is not large enough. 

Next in efficiency come kettles of water setting on the stove. More 
steam will escape from the spout of a tea kettle than will rise from a pan 
one by two feet. 

Next come growing flowers. If several boxes of growing flowers be 
kept in the room and the soil kept as wet as they will stand soil evaporation 
and plant exhalation will add much moisture to the air. 

Next comes a sprinkling fountain. A small spray nozzle can be attached 
to an ordinary tap and turned on just strong enough to get a fountain 
effect; or a small electric fountain can be installed. It will seldom be neces- 
sary to go to the expense of a more elaborate fountain. 

Next come large coarse sponges placed in pans of water. There should 
be several of these, a dozen in an ordinary sized flat. The cheaper, coarse- 
grained sponges serve best. The closer they are placed to the heat and the 
more the air circulates over them the better. 

Next come pans of water. These should be kept on the radiators and 



1200 VENTILATION— HEATING— HUMIDITY 

near the intakes. The pans should present the largest possible surface to 
the air. Pans which are less than one foot wide and two feet long do not 
do much good. By using two such pans and placing them on the radiators, 
the humidity can be raised about ten degrees. 

Lastly comes the use of patent humidifiers. These hang on the radia- 
tors and the water in them gets approximately as warm as the radiator coils. 

Arrangement for Humidity. — H. B. W. writes: "Relative to your re- 
marks from time to time as to keeping the humidity of the air in living 
rooms at a certain point, I have found that common lard pails suspended 
in hot-air registers on sticks (laid diagonally across the air ducts) will aid 
materially, provided water is kept in them. My experience is that they 
need to he filled about twice in three weeks, although this would probably 
vary according to the heat coming up from the furnace. At any rate, the 
scheme has this to recommend it — it costs nothing and will certainly do 
away with a large percentage of the dryness caused by hot-air heat." 

Reply. — There are several kinds of hygrometers. The one best adapted 
to household, office, and factory use is composed of a wet and a dry bulb 
thermometer. A dry bulb thermometer is an ordinary thermometer. When 
this reads 70° and the wet bulb reads 63° the humidity is 68. A dry bulb 
reading of 70° and a wet bulb of 62° means 64 humidity; 61° means 60; 
60° means 56; 59° means 52; 58° means 48; 57° means 44; 56° means 40; 
55° means 36; 54° means 33; 53° means 30; 52° means 26. 

A great many people write that they are surprised at the low humidities 
which they are discovering. Some of these relate to living rooms, some 
to offices, and a few to factories. 

In the natural course of time the humidity of rooms will get lower as 
the winter progresses. By January the walls will be dried out and the fur- 
naces and boilers will be harder pushed. The room humidities will cer- 
tainly average ten degrees lower than at the present time (November, 
December). 

More people are asking how the humidity can be raised. 

When an ordinary living room temperature is kept at 70° it is difficult ' 
to bring the humidity above 40. If there is steam heat a jet of steam dis- 
charging into the air can be so arranged as to bring the humidity to 70. 
The objections are the odor and the noise. 

If there is no steam water can be evaporated by humidifiers, pans of 
water, wet towels and wet cloths, fish bowls, fountains, tea kettles on the 
stove and so on. 

The greater the evaporating surface and the warmer the water the 
greater the evaporation. The stronger the air currents over the water the 
more effective the evaporation. 

With improvised evaporators it is almost impossible when the tempera- 
ture of the room is 70° to get the humidity on a cold day over 40. 

Cold bedrooms and cold schoolrooms are different. When the windows 
are thrown open and the temperature is 55° the humidity will be around 
70 without, the use of any humidifiers. 

Ideal Humidity: — T. L. D. writes: "What is the ideal humidity for 
living and sleeping rooms, and how can it best be obtained and regulated?" 

Another writer asks what is a hygrometer. Still another asks what 
type is recommended, 



HUMIDITY 1201 

Eeply. — The ideal relative humidity is 70. A sleeping room should 
have at least one window wide open. Under these circumstances the 
humidity takes care of itself. A living room should have a temperature 
of 68° F., as shown by the dry bulb or ordinary thermometer, and a wet 
bulb thermometer recording 61° F. Seven degrees difference in the wet 
and dry bulb thermometer readings means a relative humidity of 67. To 
get this humidity it is necessary to expose vessels of water in the room, to 
use some of the humidifiers, of which there are many on the market, or to 
have a small nozzle attached to the steam radiator in such a way that 
steam will blow into the room. 

What is a hygrometer? There are four types in use; the wet and 
dry bulb hygrometer, the sling hygrometer, the hair hygrometer and the 
small cheap weather indicators. Of these the wet and dry bulb is to be 
preferred. They are not patented. They are made by different people and 
can be had at any instrument store. The apparatus is really a thermometer 
and a humidity measurer combined. The dry bulb thermometer costs $1; 
a fairly good hygrometer consisting of two thermometers, water carrier, 
wick and tables costs $2.25 to $2.50. A person owning a hygrometer needs 
no additional thermometer. 

Dry Air Explanation. — W. H. S. writes: "Dry air in a room, I am 
told, irritates the lungs. Dry air in the higher altitudes is a tonic and is 
healthful — or something like that. I have asked several physicians, but 
so far have received nothing more than that it seems to be so. I get no 
reason for the difference. If you think it worth while please explain." 

Eeply. — The common way of putting this question is: If dry air in 
the arid regions is good why is dry air in a schoolroom or office bad ? The 
answer is : The dry air of an arid region is good for one condition — con- 
sumption. It is not good for the skin or for the general run of disease. 

The air in the arid regions is never so dry as is the air of the school- 
room. In Arizona the humidity is usually around 50; in the schoolroom 
it is around 20. 

In the arid regions all the air is dry. In a moist climate where only the 
schoolroom air is dry the person spends several hours a day in air around 
20 and the balance of the day in air around 90. Where the outside air 
has a temperature of 40° or below and a humidity of 90 and the inside 
air a temperature of 70° or above and a humidity of 20 or below, the 
mucous membranes of persons passing from the one to the other condition 
are put under great strain. 

Bad Air Effects. — F. C. P. writes: "1. What are the bad effects of air 
lacking moisture? What amount of water should be evaporated daily in a 
room 16' x 16' with ten-foot ceiling, heated by hot water? 2. What is the 
best, quickest, and simplest method of supplying moisture in air? It seems 
almost impossible to evaporate a large quantity by simply letting water 
stand. 3. Are there quicker methods and what are they? If. Is there an in- 
strument for measuring the moisture in air? 5. Could you name any medi- 
cal work treating fully on the moisture in air question?" 

Reply. — 1. Dries out the skin and mucous membranes. In this way it 
predisposes to colds and enlarged glands. It causes winter itch by drying 
out the skin. 

2. One to three gallons. The amount will depend on the temperature 
and humidity of the outside air. 



1202 VENTILATION— HEATING— HUMIDITY 

3. In rooms heated by hot water use the Bryce method. 

4. Yes; wet and dry bulb thermometer. It is called a hygrometer. 

5. "MacFie on Air." 

Between 50 and 70. — W. B. writes: "What is the right humidity of 
air in living rooms? Can you give a simple and inexpensive way to keep 
the different rooms upstairs and down at the right humidity for children 
and others compelled to live indoors?" 

Reply. — It should not go below 50 nor above 70. A hygrometer shows 
the humidity as a thermometer shows the temperature. How you can 
humidify depends on how you heat. The method is to evaporate several 
gallons a day for a small dwelling and to arrange it so that the evaporated 
moisture stays in the rooms. If the heat is by furnace the water pans 
must be in the air chamber over the firebox. 

Peril to Picture Operators. — T. T. writes: "Kindly inform me as soon 
as possible as to the sanitation, ventilation, and health fulness of the oper- 
ators' booths in moving picture theaters." 

Reply. — About the worst ventilated places in town are the moving 
picture theaters. There are some exceptions to this statement. The 
booths are much the worst place in the hall from the sanitation stand- 
point. The reasons are: 

1. The booth is in the gallery where the air is hottest and filthiest. 

2. The heat of the light makes the booth hotter still. 

3. The films are inflammable. 

4. The films usually have some specks on them and the consequent 
flashing, when added to the dancing of the pictures, is ruinous to the eyes 
if kept up long. 

5. The visitor stays an hour or two and then goes. The operator stays 
there several hours and is back the next day. For these reasons the 
"sanitation, ventilation, and healthfulness" are about as bad as bad can 
be. Quit the business and go into something safer. 

Should Have Hygrometers. — Mrs. L. T. Le B. writes : "I am anxious to 
have your opinion concerning the ventilation and general atmosphere of 
the public schools of our town. So many pupils complain of headache and 
bad colds are so prevalent that it seems to me that present conditions in 
that regard may be the cause. The schools are ventilated by the fan system 
with closed windows. 1. Do you not think that the windows should be 
opened at the noon hour, which is between sessions, or even more often? 
The janitors in all our public buildings are against airing, saying itns hard 
to raise the heat afterward. 2. -Now, regarding humidity, the schools are 
heated by steam, with no receptacles for water on the radiators. Do you not 
think that pans of water should be attached to every radiator? My child is 
only one of many who return from school with a headache and feeling gen- 
erally debilitated. Hearing so many complaints I have tried to find out the 
cause and it seems to me that dry, foul air may be the reason." 

Reply. — 1. Yes. 

2. Yes, though they will not help much. Not enough water will be 
evaporated. A better plan is to allow steam to discharge from the radiators 
into the room. A fan system does not give ventilation sufficient for health 
and as usually installed is productive of just the kind of ill health described 
in your letter. 



HUMIDITY 1203 

I wish you could persuade your school authorities to equip your schools 
with hygrometers and then to have hourly observations recorded showing 
the temperature and humidity. With this information in hand your board 
will be in a position to plan improvements and you will be equipped with 
information on which you can stand in demanding improvements. 

Have Humidifier Attached. — W. G. writes: "I have steam heat in my 
house, and have a hygrometer. However, I am ignorant of what the proper 
humidity should he, and the table with the instrument fails to tell. As my 
radiators are closed ones, I cannot admit moisture from them through an 
air valve, as was recommended by you some time ago. I notice that dishes 
placed on radiators do not seem to produce much effect. A concern in 
New York is making small fountains run by a little electric motor and 
pump, throwing the water in a spray a foot or more into the air and con- 
tinuing as long as the current is turned on and the basin contains water. 
This is made primarily for ornamental purposes, but if run for an hour 
or so a day, would it provide the proper humidity f I do not know where 
to find anything made for steam radiators to provide humidity." 

Reply. — Around 50 is the best humidity, all things considered. A 
steamfitter could attach a humidifier to your radiator. I have had no 
experience with the spray device but my offhand opinion is that it would 
give you enough humidity. 

Dry Air and Moist. — J. V. N. S. writes: "I see you seem to hint that 
dry air is unhealthy, and the same may be said of a dry climate. Are not 
those cities situated in a dry climate the healthiest? I should like to see 
the proof that moist air is healthier than dry air. My residence is a two- 
story brick house, fairly large, with a basement. It is heated with hot 
air. The first two years, water was kept in the furnace boiler, damaging 
paper, curtains, and furniture in the rooms. For forty years my house 
has been heated without water in the boiler. My family has breathed the 
driest air that it was possible to make, and it would be difficult to find a 
healthier family. I have not had the appearance of a cold for more than 
two years. From cellar to garret, we have endeavored to keep the air in our 
house as pure as the air out of doors." 

Reply. — A dry climate is better for certain diseases than a moist one. 
On the other hand a moist climate is better than a dry one for other 
diseases. The dry climate of the West is better for consumption than the 
moist one of Illinois. 

However, a distinction should be made between the effects of dry 
outside air and dry inside air. If you have been going around out of doors 
in an atmosphere with a relative humidity of 90 and then go into a 
house where the relative humidity is 25 you will suffer from the change. 
The inside humidities which do harm are those that are under 50. There 
is no climate where people live which has a humidity as low as this. 

On the other hand, if the air in a room has a humidity over 70 it is 
distinctly bad. My contention is that healthy air is air which is not too 
wet and not too dry. The humidity of inside air must not be more than 
forty points lower than that of the outside. 

You have been fortunate in escaping colds but it would not be possible 
to draw any conclusion as to why you have escaped them without knowing 
more about you and also more about the humidity in your house. For all 
that your letter conveys the humidity may be pretty high. 



1204 



VENTILATION— HEATING— HUMIDITY 



Good Compromise Humidity. — J. W. S. writes: "We have a pan of 
water two and one-half by six feet in each fan of our schoolroom, which 
is kept boiling by means of steam pipes, and all this vapor goes along 
with the air into the schoolrooms. We are thus able to increase the humid- 
ity in our schoolrooms from 12 to 18 per cent above what it would be if 




Louisiana Health Almanac. 
Fig. 489. — Kentucky Type Privy with Septic Tank. 



the vapor were not added. On the cold, clear days the highest per cent 
of humidity we are able to get by this method is about 1/.5. Will you kindly 
tell me what should be the per cent of humidity in our schoolrooms? I be- 
lieve we can increase our humidity by increasing the size of our evaporating 
pans in our fan rooms." 

Eeply. — The humidity should be 70 but 45 is a very good compromise. 
Your walls would sweat disagreeably if you went much higher; that is, if 
you heat by hot air introduced on the inside wall. Shallow pans of water 
kept boiling by steam pipes constitute an excellent method of raising 
humidity. You are doing well. 

Radiators and Humidity. — M. E. R. writes: "Will you kindly explain 
how you fixed your radiator to keep up the humidity, a matter to which 



HUMIDITY 



1205 



you made reference some days since? We have hot water heat, and have 
several galvanized iron cans that hang on the hack of the radiators, hold- 
ing water which evaporates so slowly that I think they are inadequate. 
I am anxious to hear of something better." 



r>-tV ■ 

yARMTJLZl l*\__ 



.<&. 




J^ ^^^ ^i^J^^ >sre^ -E^fegj 



l^rx 



*lz PLANK F« 
I SyPPOST OF PLOi'R 







&* 



WN ON 




Virginia Health Bureau. 
Fig. 490. — Specifications for Kentucky Type Septic Tank. 



Reply. — M. H. E. is right. The amount of water that can be evapo- 
rated from an iron can is far from being enough. I bought for my radiator 



1206 VENTILATION— HEATING— HUMIDITY 

a wood wheel air valve at a quarter or thereabouts. I screwed off the 
small valve on the side of the radiator and screwed this on its place. When 
I want to increase the humidity I turn the small wooden wheel and steam 
blows into the air. When there is enough I turn it off. The objection is 
the noise it makes. The engineers say that if everybody did this the 
janitors would be compelled to watch the water in the boilers more closely. 

There are several methods in use designed to overcome the short- 
comings of this simple arrangement. In one group are the silencers de- 
vised to prevent the noise. Another apparatus is one to prevent the lower- 
ing of the water in the boiler. 

At the Lane Technical High School (Chicago) the engineer, Mr. Stoltz, 
humidifies the air by the following method : He has built two galvanized 
iron tanks, each 60"xl8"xl8", in the hot air chamber. In each tank he has 
placed sixty feet of one-half-inch brass pipe through which steam circulates. 
The water in these tanks is kept at a constant level by the float valve. In 
cold weather these two tanks evaporate 750 gallons of water a day. 

The morning I was there the water in these tanks was boiling actively, 
and a cloud of steam was rising and entering the air duct. The teachers 
tell us the relative humidity of the schoolrooms is around fifty. They 
say the air is pleasantly moist and pleasantly warm. Mr. Stoltz tells us 
that he finds it easier to heat the school satisfactorily since this apparatus 
was installed. 

Call in Steamfitter. — C. S. writes: "What sort of humidifier would 
you suggest for use on a radiator heated by 'atmospheric pressure'? It is 
really steam heat carried from a central heating plant, but there is no 
possible way of allowing the steam to escape into the room. Since in- 
stalling this system I find that whereas our hot water plant kept us com- 
fortable at 70° this heat must be 75° or I am chilly. Is it possible for the 
difference to be caused by the different systems?" 

Reply. — Your steamfitter can fit a steam discharger into your radiator. 
A room in which the air is humidified is more comfortable at 70° than 
one in which the temperature is 75°, but the humidity is wrong. How- 
ever, on this point hot water heating offends just as much as does steam 
heating. If the placing of coils is such as to heat the room unevenly the 
occupants will complain of the cold at 75°. If the heating is even they will 
not complain at 70°. 

My guess is that the coils are not so well placed as in the old installa- 
tion. Maybe the house is older and more cold air leaks in; so in conse- 
quence your head is in air at 75° and your feet in air at 60°. 

Plan to Increase Humidity. — P. W. A. F. writes: "Your articles con- 
cerning humidity in dwelling houses have received my careful attention 
and I fully realize with what difficulty the person who desires to humidify 
his rooms which are heated by hot water radiation is confronted. The follow- 
ing plan, I believe, will greatly aid the conditions in the average dwelling. 

"This is the placing of a rather deep yet long, narrow pan between 
each radiator and the wall and filling this pan with water. 

"A large evaporating surface is then secured by suspending a sheet of 
some absorbent material, such as loosely woven table padding, so that one 
end is immersed in this tank and the other end extends nearly to the top or 
the radiator and throughout its length. I shall be glad to have your opinion 
of this plan, for I intend to put it into operation." 



HUMIDITY 



1207 



Reply. — Depends on the surface and how hot the water gets. If it 
evaporates one to two gallons of water a day it will give excellent results 
for an ordinary-sized living room or office with one or two occupants. The 
simplest test is to measure the amount of water evaporated. 




Virginia Health Bureau. 
Fig. 491.- 



-Cheap Sanitary Dry Earth Bucket Privy. 



visw- 



Efficient Humidity Plan. — X. Y. writes: "For the benefit of your 
readers who are trying to solve the humidity problem in hot water heated 
houses, I have thought you may be interested in a scheme which seems 
efficient if not elegant. Underneath the radiators are placed shallow gal- 
vanized pans, as large as the setting of the radiator will allow. (Under 
our low radiation the surface area is 12x50 inches.) From these water 
pans wicks are carried up between the radiator sections. For wick ma- 



1208 VENTILATION— HEATING— HUMIDITY 

terial we find the ordinary paper towel sheets, loosely rolled, most satis- 
factory, as they can be renewed at practically no expense when dust-clogged. 
The amount of evaporation can be controlled by the nmuber of wicks. 
With no wicks there is practically none, but with a goodly number we 
have at present even with a high relative humidity out of doors a daily 
evaporation of between three and four gallons in four rooms so fitted. 
Whereas before installation the house humidity was about 30, we now have 
an average of 1^3 or JfJf. with great mucous membrane comfort." 

Reply. — This is very efficient. 

Humidity by Pans. — H. L. 0. writes: "Is it necessary to have hot 
water pans on hot water heat radiators to obtain correct humidity?' 

Reply. — It is necessary to do something. Pans will help, though you 
will need more moisture than they will furnish. 

Use the Hygrometer. — D. D. S. writes: "Will you be so kind as to 
outline an easy method of approximating humidity percentage? Can suf- 
ficiently accurate results be obtained if barometric pressure is ignored? 
If so, will you state what difference in degrees between wet and dry Fahren- 
heit thermometers will indicate less than 50 per cent saturation, the 
temperature (dry) being from 68° to 70°?" 

Reply. — The wet and dry bulb thermometer combination called a 
hygrometer is the simplest instrument which I can recommend. 

Yes, barometric readings may be ignored in considering humidities. 
When the dry bulb reads 70° any wet bulb reading less than 59° means less 
than 50 relative humidity. 

Room Needs Moisture. — E. H. writes: "The temperature of our rooms 
does not go above 72° and there is constantly a window open from the 
top about six inches in every room. The windows are never frosted in 
weather about 16 or more degrees above zero, although in below zero 
weather they are frosted. Is the humidity too low?" 

Reply. — A room kept at 72°, with ventilation through a window down 
six inches from the top, will need moisture. A room kept at 55° and ven- 
tilated through wide open windows will not require additional moisture. 

Humidity Should Exceed 40. — T. F. 8. writes: "I have a 'hair 
humidometer in my office, and such a day as today — February 2 — I have 
difficulty in keeping the humidity of my office so that it will register as 
high as 35°. Even when placed outside my window, 150 feet above the 
sidewalk, the humidometer registers only 31 degrees. Is it necessary to 
have the humidity of the room higher than the outside air?" 

Reply. — Hair hygrometers are seldom accurate. The government re- 
port shows that the relative humidity at 7 a.m. on February 2 was 57 per 
cent and at 7 p.m. was 43. Keep your room humidity at 40 to 60. In 
Chicago in winter the outside humidity is usually higher than that. 

To Make a Hygrometer. — W. C. E. writes: "Can a hygrometer (the 
wet and dry kind which you have mentioned) be made by me from two 
ordinary thermometers? I have two thermometers, and would like to have 
the hygrometer. If this can be done, will you please tell me how it may 
be done and how to read it?" 



HUMIDITY 



1209 



*£=^= 




AVen+ 






c 



^ 



^5 ewer 



2^~-f/ag Stone / v^™ 




^mmdm^mir^^ 



Fig. 492. — Leaching Cesspool Constructed of Field Stones. 

Reply. — Take a small lamp wick, sew one end around the bulb of one 
of the thermometers, put the other end in a small cup of water. Stop 
in some instrument dealer's and get a table of relative humidities as shown 



*5ewer+ 







Agricultural drain 
tile pipe 



sptrips of far paper 
laid over -fops of Joints 



/-/ol/ow brick 
/a/d radially 



Manhole frame and cover 




Virginia Health News. 



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no 


a □ \/-7 


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Derails of Hollow Brick 



Fig, 493, — Hollow Brick Cesspool with Overflow into Agricultural Tile, 



1210 



VENTILATION— HEATING— HUMIDITY 



by the difference between wet and dry bulb. When the dry bulb is at T0° 
and the wet bulb is at 62° the humidity is about right. 

Humidity Discussed. — Mrs. W. B. writes: "Please tell me how hot 
water radiators can he fixed so there will be enough humidity in the room." 

Reply. — I do not know any satisfactory way to humidify the air of 
a room heated by hot water. Pans attached to the radiator do not furnish 
enough moisture. Perhaps some reader will propose a plan. 

Air Too Dry. — Reader writes: "I have been bothered this winter with 
an itching on my body. No breaking out is visible until the skin has 



/ monfrofe 
















T/ghf manho/e 


PnA 
















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a 


Q 


t> . 


■ &. 





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&. 


■* ' * ^ '1 



r 



H 



DOSING TANK 




3"av/orr>otic siphon ■ 
ft tvil/t /s' drawing 
depth 



T ^ r - 



Tank and siphon chamber 
borh 2' wide inside 



California State Bulletin, May, 1916. 



Fig. 



494. — Concrete Septic Tank and Dosing Chamber Attached, for 
Household of Not Over 10 Persons. 



been rubbed or scratched. Then little white pimples are raised and itch 
terribly. What is the trouble and what can I do for it?" 

Reply. — The air in your living room is too dry. Get a hygrometer. 
Add humidity to the air until the hygrometer shows over 40 constantly. 
At that time the itching will disappear. Otherwise it will persist until 
the heat is turned off in the spring. 

More Humidity Needed. — 0. A. C. writes: "Is our furnace man right 
when he says we do not get the heat we should have because of the two- 
quart pails suspended in several registers? He insists the small water pots 
in furnace are sufficient." 

Reply. — No. Two pails of water suspended in the registers will not 
use up enough heat to affect the temperature. Neither will they evaporate 
enough moisture. They help but do not suffice. 

Itching from Air Too Dry. — J. C. has an itching of the skin which 
nearly sets him crazy. He wants to know what he can do. 

Reply. — You are living in air which is too dry. See that the humidity 
of the rooms gets up to, say, 70°. 



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N 

i, 



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1211 



1218 



VENTILATION— HEATING— HUMIDITY 



Dirt Bands on Ceiling. — Mrs. R. W. wants to know why the ceiling 
of her room is striped with alternating bands of light and dark and why 
this is more plain near the radiator than elsewhere. 

Eeply. — The plastering is put on over laths. The wooden laths are 
better conductors of heat than the air spaces between them. Therefore 
the plaster over the laths is colder than that over the spaces. 

The water in the air precipitates at the colder zones and the moisture 

catches the dirt out of the air. 



Design jfe* Pit Peivy 




ffawp' 



The dirty band marks the location 
of the lath, the clean that of the 
space. 

The space over the radiator 
shows this more plainly because 
the hot air from the radiator flies 
straight to the ceiling, carrying 
dust and sticking it there. 

Winter Itch Cure.— M rs. M. W. 

writes: "Last winter my husband 
and I somehow acquired what we 
thought was winter itch, but what 
our physician declared was plain, 
dirty, old itch. The skin looked 
perfectly healthy, but itched vio- 
lently in spots, and, after scratch- 
ing, would look red and like goose 
flesh. It traveled all over the body 
{except the face), but, as a rule, 
seemed to be active in only a com- 
paratively small area at one time. 
After several weeks it developed 
(at the base of the fingers only) 
in rather hard flesh that scaled off, 
always accompanied by the violent 
itching, but on the rest of the body 
it continued in the form first de- 
scribed. We tried various salves, 
etc., which relieved temporarily, 
but did not cure. It finally left 
us with the coming of the warm 
weather last June. It has reap- 
peared on me with the first cold 
weather this fall, simultaneously 
with the wearing of last winter's union suits, but not on my husband, 
who has not yet put on heavy underwear. Is this a parasite or a skin 
condition? We wear cotton underwear; perspire normally; bathe often. 
Is there any relief?" 

Reply. — You have winter itch, I should say. This condition results 
in part from the warmer, more irritating underwear. Much the more 
important cause is dry air. No local treatment, except frequent bathing to 
remove the dead skin, is of service. 

The remedy is water. Drink more of it to increase the amount of per- 
spiration. Above all, put more water in the air of your rooms. Get a 



North Carolina Health Bulletin. 
Fig. 496. 



HUMIDITY 1213 

hygrometer and keep the humidity of your rooms up to 50 or above and 
your itch will stop. 

Your husband does not stay so closely at home and in consequence his 
itch is lagging a few weeks. It will get him before Christmas. 

Winter Itch Treatment. — W. K. F. writes that after suffering from 
winter itch for many years he found a cure. It is glycerin, one part; water, 
eleven parts. The lotion is applied hot twice a day. He does not use soap 
during the winter, hut cleanses his skin with the glycerin mixture. The 
skin is not to he dried with a towel after using the mixture. 

Reply. — The cause of winter itch is dry air. The remedy is humidify- 
ing the air of houses and offices. Awaiting the time when the underlying 
condition shall be remedied it is well to use this or some other palliative. 



CHAPTER LXII 



Garbage 



HOW TO DISPOSE OF GARBAGE 



The least important part of the garbage problem is garbage disposal; 
yet it is the part on which most thought lias been put. Aside from the 
financial end of the question nobody is interested much in garbage disposal 
except the people who live near the locations where the garbage is disposed of. 

They sometimes object to being made a dumping ground for the 
balance of the community. They say it ruins the value of their property; 
that it breeds flies ; that it causes foul odors ; and that it raises their sickness 
rates. They work themselves into hysterics. To them garbage disposal 




Fig. 497. — The Pit Privy, Simplest Form. This 
illustration shows how a sanitary privy may be 
had with even a simple watertight box by digging 
a pit and placing the box, with a proper cover, 
over the pit. When the pit is nearly full, an- 
other should be dug and the box moved over it. 
Care must be taken to heap up the dirt around 
the box, so that water will not get into the pit. 
When the box is removed to a new pit, the old 
one should be filled with earth raised in a mound 
over it. This is necessary to keep the pit from 
becoming a sinkhole. 




Virginia Health News. 



has a vital interest. To the balance of the community it has only a financial 
interest. 

Six methods of garbage disposal are made use of : 

1. Garbage dumps are the least to be commended and at the same time 
are the most frequently made use of. There is some advantage in filling in 
low places. Sometimes such places become pools of water. In such pools mos- 
quitoes may breed and children may drown. There is a wee bit of (usually far- 
fetched) argument in favor of filling in such low places. But they can 
be filled in with household rubbish and, particularly, with ashes, cinders, 
sweepings and excavation dirt with economy and advantage and no harm 
will result from such procedure. 

1214 



HOW TO DISPOSE OF GARBAGE 1215 

A scientific study of levels and the use of city wastes other than wet 
garbage in relation thereto would be well worth the while of any community. 
A city could save millions by buying up gullies, clayholes and marshes and 
offering builders, rubbish collectors, and producers of ashes free use of such 
spaces for dumping purposes — and make millions thereby. Boston has tried 
it; Cleveland has made gullies and "washes" into school sites and hospital 
grounds to great advantage. 

On the other hand, garbage dumps are always fringed by a half-mile or 
more of territory in which the baby death rate is scandalously high. Garbage 
dumps seem somehow to breed scandals of as many hues as Joseph's coat. 
Graft is thick in, on and around them. They are about as harmful as 
graft breeders as they are as fly breeders. 

The men who advocate garbage dumps say that flies can be kept down 
with antiseptics and black dirt. It has been proved that fly larvae, hatching 
out under six feet of black dirt, will burrow to the surface. The layer of 
black dirt or sand over garbage is never more than a few inches thick. 

The fly killers and fly repellents used on garbage dumps are ineffective. 
Even if results could be accomplished with these chemicals the amount 
which would have to be used would make the cost prohibitive. 

Why speculate? The swarms of flies that hover around and are dissemi- 
nated from dumps constitute the best possible evidence that dumps are 
fly breeders. The odor from a dump is of no health consequence. There 
is nothing to be said in favor of garbage dumps that would appeal to any 
thinking person. 

DUMPS 

However, I know of no American city without dumps. Some have fairly 
\vell kept dumps and of others the less said the less abusive one is. A dump, 
r o be an unmixed blessing, must receive nothing except excavation ma- 
terial, wrecking material and ashes. Such dumps secure drainage, banish 
mosquitoes, and improve appearances. 

Dumps that receive street sweepings are moderate fly breeders. Street 
sweepings have a fair fertilizer value, and it is wasteful as well as insanitary 
to put this material on dumps. 

Rubbish dumps are generally fly propagators. In the miscellaneous 
material which goes on them there is much fly food. Cans are always present. 
A colony of flies can live a week on the sirup or salmon left in an empty 
£an. Scraps of bread and other food remnants are certain to find their way 
into the rubbish. 

On the other hand, flies can only travel a block or two and not so 
far as that, except as the wind blows them. Food probably never draws them 
more than 400 feet. 

Therefore, a well kept rubbish dump will furnish a moderate excess of 
flies to the neighboring houses but it will never people them with swarms of 
flies as will a garbage or a manure dump. 

Rubbish dumps cannot be treated with crude oil as a fly repellent. As it is, 
they are afire a good part of the time. If they were oiled they would be a 
neighborhood menace. To treat them with a copperas solution (two pounds 
of iron sulphate to a gallon of water) might be feasible but I doubt it. 



1216 GARBAGE 

Probably fifty gallons to each ton would be required and that quantity 
would be prohibitive. To cover with ashes and excavation material would 
be the best plan. 

Fly larvae will burrow through several feet of soil to escape but that does 
not greatly concern us in dealing with rubbish dumps. They feed flies ; they 
do not breed them; that is, not in quantities. Flies will not go through 
ashes or dirt to feed. A few inches of covering will suffice to keep a rubbish 
dump in order. 

The great trouble comes from dumps that get store refuse, saloon sweep- 
ings and kitchen waste. Around such dumps flies swarm. 

The walls in the neighboring homes are black with flies. The cars on 
the neighboring lines fill up with flies as they pass along the street. The 
garbage wagons drive away from the dumps carrying loads of flies. 

The near-by children comb the field looking for food. Some of this 
is for chickens, ducks and pigs, some of it is for human use. Around the 
dumps two death rates are always high — summer complaint and typhoid. 
Such dumps should not exist at all. 

Clean-up Day, to have a punch to it, must include plans for the dumps. 
If a plan for keeping the dumps right could be offered, pushed and adopted 
in clean-up week it would be enough of itself to make the week worth while. 

GARBAGE REDUCTION 

The idea prevails generally that when garbage is sorted over the articles 
recovered will be of great value. As a matter of fact, the picking over of 
rubbish scarcely pays the expense of picking even with the market of a large 
city at hand and where use is made of the cheapest labor. The picking over 
of garbage does not pay. Bones and cans are the only two objects it pays to 
go after. 

2. The use of the reduction method requires that garbage be kept separate. 
It generally means a long haul. The pure garbage is more offensive than 
the mixtures commonly disposed of by the destructor method. This method 
can make use of old and stale garbage. Pig feeding requires fresh garbage 
and thus, indirectly, a frequent collection is promoted. Garbage reduction can 
make use of stale garbage, and thus, indirectly, infrequent garbage service is 
promoted. 

Those are the only disadvantages of the method. It can be operated 
without odor and without nuisance. The soluble odorous gases can be 
washed out of the smoke and those that are insoluble can be burned. Its 
great advantage is that next to the pig feeding method it is the most eco- 
nomical. 

The greatest value in garbage is its food value. That value is abstracted 
by pig feeding. The next greatest value is the fat and fertilizer value. 
That value is abstracted by reduction. In the reduction method the garbage 
is roasted to drive off the water. The fat is then extracted by percolation 
with naphtha and the residue is dried and ground into fertilizer stock. 
The grease is sold for soap and allied purposes and the fertilizer stock is 
mixed with chemicals to make different brands of commercial fertilizer. 

The Columbus, Ohio, plant clears 54 cents a ton above all operation cost, 





1217 



1218 GARBAGE 

5 cents depreciation, and 4 per cent interest on the money invested. The 
cost of collection is $2.10 a ton. The 54 cents earning of the disposal plant 
therefore reduces the cost of collection to $1.56 a ton to the taxpayers. 

Changes have been suggested which would quadruple the net earnings on 
the disposal plant. In other words, the disposal plant should make enough 
on what it sells to pay for the total cost of collection. 

The plant at Cleveland is of an old design, never of the best type and 
unduly costly to maintain, yet it always earns a goodly sum to pay on the cost 
of collection and occasionally for short periods the earnings are great enough 
to pay the entire cost of collection. 

As no city has enough money, as the complaints of poor garbage col- 
lection service are constantly met with the plea that there is not money 
enough, no city of large size is justified in foregoing the profits from 
garbage reduction. However, a garbage reduction plant is expensive to 
build. It has seemed to me that somewhere around 150,000 inhabitants is 
the proper dividing line. A city over that size can afford to, and should, build 
a garbage reduction works. Below that and say down to 25,000 a garbage 
destructor is proper and below 25,000 a garbage crematory. Of course, these 
lines are suggestive only. 

BURNING GARBAGE 

3. Garbage is without value as fuel — which does not mean that burning 
garbage is not a good way to dispose of it. Burning destroys garbage in 
an inoffensive manner and that is worth paying something for. Just how 
inoffensive is this method depends upon how the garbage is handled be- 
fore it is thrown in the fire and how hot the fire is. Of these two factors 
the first is much the more important. 

Technically, this way of destroying garbage is divided into two methods — 
cremation, or burning at a temperature of less than 1,200°, and destruction, 
or burning at a temperature of over 1,200°. 

Garbage quite well drained out will just about burn itself — that is, 
theoretically it will. Practically, some sort of fuel must be added. If the 
garbage is cremated somewhere about 300 to 400 pounds of coal is required 
to burn each ton. 

Sometimes the garbage is cremated on the premises in household crema- 
tories. In these the temperature of the firebox is less than 1,000°. In con- 
sequence, the smoke smells. As the amount of garbage burned is small, how- 
ever, there is seldom complaint of odors. Also, because not much garbage is 
consumed, but especially because of the freshness of it, there is little or no 
complaint of odors from the garbage on the way to the furnace. 

The only objection to this method — and it is a valid one — is that garbage 
disposal in a city can never be an individual matter with any safety and 
comfort; and if the community is going to dispose of some of its garbage 
it has the right to have it all. To allow individuals to hold out their grease 
or garbage for any special reasons puts too heavy a burden on the tax- 
payers. The courts have held that if the municipality is forced to take the 
lean it is entitled to take the fat. 

Where a crematory is owned by the municipality sometimes there is 
complaint of odors when the process is cremation. At temperatures of less 



HOW TO DISPOSE OF GAEBAGE 1219 

than 1,200° some of the garbage gases go off unburned. A low temperature 
crematory is less expensive to build than a high temperature destructor. 

If a community is not large and not rich it will be better for it to save 
money by building a crematory, finding for it an isolated location. 

4. Garbage destructors burn garbage at a temperature of 1,600° and over. 
If a good deal of rubbish and manure is mixed with the garbage they require 
little or no coal. 

Garbage can be destroyed in a good destructor at about 30 cents a ton. 
The municipality owning a destructor must figure the per ton cost of collec- 
tion and then add to it about 30 cents for disposal. 

On the other hand, the neighbors do not complain of garbage destructors. 
The smoke is not offensive. The mixed garbage and rubbish en route to the 
destructor are not so offensive as straight garbage. 

GARBAGE ON THE SOIL 

5. This method of garbage disposal is made use of frequently but only 
because the authorities do not know what to do and usually do not know how 
to go about finding out. Generally speaking, this method develops as part 
of a contract system and is not community work. In such towns there are 
garbage collectors who charge from a quarter to a dollar a month to gather 
and dispose of the garbage of a resident. When asked what they do with 
the garbage they reply that they plow it into the ground. Sometimes they 
do; more frequently they put it on dumps. I never have heard of a con- 
tractor burning this garbage. 

There is an idea that garbage has fertilizer value. As raw garbage 
this waste harms the soil far more than it helps even when the soil needs 
many of the chemicals contained in the garbage. It sours the soil. 

Certainly there is never enough fertilizer value in it to pay for the expense 
of scattering and plowing in the garbage. Plowing will not cover it deep 
enough to prevent the fly larvae, with which garbage abounds, from burrowing 
to the surface. 

On top of the inefficiency of this method is the fearful expensiveness of 
it. When what is paid for garbage collection by a householder during the year 
is compared with his taxes he finds that garbage is costing him about as much 
as he is paying for fire, police and health protection together and maybe more. 
The method has nothing to commend it. 

FEEDING TO HOGS 

6. The food value of garbage is much its greatest value. The only way 
devised in this country to get the food value from garbage is by hog feed- 
ing. 

In Denver, Colorado, the profit from the hog feeding pays the cost of 
both collection and disposal. In Worcester, Massachusetts, it has occasionally 
done even better than that. 

In some cities the city pays the expense of collection and of the wagon 
haul, but the contractor pays the expense of the railroad haul. Thus we see 
that the financial advantage of disposal by hog feeding is great. 



1220 GARBAGE 

The objections urged are that the hog pens are offensive and breed flies ; 
that the hogs are sickly and may contract cholera and tuberculosis. Both 
cholera and tuberculous hogs are prone to find their way to market. 

Many places now require that the garbage be cooked before being fed. 
This has always caused the tuberculosis rate to drop, as shown by the govern- 
ment records. Cholera is successfully prevented by vaccination. 

The pens usually are a nuisance. A careful and cleanly contractor will 
prevent this. Many will not. 

Land isolated enough for hog feeding yet accessible to the city is hard to 
find. I expect to see the faults of hog feeding corrected and that method of 
garbage disposal grow. There are communities to which it is well adapted. 



ST. JOSEPH'S GARBAGE REPORT 

St. Joseph, Missouri, followed the plan of dumping its waste in the 
Missouri River from its village days until the time when it was stopped by the 
United States government. It then appointed a commission to study the sub- 
ject of waste disposal. The recommendations of that commission were : 

1. That the municipal collection of all wastes be established. 

2. That vaults in sewer districts be abolished. 

3. That stable manure be collected and sold. 

4. That the reduction of garbage at a profit in St. Joseph is impracticable. 

5. That an effort be made to cooperate with neighboring cities in the 
building and maintenance of refuse disposal works but in event of the failure 
of this effort that St. Joseph's garbage be burned in a destructor. 

6. That a tract of land be purchased for the installation of municipal 
utilities. 

Scores of American cities have appointed commissions on refuse disposal. 
Some of these have been most thorough and scientific; others have not gone 
into the subject deeply. 

Milwaukee, appreciating the variation in the wastes of cities by reason of 
variation in the manufactures as well as variation in domestic customs, in- 
cluded in its report the results of a scientific investigation into the values of 
its wastes. 

In the Boston report there is an analysis of the wastes of that city from 
which we learn that, expressing the tonnage of market refuse by 1, the 
tonnage of rubbish would be 1.5, of garbage 8.5 and of ashes 33.3. 

There are so many of these reports now in hand that there is not much 
need of visiting commissions or testimony taking bodies. Any commissioner of 
public works can analyze these data and use them as a basis for an opinion as to 
what is best for his community. 

Practically every commission has reported that the municipality should 
collect all of the refuse. The Boston report recommends that the community 
collect the refuse but that a charge be made for collecting the refuse from 
certain groups. The recommendation relative to stable manure is a good one 
founded on good economic principles as well as on good sanitary principles, 
yet I know of no community that has carried it out. 

Cooperative treatment of refuse by cities adjacent to each other has 



STABLE MANURE 1221 

not been carried out in this country. In view of the great economic ad- 
vantages of reduction and the further fact that the first cost of reduction works 
puts that method beyond the reach of small communities the suggestion of 
cooperative effort is well worth while. Failing in efforts to cooperate the 
decision to burn was proper. 

The fourth point decided suggests the advisability of cities' providing land 
funds, as German cities have done, and using those funds to purchase lands at 
bargains and then holding them for garbage disposal and other uses. 



STABLE MANURE 

We cannot think of cleaning up without talking about the manure 
box. It would be like the small boy washing his face and leaving a dirt line — 
dirty ears and neck. 

Paper in the alley is as nothing compared with the manure box. It's 
the fly that the whole thing hinges on. The cleaning is to be measured in flies. 
Flies breed in stable manure. They breed elsewhere, it is true, but the breeding 
place de luxe is the manure box. Then let the city cleaning plan include the 
manure box. 

Flies pass through the egg stage and the larva stage to the fly stage in ten 
days in hot weather. In cold weather it may require three weeks, which 
means that the manure box which is emptied every week in hot weather 
and every two weeks in cooler weather does not do much harm. 

The top three feet at least should be emptied. It is in that area that 
the eggs and larvae will be. 

If the box has a fly hole anywhere on the side all the manure for a 
foot or more around must be emptied. Practically, this means that the manure 
box must be made flyproof with a fly screen and that the whole contents must 
be emptied weekly from May until November. 

Forbes of the University of Illinois says that flies will not breed in manure 
if it is treated every day with a sulphate of iron spray. He recommends that 
a solution be made by dissolving two pounds of the iron in a gallon of water 
and using that amount for each horse each day. 

Old-fashioned lime does no good at all as a repellent. Chlorid of lime 
or chlorinated lime Howard recommended several years ago ; but I think he has 
lost faith in it in recent years. 

A few years ago the Jacksonville, Florida, authorities found the ground 
in dirt floor stables teeming with fly eggs and fly larvae. It was their con- 
clusion that a dirt floor stable was always a fly breeder. So our city cleaning 
friends might well look after the stable floors. 

They must not get the idea that automobiles have driven horses out of 
town. There are nearly 100,000 horses in Chicago and the majority of 
them are stabled in the most densely populated part of the city. 

The street sweepings while on the street and also while in the side- 
walk boxes are not fly breeders. They are knocked around too much to 
appeal to Madam Fly. Rather is the fly in search of the more quiet, more 
secluded alley boxes. 

It will do but little good to have these boxes emptied during clean-up 



1222 GARBAGE 

week and left overflowing and uncovered during the weeks that follow. Clean 
ing up includes the plans and equipment necessary to keep clean. 

Disposal of Garbage. — E. H. L. (Colorado) writes: "Kindly tell 
me an effective but simple sanitary way to dispose of garbage in the 
country." 

Reply. — Garbage can be fed to hogs and chickens and this is a good 
method, especially in Colorado. If this method is not available or feasible, 
domestic garbage can be buried. It can be burned in a crematory built 
of stones after the fashion called "kitchen sink crematories" in the United 
States army. This is a small pit lined with stones, deeper at one end than 
at the other, and with a central pile of loose stones reaching higher than the 
level of the pit. A wood fire is built in the pit. After the stones are heated 
through, the garbage is fed to the fire at a moderate rate. 

Burning Out Garbage Cans. — V. E. M. writes: "Here is a practical 
suggestion about garbage cans which you may think useful: We have a 
sheet iron can, and even after it is emptied it is a great breeding place of 
flies, etc. I put in a few newspapers and set them afire. The heat destroys 
germ life and leaves nothing but a few ashes, and it is more effective and 
less expensive than scalding or the use of disinfectants. Of course one 
must watch it for a few minutes to prevent the spreading of fire." 

Reply. — The suggestion contained in this letter should have a wide 
circulation. Offensive cans can be made inoffensive and sterile by burning 
them out. Where it is allowable to wrap the garbage in paper this is not 
necessary. 

Burning Leaves. — 67. R. J. writes: "Please tell whether or not the prac- 
tice of disposing of fallen leaves in the autumn by piling and burning them 
in the streets tends to spread such contagious diseases as diphtheria, etc." 

Reply. — No. 

Danger Has Passed. — E. 8. writes: "A privy vault, used by a family 
of five or six persons for three years, was covered with five feet of dirt 
fourteen years ago. If ever there was any danger to the occupants of the 
house that was built over it, has that danger passed?" 

Reply. — Yes. 

Garbage as Compost. — B. J. A. writes: "I reserve space in the garden 
about 6' x 12', on which I dump the lawn mowings and vegetable tops, 
leaves, and the like. The garbage is dumped, and lawn grass and the like 
is put on the top of it, but not sufficiently thick to keep the air from reach- 
ing it, and the result is that the garbage nitrifies but does not to any 
extent putrefy. Flies when feeding do not dig down into dark places, and 
I have noted that, even when you can almost see through the covering of 
the garbage, flies are slow to enter this opening to feed. In the fall I dig 
this garbage pile and pulverize the contents. Such as does not pulverize I 
fork over and use to start another pile in some other place, so that the 
teachings from it are at a different place in the garden during each year. 
People look at me in astonishment when I show them this sanitary gar- 
bage heap" 

Reply. — This method is worth trying in towns and villages without 
proper garbage disposal. If, however, all premises were clean and the flies 
were put to it for refuse they would go down into these piles. 



CHAPTEE LXIII 

Insurance 

EFFECT OF HEALTH INSURANCE 

Eecent figures show a remarkable improvement in German health con- 
ditions.- The number of deaths from diphtheria was 54,760 in 1893 whereas 
from 1912 to 1916 no yearly total has been as high as 10,000. Typhoid has 
fallen from 18,756 in 1875 to 2,000. The tuberculosis rate' is just one-half 
what it was thirty years ago. 

The death rate of children under one year of age, in German cities, is 
about one-half what it was ten years ago. For instance, of 100 babies born, 
the number of deaths at less than one year of age was in Darmstadt in 1903, 
17.4; in 1910, 9.2; in Dresden in 1903, 19.2; in 1910, 12.8; in Elberfeld, in 
1903, 16.9; in 1910, 9. 

These improvements are the result of health activities, the most compre- 
hensive of which was the Bismarck health insurance bill made operative in 
1892. 

The English death rates also have shown great decrease, though not so 
great as Germany's. London seems permanently intrenched in its position as 
the city with the lowest death rate among large cities. As the result of the 
operation of the insurance bill which became effective a few years ago, London 
should make an equally satisfactory showing by 1917. 

These reduced death rates, reduced sickness rates and the economic 
changes with which they are associated are bearing down hard on the practice 
of healing. When there are not so many to be healed there is not so much 
for the healer. In this country all of the Christian Scientists, osteopaths and 
chiropractors, about half of the homeopaths and eclectics and a respectable 
minority of the so-called regulars are practically always found opposed to 
health legislation. 

In Great Britain the British Medical Association has indorsed the na- 
tional insurance bill but it is contending for more remuneration for services. 
Its members do not believe they should give a man medical service for a year 
for $1.50. Among the matters to be discussed by the forthcoming meeting 
of the British Medical Association are better remuneration for physicians in 
connection with school inspection, care of children, dental work, hospital 
and dispensary work, consumption and maternity service. 

There is no doubt that the people have the right to health and efficiency. 
They will always approve measures which bring about these ends. When once 
the people are informed, such issues make the finest of platforms for political 
parties — platforms on which statesmen and politicians can stand to advantage 
with the people. 

1223 



1224 INSUKANCE 

It is unfortunate that some divisions of healing find it necessary to op- 
pose this work. A wiser policy for them would be to back up the proposals 
but to ask for living conditions under their operation — wiser for them and 
wiser for the people. On this point Lloyd-George said : "Sweated labor is the 
worst labor in the world. If you want to get the best out of a man you 
must pay him a wage which satisfies his reasonable demands. Improve the con- 
dition of the doctors and you improve the general health of the country. '* 
This is the present attitude of the American Medical Association and, I think, 
will eventually be the attitude of the homeopathic and eclectic professions. 



SOCIAL INSURANCE 

The gradual evolution of social insurance is one of the themes of a 
work by Dawson on "Social Insurance in Germany." In that country, as 
everywhere else, governmental activities are foreshadowed by the activities of 
men acting in groups. In Germany the direct forerunners of the insurance laws 
were workingmen's unions paying sickness and disability benefits. In 1854 
the Diet passed laws which strengthened these societies and increased their 
efficiency. One of these laws gave cities the right to pass ordinances requiring 
people to join benefit societies. 

In 1882 Bismarck forced the passage of a scheme of obligatory sickness 
insurance. In arguing for the measure he said: 

"It is the tradition of the dynasty which I serve that it takes the part 
of the weaker ones in the economic struggle." 

The first law passed in Germany does not bear much resemblance to the 
law as it stands now. Just as the law itself evolved out of the benefit features 
of the unions so the law changes as experience demonstrates the wisdom 
of change. 

In many of its provisions the German law is not the equal of the English 
law. There is a provision of the English law that if a town neglects its sani- 
tation and in consequence has a high sickness rate the extra cost is assessed 
against the taxable property of the town. 

Another provision is that if there is a great deal of sickness among 
the workers in a factory and if it is found the factory is not kept in a sanitary 
condition the extra expense of insurance must be borne by the owner of the 
factory. 

There is great agitation in Germany now to use some of the features em- 
bodied in the English law. Especially are they trying to vary the contributions 
to the insurance fund according to the degree of healthfulness of different 
occupations. It is their contention that the insurance rate for the brass 
industry should be higher than that for some industry that has little tendency 
to disable men. The extra expense should be divided, in their judgment, 
between the employer, the employee and the state, as the manufacture of brass 
is a community necessity and therefore a community hazard and expense. 

Discussions of questions of this type in bringing about the end sought 
are also incidentally of great service in popularizing information as to the 
effects of different occupations on health and efficiency. 



INDUSTRIAL INSURANCE 1225 



INDUSTRIAL INSURANCE 

In England the cost of insurance is divided between the employee, the em- 
ployer and the government. In Germany the cost is borne by the employee 
and employer, the government contributing nothing. As the English system 
was not adopted until the German had been working for twenty years natur- 
ally it is an improvement, at least in many particulars, over the plan which 
pioneered. 

In Germany insurance against illness and dependence in old age is 
charged for on the basis of wages. Accident insurance is on a mutual basis 
and varies from year to year. 

The division of cost of sickness and invalidism is divided between employer 
and employee on the basis of about 6 to 10. A workingman getting $7.50 a 
week pays 21 cents for insurance and his employer pays 13 cents. For sickness 
insurance the employee pays about 2.3 per cent of his wages and the em- 
ployer 1.7 per cent. The cost for insurance to provide for old age and in- 
validism is about 1 per cent of wages. The cost of this last type of insurance is 
divided equally between employee and employer. 

For this the service rendered is of many sorts. These health activities are 
well worthy of note. 

Up to the end of 1910 the amount that had been devoted to the building 
of sanitary homes to replace tenements and shacks was $75,000,000. Nearly 
$5,000,000 had been spent in building quarters for single persons; for build- 
ings for the indirect conservation of public health, $38,000,000; education 
of the public in public and personal hygiene, $20,000,000. 

In many places these funds have established recuperation or convalescent 
homes. Since 1899 much energy has been exerted in establishing forest re- 
sorts. At the present time there are more than one hundred of these. The 
better known are those near Berlin, Dusseldorf, Munich, Dresden, Leipzig, 
Cassel, Carlsruhe, Frankfort and Hanover. These resorts are made as in- 
expensive as possible. The buildings are cheap wooden shacks with shelter 
benches, chairs and hammocks. A lunch counter serving bread and milk 
is provided. Generally, the forest resorts are within seven miles of the city 
on lines of easy communication, and the invalids are expected to reach 
them in the early morning and to leave for home by night. 

They take care of people with weak nerves, asthma, anemia, mild heart 
disease and convalescents generally — "those persons in indifferent health who 
need to rest and recuperate in the open air." 

Charlottenburg maintains what is known as a Holiday Colony for children. 

Much of the activities of the boards is directed toward the lowering of 
infant mortality. Dawson says the central idea coming to be seen, or seen with 
increasing clearness, is that men value fair and full use of their faculties more 
highly than distress benefits. They want healthy life, sound limbs and unim- 
paired energies, not accident compensation; opportunity and power to work, 
not infirmity pensions. 



CHAPTER LXIV 

Hospitals — Schools 

VALUE OF THE HOSPITAL 

The usefulness of the hospital in this country is not generally understood 
or appreciated. For one reason or another there seems to be an unwarranted 
prejudice entertained against it by a large percentage of our people. This in 
some measure is due to ignorance of its functions. 

There has also been coupled with the name "hospital" in this country a 
feeling of dislike superinduced, no doubt, by superstition. In other words, 
when you say the word "hospital" to a number of people "like a duck in thun- 
der" they seem to lose their mental bearings. 

Let it be said (and to the credit of our people, too) that this dislike for 
hospitals is being rapidly and fortunately overcome. 

Both the doctor and the layman are beginning to realize that the proper 
place in which to carry on the fight against the ravages of disease and to lessen 
human suffering is in the hospital. It is in the hospital that the medical 
man and the surgeon can do the most effective work in their efforts to elucidate 
the cause of disease, to discover methods for preventing disease and to apply 
most scientifically remedies and surgical measures for curing disease and re- 
pairing fractures. 

"The role which the modern hospital plays in the education not only of 
the medical profession hut also of the public in general is far reaching and its 
scope is practically unlimited. The abundance of clinical material which comes 
under the eye of the physician or surgeon is important in increasing his 
knowledge of diseases and their treatment." 

The functions of the hospital, however, are not limited to the mere caring 
for the sick and the injured. The hospital is the center of genuine scientific 
medical and surgical work. 

Here the latest and most improved methods of caring for the sick and the 
injured are employed. Here the nurse receives her education in how to 
conduct a campaign in favor of public health. Here the sanitary engineer 
goes to get points on how to build and operate public institutions. Here 
the sanitary physician receives his training in how to prevent the spread of 
diseases, especially those communicable. 

Here you find the bacteriologist, the chemist, the scientist, actively at work 
furnishing special knowledge to the statistician as a basis from which he 
makes up his calculations. Here is the headquarters for that large body of 
doctors and nurses who compose our sanitary educators and who go about 
disseminating knowledge of the way disease spreads and the ways in which 
it is prevented. 

1226 



VALUE OF THE HOSPITAL 1227 

This body of missionaries of sanitation constitutes, in my judgment, the 
most important army of men and women engaged in the modern movement 
for the conservation of public health. In the campaign against contagious 
and infectious diseases, particularly tuberculosis, they have disseminated 
much knowledge concerning the importance of personal hygiene and prac- 
tical methods of sanitation. 

The anti-tuberculosis movement brought the knowledge of how to fight 
this particular microbe into the home of the individual. Knowledge of the 
sanitary disposition of the sputum, of how to make tenements and shops hy- 
gienic and of what constituted healthy habits of the individual were taught to 
each member of the home. 

The people were taught that the success of the fight against the great 
white plague was an individual fight and that the duty of each individual 
was so to shape his life and habits as not to affect his friends and neigh- 
bors. 

The credit for setting in motion the machinery which has so successfully 
carried this knowledge of hygiene and sanitation into the home of the in- 
dividual is largely due to the hospital. 

It must not be forgotten that these results were not accomplished by 
merely disseminating information through lecture bureaus, pamphlets and 
general instruction. 

These doctors and nurses — missionaries — went personally into the field of 
work and personally taught sanitation and hygiene. 

What they have done to educate people concerning the cause and cure of 
tuberculosis they have done equally as effectively regarding the cause and cure 
of other contagious diseases. Of them Bishop Spaulding would say: 

"They are true physicians, waiting upon the miseries of man; like sen- 
tinels, at their posts they stand, ever ready to bring relief. Xeither dark- 
ness of night, nor storm, nor contagion, nor pestilence, nor the field of 
carnage can deter them when duty calls." 

It is through this personal work that much of the information used for 
making up the vital statistics record, particularly among children, has been 
secured. 

For some reason or other a fallacy has obtained among the doctors as 
well as the laity that the hospital is only for surgical and operative cases. 
This, however, is not true. On the other hand, the hospital is the safe place 
for a case of typhoid, pneumonia, appendicitis, peritonitis — in fact, any 
illness of sufficient seriousness to require daily visits by the physician and an 
attending nurse or where much nursing or attention is required on the part of 
members of the family or friends. 

Here you find system and regularity in the care of the sufferer and, should 
an emergency arise requiring the hasty intervention of surgical procedures to 
foil death, much time can be saved. 

The time element with reference to the conditions when the operation 
is done is also a determining factor when we come to make up the prognosis 
of the case. 

No doubt many a life could have been- saved by quick surgical procedures 
when an operable case reached the crisis had the case been where the opera,- 
Hon could have been performed. 



1228 HOSPITALS— SCHOOLS 

Many surgeons of renown hesitate when asked to operate under the 
handicap of ill prepared surroundings. 

To operate in a strange place with strange help is unfair to the patient and 
to the surgeon. His mind should be free to concentrate on what his eye is 
seeing, his fingers are feeling and his knife is cutting. 

He cannot divide his thought and be just to the patient; and even with 
the best of oversight strange attendants and strange surroundings not in- 
frequently mean a break in surgical cleanliness — a chain as weak as its weakest 
link. 

When sick and in the hospital you are reasonably sure of being efficiently 
cared for. In the hospital a chart is kept by the attending nurse so that each 
time the doctor makes a visit he has but to glance over this chart in order 
to know how his patient has progressed, in order to know the condition of 
his patient. 

There is then little for the doctor to do save to look at his charts, occa- 
sionally attend dressings (when the case happens to be a surgical one), and 
direct the nurse as to the further care of his patient. 

The patient feels more at ease realizing that he is not a burden to family 
and friends and that every attention possible will be accorded him tending 
to make him comfortable and well. 

The family, knowing that the sick one will be properly cared for, that it 
can hear from him at almost any hour of the day or night, soon becomes 
reconciled to this condition and is far better off, being relieved of the burden 
of care which would otherwise have been imposed and being better able to attend 
to its daily duties. 

WHO SHOULD GO TO A HOSPITAL 

Shall an expectant mother go to the hospital ? Yes. Health department 
reports show that about one-thirtieth of the babies born die during the first 
twenty-four hours of birth. The death rate during the first week is very 
high. The newly born babe has but a feeble hold on life and little, seemingly 
unimportant influences may decide whether the baby will live or not. The in- 
fection of the baby's eyes which ends in blindness starts suddenly and progresses 
rapidly. The chance of saving sight is greater in the hospital than outside. 

When it comes to the mother, the death and accident rate among mothers 
is much less in a hospital than outside. There is less infection, less childbed 
fever and less danger from hemorrhage. The risk in every direction is less. 

When we consider the trouble in the home, the advantage is on the 
side of having the mother go to the hospital. The household is spared disar- 
rangement. One reason for the growth in midwife confinement is the matter 
of household necessities. When a woman of small means is confined in her 
home by a physician, provision must be made for the physician, the nurse, and 
a servant to help out. When the service is rendered by a midwife, the doctor, 
the nurse and the servant are all rolled into one. In my judgment, the house- 
hold service advantage is the largest factor in the growing use of midwives. 
The cure for the situation — and the high death and accident rates demand 
a remedy — is enough hospitals and dispensaries to care for the maternity cases. 
And finally, it will be found that a case of confinement costs less in the 
hospital than at home. 



VALUE OF THE HOSPITAL 1229 

Shall consumption be cared for in a hospital? Yes. The chance of getting 
well is very much better in a hospital than outside. A man who learns that 
he has consumption will improve his chances materially if he will go at once 
to a sanitarium. He will get rest and an environment which makes against 
worry in contrast with his home where things make for worry. He will be fed 
right. He will get air. He will learn how to take care of himself and 
others. Learning by doing is better than learning by listening. If his 
disease is not progressive in type he may be able to finish his cure at home. 

Every case of advanced tuberculosis should be in a hospital. They are 
safer and happier there. Their chance of cure is greater there than outside. 
An advanced consumptive kept at home is certain to infect half of his 
immediate family, although many of them may cure their infection after a 
short "run down" period. 

Should a case of typhoid fever go to the hospital? Yes. The death rate 
from typhoid fever in hospitals is lower than outside. In an ordinary epi- 
demic out of each one hundred cases treated outside hospitals, ninety get well. 
Out of a similar number treated in hospitals ninety-four will get well — a dif- 
ference worth considering. 

Aside from the influence on a man's chance of recovery is the question 
of protecting the community. Typhoid cases cared for by nurses in fly- 
screened houses where there are good toilet facilities do not endanger any- 
body. Unless these conditions are met there is a moderate amount of danger. 
If there is no regard whatsoever for sanitary law there is great danger. 

Shall teething babies be cared for in hospitals? ~No. This answer re- 
quires some modification. If the choice is between a very poor home and a 
hospital the answer should be — Yes. If the mother can go to the hospital and 
breast-feed her baby — Yes. If the wards are refrigerated so that the tem- 
perature is kept below 75°, if the windows are screened and if the milk is 
given to the babies from cows on the premises or if it is received at the 
hospital in less than twelve hours after it has been milked and used in less 
than twenty-four hours — Yes. 

In between these extremes there are the cases that are to be decided 
after weighing the sanitary virtues of the hospital and the sanitary vices of the 
home — each case to be decided individually. The hospital baby death rate 
is very high. In the old-style hospital it was nearly 100 per cent. The 
more modern ones are showing lower death rates but their rates are still above 
those of babies in reasonably good homes. 

Shall ordinary illness be cared for in a hospital? Yes. The home is for 
the well. The hospital is for the sick. The home is planned to care for a well 
man with a high degree of efficiency. When it comes to caring for sick men 
its efficiency is low. If a home can care for a sick man efficiently then cer- 
tainly there is great waste in its care of the well. A home that has a great 
excess of room, of space, of everything, can care for a sick man — not well but 
passably well. But see the habitual waste of such a place. 

The chance of recovery in a home is less than in a hospital. If the illness 
is mild and recovery is certain this does not make much difference. The sick 
one is disturbed more by worry, noise and domestic disarrangement; but no 
vital harm is done. If the illness is violent and life hangs in the balance the 
advantage of the hospital over the home may be enough to determine the issue. 



1230 HOSPITALS— SCHOOLS 

In our thought of the sick member we must not overlook the well. The 
breadwinners can stand the extra strain much better when the sick one is in a 
hospital. It is presumed the home is what it ought to be in this phase 
at least — the place where the workers-out can be at ease to recuperate from the 
burden of one day and to prepare for the trials of the next. Usually illness 
places an extra strain on the workers-out and the mother in charge of the 
house. Generally it is poor judgment to load them with this extra strain, espe- 
cially as the alternative — hospital care — gives the sick person greater comfort 
and a better chance of recovery. 

The above is the sensible way to look at hospitals. Eventually it will be 
the way everybody will look at them — rich and poor alike. If everybody 
thought this way now there would not be beds enough for the sick. The 
percentage of beds to population will probably grow about as fast as sentiment 
demands. Before many years towns of 5,000 and even thickly populated 
rural districts will have hospitals. 

CASES OF CONTAGION IN HOSPITALS 

Should every case of contagion go to a hospital? To this question there is 
but one answer — Yes. There are certain conditions under which the need 
is most imperative. For instance, contagion developing in a hotel must 
go to a hospital, however strong is the inclination otherwise. The demand 
is almost as great where the case is in a flat building or in a house where 
several families live on the same floor or in the same building. If several 
families use the same toilet facilities, as is the case so frequently in poorer 
homes, the disease always spreads if the case is left in the home. 

Certain diseases are more easily spread than others. Smallpox in a city 
cannot be left in the home with safety. Measles is about as certain to 
spread when left in the home as is smallpox. Scarlet fever and diphtheria 
are much less catching and frequently no spreading follows the leaving of a 
case in the home. 

Spinal meningitis and infantile paralysis are not so dangerous but that 
they can be left at home during the disease ; but after convalescence is estab- 
lished it is highly desirable to carry the patient to the hospital or convalescent 
home and leave him there until he is safe. 

Whatever the form of contagion the sick one stands a better chance in 
the hospital than at home. There never was a home good enough or provided 
with enough nurses or enough doctors to make it as good a place to be sick 
in as a good hospital with the special nurses and special physicians that 
money can buy. When it comes to comparing a crowded home with a hospital 
the advantage is all on the side of the hospital. The parent who keeps his 
child sick with contagion at home is not fair with his child. He increases 
his chance of dying at least 10 per cent, and sometimes much more. That is a 
pretty big price to pay for sentiment. 

Should surgical cases be cared for in a hospital? Again the answer is 
yes. The emphasis of the answer depends on circumstances. If the case 
is one where infection must be strenuously avoided the answer is emphatic. If 
it is one where accidents are liable to happen or emergencies to arise, emphati- 
cally yes. 



SCHOOLS 



1231 



If the case is one where life is to hang in the balance, where everybody 
must work at high efficiency or death will result, emphatically yes. Other 
types of cases permit more leeway. There are times when one or another 
consideration may make it wise to keep the patient at home. But even 
in these the burden of proof should be on the home. 



SCHOOLS 

SCHOOL EFFICIENCY EFFORT 

A book well worth one's while is Miss Denison's "Health of School 
Children." In this book she says: "The chief reason that national and 
large local groups of physicians interested in school health have not been 
more effective is that they have not yet appreciated the value of lay coopera- 
tion." 

Since the development of the public school system parents, physicians, 
and everybody have been disposed to unload the child on the school teacher. 




California State Board of Health Bulletin. 



Fig. 499. — Typical Sewage Disposal by Subsurface Irrigation. 



Not only is mental training expected but physical and moral training as well. 
The parent has leaned on the school teacher, as everybody knows. 

The physician has been even a worse offender. Nine physicians out of ten 
know nothing about the hygiene of the schoolroom; have given no thought to 
posture in relation to development or even to the spread of contagion through 
the schools. The physician has unloaded on the teacher. 

If one reads the books (of which there is a considerable number) on the 
different phases of school hygiene he will note that most of them are written 
by teachers. The few from the pens of medical men are written by such as 
are not working at their trade; none of them at least is practicing curative 
medicine. 

Now it is a fact that the physical care of the child limps along, lame 
and halt, while the mental care goes by leaps and bounds. The reason is a 
lack of public interest. As it is on the shoulders of the teachers that the burden 
falls Miss Denison's suggestion should have been tendered the teaching rather 
than the medical profession. 

In addition Miss Denison estimates that the people of the United States 
spend $10,000,000 a year in helping out the schools. This money is put 
out for school lunches, school playgrounds, open-air schools and a thousand 
activities supplementing work done out of public funds, 



1232 HOSPITALS— SCHOOLS 

For instance, business men of Columbus, Georgia, contributed $10,000 
for kindergartens. A bequest of $120,000 provided Oshkosh, Wisconsin, with a 
manual training school. Two million dollars was bequeathed to help out the 
Muskegon, Michigan, schools. One thousand dollars was given to the Eacine, 
Wisconsin, school library. The outdoor schools of Chicago are aided by the 
Elizabeth McCormick Memorial fund — and so on through a long list. 

The style was set by Benjamin Franklin who bequeathed $500 as a 
fund the interest on which was to be used to help out the Boston schools. 

Anyone who reads this book by Miss Denison will be astounded to know 
how much is being done; also to know how differently it is being done. 

No two communities are doing exactly the same thing in exactly the same 
way. This, of course, means that things are being wastefully done. 

If there were a standardized method of procedure and every town trying 
to do something for school hygiene would follow these standardized methods 
a dollar would go twice as far. 

A great many million dollars have been expended on the ventilation of 
school buildings. This ventilation has been all right from the engineering 
standpoint yet all wrong from the health standpoint because the only sani- 
tary standards for ventilation are forty years old. 

A New York woman has given a sum of money to be expended in es- 
tablishing sanitary standards of ventilation particularly for schools. While it 
will not be possible to have a report at Buffalo from the commission created 
for this purpose Winslow, Kimball and perhaps others of prominence are on 
the board and the machinery will be set going for a wide publication and ac- 
ceptation of the report when it is issued. 

However, this is only an illustration. Physical examination, control of 
contagion, school nursing, school feeding, open-air schools, cold-room schools 
— in each of these there is urgent need of standardization of method. 

Efficiency is the talk of the day. The railroad man wants to know the 
efficiency of rails, tires, engines, cars — everything. The business man will 
take time from his business to study efficiency in salesmanship or in some 
other department of his business. He will employ efficiency engineers and 
permit them to come and go as they please through his affairs. 

In fact, efficiency makes an impression on the impassive mind of the 
business man where sickness rates, disease rates and death rates are impotent. 

It has always seemed to me that the business mind is of the show-me 
type and efficiency engineering from beginning to end is on a show-me plan. 
These other arguments are not easily reducible to the show-me basis and in 
consequence they do not lend themselves readily to argument for business since 
business is on a competitive basis. 

It is not difficult to prove the loss of efficiency in school children. Chil- 
dren are taught in classes of about forty. Of this forty about five are so im- 
possible that the teacher sets the pace without regard to them. At the top 
are about two who are rapidly passed on to higher grades. 

There remain about thirty-three for whom the pace is set so that the 
weakest ten in the group can keep up. That means that the top fifteen could 
go much faster than they do ; could learn much more thoroughly as well. When 
they are held back to the pace of the low ten they are working at low 
efficiency. 



SCHOOLS 1233 

This condition is recognized by the teacher. She works extra hard in an 
effort to bring the pacemakers, the low ten, along as rapidly as possible. She 
is presently in a state of chronic fatigue. She works at low efficiency. 

Of the millions of money spent for education much the larger part paid 
from current funds is for teachers 5 salaries. In the Hoboken budget exhibit 
there was a diagram showing that about 70 cents out of each dollar went for 
teachers' salaries. 

Therefore, when teachers work at low efficiency, the taxpayer is hard hit. 

The school teacher does not work at low efficiency because she wants to. 
Her anxiety to get results that are impossible is partly responsible for her 
low efficiency. 

In fact, the cause is beyond her direct control. She sits at one end of the 
line compelled to mold minds whose incapacity for molding at an efficient rate 
has been determined by factors at the other end of the line. She must mold 
the clay as it is furnished her. Is there anything she can do ? 

These facts are unknown to the community in general. The fathers are 
too busy with their business and the mothers with their homes. Xobody has 
ever told the taxpayer about these wasted millions. 

Nobody (speaking with as much authority as the school teacher) can tell 
him about the waste. She knows and the parents know she knows. They will 
listen to her. 

As Miss Denison says, the matter will never make a public appeal until it 
gets away from the professional societies ; until the to-be-helped rather than the 
helpers feel it their concern. 

The child is unable to learn because of his physical condition. 

He may have too much thyroid or too little, too much or too little of some 
other gland, or he may have bad teeth or be a mouth breather or a catcher or a 
snuffler — any one of these or many other conditions may be responsible for his 
predicament. But here lies the cause in three cases out of four. And 
why not ? 

We have known for centuries that in the years from seven to seventeen 
the mind must be looked after. Certain exceptional brains will travel through 
those years without control and direction and will acquire power as well as 
training. Those are the exceptions. 

The average brain left undirected in those years travels toward the 
penitentiary or poorhouse, or into the group of untrained labor. These facts 
are so well established that education is compulsory. 

The changes in the body between seven and seventeen are as important as 
those in the mind. If it is necessary for the welfare of society that this enor- 
mous educational machine should be supported to train the mind is it logical 
that the body should be wholly uncared for? If it be argued that that can 
be left to the parent, the home and the child the answer is that education can 
be left to the same agencies. 

When education is left to these groups unaided the percentage of unfit 
minds increases though many minds come out all right. Is it not logical 
to assert that when the physical side is left to the same agencies unaided' the 
percentage of the unfit is increased, even though a great many come out 
all right? 

Under a better system is it not probable that we shall get after a while 



1234 



HOSPITALS— SCHOOLS 



a better idea of what is physically right just as our present standard of a 
trained mind is much higher than that of half a century ago ? 

If the mind and the body are Siamese twins and the developed, trained 




Illinois Dept. of Public Instruction. 

Fig. 500. — McCabe Drinking Fountain Attached to a 
Pump. 



twin is being held back by the untrained one shall we bring up the halt one 
or shall we lame the other one? 

There is no use trying to run the halves of the machine at different 
speeds. Education must not go back. 

The child is an egoistic parasite. The schools train him out of egoism and 
somewhat out of parasitism. Eubbing up against other children gives him a 
chance to find himself. 

The demand for efficiency is increasing. The public schools will find 
that the burden put on them in the future will be much increased. 

This half of the machine cannot slow down. The other half must be 
speeded up. That is not possible when the years from seven to seventeen are 
not made use of for the perfection of the machine. 

The condition to which it can be brought by home and parental and in- 



SCHOOLS 



1235 



dividual care will not allow of any more speeding up. It is like trying to use at 
speed ball bearings where two-tenths of the balls are imperfect. It cannot 
be done. It is unreasonable to think that it can. 



(From Water-Supplies, by Thresh) 




Iowa Bulletin. Dept. Public Instruction, Springfield, III. 

Fig. 501. — Homemade Filter for Do- Fig. 502. — Antiseptic Tank or Chemical System 
mestic or School Use. for One-Room Schools. 

To proceed further on our present lines does not commend itself to 
Yankee horse sense. 

SCHOOL HYGIENE 



This is what Dr. Corlin wrote the Michigan Board of Health to show 
what bad school conditions could do : 

"Numerous hale, ruddy, little pupils, five, six, seven and eight years of 
age have entered with much ambition for their first school instruction. As I 
have had my own children among them and others to treat, I have watched 
the effect of their condition and surroundings and know whereof I affirm. 
In this building, on a small scale, I have seen Darwin's theory of the 
survival of the fittest tested, and its correctness demonstrated. 

"Year by year, this school is constantly crowded beyond its healthful 
capacity, notwithstanding that the weaker ones are continuously compelled 
to drop from the ranks and remain at home to recruit their exhausted energies. 

"A little boy who, during a period of four years, was confined in one 
of these rooms accomplished no more than could easily have been done in 
two years' time under suitable and healthful surroundings. 



1S36 HOSPITALS— SCHOOLS 

"Because of the vile air of this room, he was permitted by his father 
to attend but one and a half hours each morning and afternoon, and, even 
so, he could attend the school for no more than eight or nine successive weeks, 
because of resulting sickness, from which a few weeks' absence from school 
never failed to restore him. 

"He was finally sent to a more distant and, from a sanitary point of view, 
a better school, and, in a clean, light, and airy room, where he attended 
regularly and without interruption, improved in physical health and accom- 
plished much more in his studies than at any previous time." 

To which Professor Woodbridge adds: 

"The hardest worker in a school-room is the teacher. The character of 
a teacher's work is as susceptible to the debilitating and blunting effects of 
environment as is that of the scholar. Whatever affects the teacher's working 
capacity correspondingly affects the productive work of the pupils." 

Compulsory education is all right. It has been upheld by the courts. It is 
backed by public sentiment. However, compulsory education is a misnomer. 
The laws should be known as compulsory attendance laws. 

Education implies something more than attendance. Children who are 
not in good physical condition do not get much educational benefit from 
attendance. If the hygienic conditions are extremely bad they may be griev- 
ously harmed by compulsory attendance. 

The burden put upon the teachers by bad school hygiene is great. 

SCHOOLROOM VENTILATION 

Schools are usually well lignted Dut poorly ventilated. In fact, they 
usually surfer from too much rather than too little light. Nor have I ever 
been able to see much danger from schoolroom dust. But when it comes to 
ventilation including regulation of temperature and moisture, conditions are 
bad. They are unfit for grown people to stay in, to say nothing of 
children. It is the fault of ventilation methods which are overdeveloped on 
their mechanical side. They are so bad hygienically because they are so 
good mechanically. Why ? 

All school ventilation by a mechanical system is based on the idea that the 
carbonic acid gas of a room is poisonous and we must add enough diluting 
air to keep its percentage down. We know now that carbonic acid gas is 
nearly harmless. Eosenau has shown that there are harmful chemicals in air 
that has been breathed; but not even this alters the opinion that the proper 
plan is to remove and not dilute. 

A ventilation system which is based on the dilution of breathed air is in- 
efficient and at the same time expensive. It is wasteful because it requires 
2,000 cubic feet per person per hour while if the temperature is kept down, 
the humidity up, and the rooms are blown out from time to time a much 
less quantity gives much better results. 

Mechanical systems are faulty for a second reason. The air is too still 
and too uniform in temperature. Hill proved that still air is harmful; 
Pfliigge's pupils that air uniform in temperature is harmful. 

The teacher can watch the temperature and humidity of the room with 
profit to herself and with no material increase in her trouble. Let there be a 



SCHOOLS 1237 

wet and dry bulb thermometer in each schoolroom. Make it the duty of one 
student to make an hourly reading of each. From these readings the 
humidity can be determined by the chart which is a part of the hygrometer 
equipment. The temperature of the schoolroom must not be allowed to rise 
above 70°. The humidity must not be allowed to fall below 50. 

How these requirements are to be met is the problem of the engineer, 
not the teacher. But if she will be insistent enough that these requirements 
are met she will be able to teach with far less effort than now. In addition, 
from time to time let the rooms be aired and the temperature lowered by 
opening the windows. The blowing that is good for sick air is the blowing 
that can be felt. 

These are easy and worth while things. The doing of them adds but 
little to the teacher's burdens. On the other hand when they are successfully 
done they lighten the teacher's load. Attended to, three o'clock comes earlier 
in the day, Saturday gets nearer Monday and June gets in speaking distance 
of October. 

Of course, in time the entire method of school ventilation must be made 
over from cellar to garret. The hygienists must lay down new standards 
and the ventilating engineers must meet them. 

Improvement of Ventilation. — The Chicago Ventilation Commission 
has indorsed the following propositions: 

1. In a mixture of air containing carbonic acid this gas does not settle 
out and rest near the floor. 

2. The dilution method of ventilation is ineffective and uneconomical. 

3. The putting of a given volume of air into a room does not necessarily 
constitute ventilation. 

4. Ventilation is better done by air currents than by dilution. 

Anyone acquainted with the present methods of ventilation knows that 
the theories of the ventilation system now employed are the direct opposite 
of these conclusions. It would be strange if the practice founded on wrong 
principles should be right. Therefore, we are prepared to find the practice 
faulty. 

The principal faults of the Chicago practice are the following: 
. 1. The temperature is not properly controlled ; is not properly observed ; is 
not properly taken; is generally too high. 

2. The humidity is not properly observed ; is generally too low. 

3. The air in the room is too still. 

4. The inside walls are too hot, the outside walls and windows are 
too cold. 

5. The air as introduced in the room is too hot. 

6. There is no provision for blowing out the room by putting the windows 
up. 

Discussing these points in order: 

1. Pfliigge has demonstrated that high temperature is the most harmful 
agent in air which is harmful. It is now quite well accepted that in watch- 
ing ventilation the main thing to watch is the temperature. The schoolrooms 
have a temperature which, theoretically, is fixed at 72°. But where is the 
thermometer placed? The outside walls are many degrees colder than the 
inside; the places near the hot air intakes are much hotter than any other 



1238 HOSPITALS— SCHOOLS 

place in the room; the temperature varies in the different levels above the 
floor. 

Does the thermometer show the average temperature of the room or the 
temperature of some point lower or higher than the average ? The theoretical 
temperature is four degrees too high. 

Suggested remedy : 

(a) Set the official temperature at 68°. 

(b) Furnish every room with a thermometer which can be moved to 
different parts of the room, that an average may be struck. 

(c) Have the children or a child make an hourly record of the tempera- 
ture in the room. 

2. Air more than 70 per cent saturated with moisture is very oppressive 
when it is hot and very chilling when it is cold. Air less than 50 per cent 
saturated with moisture dries the skin, nose, throat and bronchial tubes and 
causes infection when the air contains dust and bacteria. 

The humidity of the inside air should be within twenty points of that 
of the outside air or harm will result. Keep this point clearly in mind. If the 
outside air is at 32° F. and the percentage of saturation with moisture is 100, 
and if this air be heated to 132° and no water added to it or taken from it it 
will be about 3 per cent saturated with moisture. Such air dries up the 
tissues. 

Says MacFie : "The living matter of the body contains about 80 per cent 
of water, and, on the water in its composition, its vital activity depends. 
Abstract the water and dry up the tissue, and its vitality is arrested or 
destroyed. In man, the loss of about 10 per cent of his body water means 
death." 

The present plan takes in ordinary outside air and dries it by heat. No 
moisture is added. To make it healthy moisture should be added almost in 
proportion as heat is added — say as 4 is to 5. No observations on room 
humidity are made. 

Suggestions : 

Wet steam should be turned into the heating chambers. 

Every room should be equipped with a hygrometer. 

The children, or a child, should make an hourly record of the humidity. 

3. Leonard Hill has proved that air cannot be healthy unless it is moving 
with a good deal of velocity. As it strikes the body it must have force enough 
to blow the foul air away. It must clean the breathing zone, the air around 
the head. It must clean the air around the body under the clothes — Sedg- 
wick's "aerial envelope." 

Still air is deadly. The present method aims to give the air a morgue-like 
stillness. The hot air, frequently around 130°, is introduced about eight 
feet above the floor. Theoretically the air blows across the room next the 
ceiling, diffuses to the floor and gently leaves by an exit near the floor line. 
The object is to do away with air currents. 

Suggestion : 

Equip the schoolrooms with electric fans to run during the winter. Fans 
are a source of comfort during the summer ; they are a source of health during 
the winter. 

4. Inside walls are always warm when the building is warm. If a person 



SCHOOLS 1239 

could not get rid of the Iteat which he made and kept on making heat at 
the average rate he would reach the boiling temperature, 212°, in thirty-six 
hours. Fifty children in a schoolroom make a great excess of heat. 

The inside wall and the children are two factors requiring no heat. The 
air for ventilation and the outside walls are two factors requiring heat. The 
radiation in a room should always be near the outside walls. 

The present method keeps the inside walls too hot; and at the same time 
the outside walls are so cold that they sweat and frost if the relative humidity 
of the air in the room goes over 50. Therefore, either the outside walls 
and windows will be constantly wet or else the relative humidity of the air 
of the rooms must be so low that it is unhealthy. 

Suggestions : 

Set the fans so as to blow air against the windows as the storekeepers 
now do. 

If there are no fans it is better to tolerate the window and wall sweat- 
ing than to try to keep the pupils healthy with the overdry air now fur- 
nished. 

5. Air which comes in contact with a human being should always be under 
95°. If hot air is kept moving rapidly and the relative humidity is kept around 
70 the harm is greatly diminished. Air entering the Chicago schoolrooms 
on a very cold day will range from 115° to 130°. It is very harmful if it 
touches any teacher or child. 

Suggestion : 

Every precaution should be taken to deflect this air so that it strikes no 
one until it is greatly cooled. The present methods accomplish this about 
as well as it can be done. The only remedy is in a radical change in the 
methods. 

6. All are agreed that blowing out is the most effective method of 
cleaning. When the children return to the schoolroom from play they are 
making heat in great excess. If the room is over 68° they get overheated 
and sweat. 

Suggestions : 

All schoolrooms should be blown out during each play period. The 
children should return to a room in which the temperature is at 60°. 

The intervals between blowings out should not be longer than four 
hours. 

If the ventilation system cannot adjust itself to periodic blowing out of 
the room that of itself is enough to condemn the system. 

The above suggestions are applicable to the present installations. None 
of them except the fans will cost much money. A combined thermometer 
and hygrometer can be had for about twice the cost of a thermometer. In the 
main, the suggestions call for some retraining of the school engineers and 
that is about all. 

When new schools are built they should be heated and ventilated along 
the following lines : 

1. Eadiation placed along the outside walls. 

2. Air intakes through the walls back of the radiators. 

3. Air outlets located on the inside wall near the ceiling. 

4. Outlet duct: in the attic equipped with exhaust fans. 



1240 



HOSPITALS— SCHOOLS 



5. Provision for discharge into the room of enough saturated steam to 
maintain the relative humidity at 50 to 70. 

6. Provision for enough radiation to keep the room temperature at 68° 
F. and the temperature of the outside walls high enough to permit of a 
humidity of 60 to 70. 

7. Windows which can be raised. 




Illinois Dept. of Public Instruction 



Fig. 503. — Perspective of Modern One-Room School. 

Such a system can be installed for much less than the present cost of 
installation. It will do away with the present elaborate heating and mixing 
chambers. It will reduce the expense of installation of ducts much below 
its present rate. It will mean a smaller fan cost. 

The volume of air to be handled need not be 1,800 cubic feet per pupil 
per hour. So large a quantity was demanded for the present system because 
of the mistaken method of ventilation by dilution. This can be reduced two- 
thirds. This will save enormously in the cost of heating. It will save in 
the volume of air to be handled and therefore in the cost of fan installation 
and maintenance. 

On windy days the rooms on the windward side would require no exhaust. 
The fan work would then be limited to the rooms on the lee side. These items 
would much more than offset the cost of a steam or hot water installation. 
Besides, it would cost less to heat and humidify when the temperature was 68° 



SCHOOLS 



1241 



than to heat and not humidify where the temperature was kept at 72°. 

Heating and Ventilation of the One-Room School. — The one-room 
school generally stands exposed to the wind. Its walls should be well insulated 
and its windows well chinked and provided with storm sashes. There should 
be deadening beneath the floor because at best the floor will be cold. The 
temperature of the room must not go above 68° and the wet bulb must stand 
as high as 56°. The room must be blown out by opening the doors at least 
three times during each day and the children must come from play into a room 
with a temperature of 60°. 

We will assume that the room is heated by a stove located toward the 







|H i 



Illinois Dept. of Public Instruction. 



Fig. 504. — Showing Stairway to Basement. 



center. The stove must be jacketed so that air flows between the jacket and the 
hot iron wall. It must be set close to the floor and be provided with perfora- 
tions in the jacket to suck in cold air from the floor zone and warm it up. 
Fresh air should be taken through pipes which lead from underneath the house 
to the jacket and space around the stove. These ducts should be provided 
with dampers. 

Outlets provided with dampers should open through the roof or into an 
unused attic where there is one. At least one outlet should be around the 
stovepipe to get the lift of the heat in the pipe as a means of emptying the 
foul air from the room. If it is necessary to economize fuel some of the fresh 
air can be brought in through a tube within or alongside the stovepipe so as 
to use some of the waste heat of the smoke to preheat the fresh air. 

In order to moisten the air the upper part of the stove should be occupied 
by a water pan several feet square. The water must be near the boiling point. 
Gallons must be evaporated each day — say ten to twenty — enough to keep the 
humidity over JfO. 

To clean the air cheesecloth filters should be placed in the intake pipes, 



1242 



HOSPITALS— SCHOOLS 



These consist of two frames arranged like an embroidery frame. Into this 
frame a fresh piece of cheesecloth can be inserted. 

The standards for country school ventilation are: 

Temperature, 68°, 

Foot zone temperature, 65°. 

Wet bulb temperature, 56°. 

Clean air. 

Clean floor. 

Air freshened several times a day. 

Teaching in Cold Air. — It was inevitable that the teachers and pupils 
made anemic and listless by the warm, dry air of mechanically ventilated 




Illinois Dept. of Public Instruction. 

Fig. 505. — A Less Expensive School House. 



schoolrooms should become discontented. When the school inspectors found 
such a train of enlarged glands and recurring colds as their statistics show 
this discontent started a demand for better school ventilation. From this de- 
mand three offshoots have crystallized: 

Teaching in rooms where the windows are periodically opened. 

Teaching in open-window rooms. 

Teaching in opon-air schools. 

Each of these is suited to a certain type of child and unsuited to others. 
For the average child in a cold climate the first is adapted. For the child 
that has glands, is a mouth breather or catches cold easily the second is better. 
For the tuberculous child and the child from a home where there is active 
tuberculosis the third has been worked out. 

A procedure so simple as opening the windows is best carried out accord- 
ing to a plan. I know of none better than to throw them wide open for 
the last five minutes of all recess periods and for one minute each hour during 
the teaching periods. The janitor can shut down his fans during these periods, 
or the teachers can place a board over the ventilation inlets and outlets if heat 
cost is complained of. 

Children returning from play to a schoolroom will cough and show other 
evidence of discomfort if the room is warmer than 60°. 

When the windows are thrown open all parts of the room are of the 



SCHOOLS 



l?A?> 



same temperature. People complain not of the cold rooms but of the cold 
places in a warm room — the floor, next the windows, near the doors. A 
general room temperature of 60° where the windows are open wide is not so 
liable to cause complaint as in a room in which a window is raised a little way. 
Open-window rooms and open-air schools require unusual teaching ar- 
rangements and are needed for none but unusual children. 




FOBtZH 



Tt-oocs CL**** 



Illinois Dept. of Public Instruction. 

Fig. 506. — One-Room School. 



Cold-Room and Open- Air Schools. — The temperature of cold-room 
schools should not go below 55° even in the coldest weather. It should not 
go above 60°. There should be enough radiation to maintain this temperature 
where the windows are wide open. The children should wear their coats, 
woolen gloves and caps in the schoolroom. 

School lunches are not especially needed in open-window schools. Most 
school children would learn faster if they were better fed but this need is 
not materially greater with open-window school children than with the gen- 
eral run. 

The temperature of open-air schoolrooms is that of any sheltered, shady, 
outside area. Children attending outdoor schools must have special clothiug. 



1244 HOSPITALS— SCHOOLS 

special food, special rest hours and special medical attention. They wear felt 
boots, woolen mitts and a flannel oversuit with hood. They are given three 
meals a day. 

LUNCH AT 9 A.M. 

1 glass of milk, cold or hot, with bread; or 

1 bowl of soup and bread. 

DINNEK AT 12 M. 

2 glasses of milk and bread and butter. 
1 bowl of soup. 

Meat — beef or mutton. Sometimes fish or eggs. 

Vegetables — potatoes (one), peas or beans. (Green vegetables when 
possible.) 

Dessert — Fruit, raw or stewed, or pudding. 

LUNCH AT 3:30 P.M. 

1 glass of milk, bread and butter and occasionally jam, jelly, or molasses. 

After lunch they should be required to rest by lying down for one hour. 

They should be weighed periodically, measured, and examined at stated 
intervals. 

In spite of the physical handicaps of the cold-air students — for none 
out moderately subnormal children are given this special treatment— -they grow 
fatter and become rosy; their enlarged glands subside; their disposition to 
catch cold decreases. From the educational standpoint it pays, for they 
learn fast and attend regularly. 

The per capita cost of the open-air school is too high to make it avail- 
able for the ordinary run of students. 

The per capita cost of open-window schools is not much above the 
average except in those cases where, for special reasons, special medical and 
nursing service is given and free lunches are supplied. 

MEDICAL SCHOOL INSPECTION 

Children of school age are undergoing rapid changes. They double in 
size and weight within a few years. Their bodies take on new shapes. 
Their brains increase in volume and improve in texture. The change in 
mental capacity from that of the first grade student to that of the fourth 
year high school student is no greater than the change in the physique during 
the same years. 

A few years ago there were people who did not believe in education. 
There are some now, but they are few. 

The mind of the child, during education, needs the supervision of 
teachers — so much practically everyone now concedes. It is just as inevitable 
that everybody should eventually see that the physical side of school children 
needs control and direction. 

School life is essentially social. In that lies its great educational 
strength. In part is this true of book education. Especially is it true of 
education in life, in self-discovery, in perspective, in meum and tuum. 



SCHOOLS 1245 

It is impossible to conceive of advantages without disadvantages. Some- 
thing for nothing is impossible. When children congregate, colds, measles, 
scarlet fever, and other contagion will invariably come along. 

In the country where gossip is a pretty fair school inspector contagion 
depletes the schoolrooms somewhat. In the city, where gossip is not worth 
much as a moral agent, uninspected schoolrooms average less than 90 per cent 
full. 

Partly full schoolrooms mean inefficiency. In other words, the taxpayer 
is not getting all he is paying for. 

And then, periodically, an epidemic sweeps along. If there is no school 
inspection the schools must close. If there is school inspection they can 
be kept open. To close the schools means waste of the taxpayers' money. 

Teachers say classes could get on much faster if the students all attended 
regularly and all were in good health. Ask any teacher if this is not so. 
If the mouth-breathing child, the child with the snuffles, if any .neglected 
child is holding the class back, whose liberty is being interfered with? If 
the class is being held back by such children — and any teacher will say so — 
is not the taxpayers' money being wasted? 

In Chicago there are not seats enough to take care of all the children who 
want to go to school. There would be ample if the children were all bright 
enough to have the classes push along rapidly and if nobody failed to make 
grade. 

Mrs. Young tells us that repeaters — children who fail to make grade — 
cost Chicago $200,000 a year. Now, everybody is agreed that bad eyes, bad 
teeth, bad throats, bad physical condition generally, are responsible for more 
than 90 per cent of the failures to make grade. It does not seem right 
to throw this great burden on the taxpayer if there is any way to prevent it, 
and everybody knows there is a way to prevent it, and that way is through 
care of the health of the children. 

And yet there are those who would encourage a small minority in fasten- 
ing these burdens on the majority ! 

Benefits of School Inspection. — A few years ago we closed our schools 
to stop epidemics. Now to stop an epidemic we keep the schools open and con- 
trol the epidemic through school inspection. It has even been proposed that 
epidemics in vacation season be met by opening the schools and providing in- 
spection. 

It costs a good deal more to close the schools than it does to maintain 
a temporary inspection for contagion and besides, inspection is much more effi- 
cient. Under the old plan we would fumigate the house and thereby kill 
any lonely bacillus that might be hanging around. Then we would bring 
back the school children and have one scarlet fever scaler come in with a 
million contagion germs in his throat. 

Now we know that it is people, not things, that we must watch. And this, 
of course, adds greatly to the responsibility of the already burdened grade 
teacher. If the school has a well executed medical inspection and good school 
nurses the teacher can keep her mind on teaching her pupils. If she has 
neither of these she stands on guard alone and she must divide her mental 
energy. 

I think there is no question that if there were no school children there 



1246 HOSPITALS— SCHOOLS 



would be little scarlet fever or diphtheria— certainly little diphtheria. 
Wherever the school children are vaccinated there is no smallpox. At least 
there is so little that health officers do not worry about it. The control of 
diphtheria is coming near enough within range to allow us to say, "When there 
is no danger of infection of school children then there will be little diph- 
theria." 

Since the teacher stands on guard at the point where the enemy is going 
to strike she must not sleep at her post. She must learn to draw common 
sense conclusions from sore throats, snuffles, rough skins, fevers, headaches, 
absence from school and stories of sickness at home. Many of her conclusions 
will be mistaken but the guard must sound the alarm even though the danger 
is finally found to be imaginary. 

If the school is the usual means by which contagion is spread should it 
not be one of the agencies by which it is controlled ? Or, to put it differently, 
if the community by its practices makes the school a spreader of contagion 
is it not up to the community to establish practices that will make the 
school a means of controlling contagion ? 

The teacher has a selfish interest in this matter. She is more liable 
to contract contagion than is the average member of the community. 
The sentinel is always in danger. 

Dr. Luther Gulick told the National Education Association that before 
many years anemic, physically below par children would be sent to school 
to get well — an outgrowth of the practice of using the schools to control 
contagion. 

Medical Inspection in Chicago.— In Chicago the inspection of school 
children consists of several parts: 

1. Inspection to exclude contagion — a service performed by the Health 
Department. 

2. Inspection to exclude minor communicable conditions such as lice, 
itch, and some other skin conditions — service performed by the health de- 
partment through medical inspectors and nurses. 

3. Inspection, examination, and special attention to markedly defective 
children ; for example, the blind, deaf, crippled and markedly subnormal — 
service by the board of education. 

4. Dental inspection of school children and dispensaries for relief — service 
by philanthropy under direction of the dental society. 

5. Physical examination of the school children with advice given the 
parent that treatment would be beneficial— -service formerly performed by 
the health department medical inspectors and nurses. 

6. Bequest that parents have their children examined physically at the 
beginning of the school year and that the results be forwarded to the school 
board — request made by the board of education; blanks furnished by the 
board. 

Services Nosi 1, 2, and 3 have been a part of the school routine for 
about four years and No. 4 for about two years. 

One spring the National League for Medical Freedom advertised its 
opposition to Nos. 1 to 5 inclusive. This opposition was to the expenditures 
of public money for the compulsory examination of school children. Forced 
to tie up its opposition in some way ' with medical treatment the League 



SCHOOLS 



1247 



declared the intent of the authorities to be at some time or other to com- 
pel treatment. Inferentially, the treatment, when the time came to give 
it, would be compulsory and would be given by one school of medicine to the 
exclusion of all others. 

The League has a wonderful nose for fear. It has a wonderful capacity 
for foreseeing what may happen some time or other, of which it proceeds to 
get afraid. 




Illinois Dept. of Public Instruction, 

Fig. 507. 



The following fall the board instituted No. 6 — a recommendation that the 
parent have the physician of his choice examine his children — whereupon the 
League came out with a circular condemning that recommendation. 

As I have understood these Freedomites the freedom of the family to 
employ whom they pleased was just what they wanted. Now, when they get 
what they want, they are "agin" it. When government goes ahead on a con- 
structive policy, they are "agin" it. If government modifies the policy to give 
the Freedomites the freedom asked for, they are "agin" that. 

They defy the government to jump any quicker than they can. Nobody 
can hop on their rock any quicker than they can hop off. They are the 



1248 



HOSPITALS— SCHOOLS 



champion hoppers. In comparison a flea is a puling paralytic. As a matter 
of fact, they switch their argument as they deem it expedient to do so, holding 
fast, however, to their fundamental position. 

They do not believe in physical perfection or physical imperfection; in 
physical efficiency or physical inefficiency; in contagion or immunity; or in 
any of those things. They believe that talking about these "errors" creates the 
conditions found. On this they base their opposition to school inspection. 







Illinois Dept. of Public Instruction, 

Fig. 508. 



This they hold unchangeably. This makes a perfectly proper line of cleavage. 
Those who believe in that way should oppose school inspection. Those who 
believe otherwise should support it. 

Work of the School Inspector. — As the work is now divided the school 
inspectors are divided into two groups — those who inspect for contagion 
and those who examine for physical defects. The first group examines the 
children to discover smallpox, scarlet fever, diphtheria, measles, whooping 
cough and a few diseases of lesser consequence. When a case is diagnosed 
as one of contagion the child is sent home and a quarantine is established. 



SCHOOLS 1249 

The inspectors do not treat cases. They are prohibited from taking any part 
in the treatment of any case. Their duty is to see that the rights of the 
community are protected. 

In the cases of ringworm, itch, lice and similar mild communicable 
conditions they make the diagnosis and instruct the nurse what to do. At one 
time it was the custom to exclude these children from school after advising 
the family to have a physician tell them what to do. It was found the plan 
did not work. The parents would not call a doctor for a simple condition 
like lice. They would do nothing and the children just stayed out of school 
indefinitely. 

Each school physician does a certain amount of vaccinating in his 
schools. A few years ago the Illinois Supreme Court decided that Chicago 
could not have compulsory vaccination unless the city council passed an 
ordinance requiring it; that the health department, acting under the general 
police power of the cities and village acts, could not require it. This is what 
those called the anti-vaccinationists usually refer to as a decision against 
vaccination. The decision was given long enough ago for its effects to 
begin to show. There were some cases and some deaths among school chil- 
dren from smallpox last winter — the first in many years. The vaccinating 
is done on those whose parents want it done. About 99 per cent of the chil- 
dren are vaccinated. 

When children have been out of school for several days the school inspector 
must pass upon them before they are allowed to mix with the other children. 
This is a brief statement of the work of the medical inspector for contagion. 

The examiner for physical defects examines the eyes, ears, nose, throat, 
mouth and teeth of the child. The clothes are not removed. In a general way 
deformities,, poor muscular development, anemia, heart and lung diseases are 
guessed at from the history and from general appearances. A report of the 
findings (with recommendations) goes to the parents, another to the school 
and a third to the health department. 

If a parent sees fit to neglect his child there can be no compulsion. The 
examiner does not treat the children. If the child is defective and as a result 
the teacher finds teaching is difficult she must do the best she can, since the 
parent cannot be forced. If other children are held back by this child 
they must put up with it. The parents cannot be forced. If this dull 
child helps to overcrowd the schoolroom and keeps the other children from 
getting an education it cannot be helped. If such children increase taxes 
it cannot be helped. 

The school inspector can exclude contagion — beyond that his work is 
wholly advisory. 

What the Parents Have a Right to Expect from School Inspection. — 
Parents as a group have a right to demand : 

1. That contagion will be less than in uninspected cities of the same size 
in the same climate. 

2. That epidemics will be more than twice as far apart as before school 
inspection. 

3. That it will never be necessary to close the schools for contagion. 

4. That each generation will grow up stronger than its predecessor. 

5. That there will be fewer deaf, fewer hunchbacks, fewer cripples. 



1250 HOSPITALS—SCHOOLS 

6. That eventually the schools shall be properly ventilated. 
Every parent has the right to expect : 

1. That his child shall have fewer colds, fewer coughs, fewer sore throats, 
less rheumatism and less heart disease than prevailed before inspection. 

2. That his child shall go through his school life without ever having been 
in danger of smallpox or of losing a day from this contagion. 

3. That his child shall go through school life without having diphtheria. 

4. That his child's chance of scarlet fever shall be reduced to one out of 
six ; of measles and whooping cough to less than before school inspection. 

5. To be told when sore throats are due to diphtheria and when to ordinary 
bacteria. 

6. That his child shall not get lice or itch or ringworm in school, or, if he 
does, that school inspection shall correct the condition promptly. 

7. That his child shall have headaches rarely or never; not be tired at 
night or listless or pale and flabby looking. 

8. That his child shall not become a mouth breather or get to be lantern- 
jawed. 

9. That his child shall want to play, enjoy play and know how to play. 

10. That his child shall make at least one grade a year and every year 
or so an extra grade. 

11. That if his child be feeble-minded or deaf or blind or crippled or 
tuberculous he shall be cared for by special teachers in special schools and in a 
special way. 

The parent should support his child in school, requiring him to make 
little if any money during the school years. 

That is about what the law says and it is good sense and good judgment 
as well. 

If the parent is forced by law to keep his child in school for six hours a, 
day five days a week for ten months a year for eight years he lias the right to 
insist that the schoolroom be well ventilated ; that contagion be kept out of. the 
group; and that the school do everything it can for the physical welfare of the 
children to the end that they study better, learn faster and grow up in strength. 

Parents, demand your rights! 

Exclusions from School. — The New York health department recently 
has revised its rules for excluding children from school on account of con- 
tagion. 

Children suffering from diphtheria are excluded for at least one week 
and are not readmitted until the throat and nose are well and cultures are 
negative. The certificate of health for readmission must come from the 
health department. Children from the same family residing at home can 
be readmitted to school at once if quarantine is well kept and throat cul- 
tures are negative. 

If quarantine is not kept all children from the family are excluded 
until the quarantine is raised. If children are removed from the infected 
home they will be readmitted to school if cultures from their throats show 
no diphtheria bacilli. 

Cases of scarlet fever are excluded for at least five weeks or until the 
skin has stopped shedding and all discharges from the nose and throat and 
all cough has stopped. Elsewhere in the report the statement is made 



SCHOOLS 



1251 



that it is very doubtful that peeling has anything to do with the spread 
of scarlet fever. 

Nevertheless, the authorities do not feel certain enough of their ground 
to rule that peeling can be disregarded and attention concentrated on the 
nose and throat discharges. 



DDODUnD 
QDDODQD" 

School £ooaa 

D.n.nnnon 

D-DDDDDD 

: <&.-o- v gr 






S^7 1 

in 




•FlR^ffLODRPLAM 

Illinois Dept. of Public Instruction. 

Fig. 509 

When the scarlet fever germ has been discovered and studied we may be 
able to shorten the exclusion period of some cases to one week, as with 
diphtheria, but that time has not yet arrived. If quarantine is kept those 
children in the family who previously have had scarlet fever are allowed to 
remain in school. 

Children of the family who have had scarlet fever but who have been 
removed from the house where the case, occurred are allowed to return to 
school after five days if in the meantime no scarlet fever has developed 
among them. If they continue to. .reside at home . they will be excluded from 
school until the cases .are. officially. .'"discharged.;,.: . • ■ ■ ..,•.... -•• • 



1252 HOSPITALS— SCHOOLS 

In measles the patient is excluded from school until five days after 
the appearance of the rash at which time (if the cough and all discharges 
have disappeared) he can return to school. Those children who already have 
had measles can continue attending school if quarantine is kept. 

As the incubation period of measles is fourteen days children removed 
from the home where a case is found are not admitted to school for fourteen 
days after the removal. In German measles the child is excluded from school 
for one week and admitted upon a certificate from the school doctor. 

In whooping cough the child is excluded until the whoop has entirely 
stopped, say in from six weeks to two months. In mumps the child is excluded 
until the swelling has disappeared. In chicken pox the child is excluded until 
the scabs have disappeared. As this disease is so liable to be confused with 
smallpox the rules insist on an inspection by the school doctor. 

The School Nurse. — The report of the Committee on Medical Inspection 
of Schools to the Section of Preventive Medicine of the American Medical Asso- 
ciation gives the following as the work of the school nurse : 

"School nurses are assistants to the staff. Their field work is essentially 
as follows: 

"To assist members of the staff in the skilled examination of pupils and 
otherwise as assistance is needed. 

"To assist teachers in making preliminary surveys of their pupils and 
in giving initial examinations, notifying parents of essential needs of 
pupils, etc. 

"Visiting parents and in all justifiable ways establishing effective co- 
operation between home and school. 

"Further, the function of the school nurse is that of the social educator 
in the field of hygiene. As such the work of the school nurse is one of 
high order. 

"The staff of experts, the teaching force of the schools and school nurses, 
working from the standpoint of education, form an educational corps to 
secure the effective cooperation of home, school, and school authorities in 
meeting the requirements of the physical and mental health and growth of 
pupils. When educational means fail the law must remedy instances of 
neglect of health and growth of children." 

When a physical examination has been made and the parents have been 
told what should be done but a small part of the work has been accomplished. 
Cornell's experience is that only a small percentage of the parents will accept 
the advice given. The percentage will vary according to the neighborhood. 
Some neighborhoods take care of the children better than others. Some 
inspectors are much more successful in getting work done than others. 

The nurse goes to the home, gets hold of the parent, talks over the 
whole matter and often takes the child to the hospital, dispensary or physician. 
Some nurses can persuade every parent to have his child cared for ; others are 
less successful. 

School Inspection for Abnormal Children. — In order that unusual chil- 
dren may be more accurately studied and the proper treatment given them 
Dr. MacMillan of the Child Study Department of the Board of Education 
(Chicago) established a series of averages, "norms" or measuring rods, by 
closely examining 8,000 children. The examination covers the following points : 



SCHOOLS 1253 

1. Age. 

2. Height — standing and sitting. 

3. Weight. 

4. Endurance and persistence. 

5. Motor ability and strength. 

6. Lung capacity. 

7. Head measurements — the length, breadth, circumference, estimated 
cubic dimensions — internal and external. 

The physical examination goes hand in hand with a mental test covering 
the following points : 

1. Acuteness of senses — sight, hearing and touch. 

2. Perception, sensitivity to likes and differences. 

3. Memory. 

4. Association. 

5. Types of thinking. 

6. Types of learning. 

7. Range of information. 

The normal having been established, those reasonably near it are cared 
for in ordinary schools and by the ordinary teaching methods. Those 
far away from the norm line are specially studied and sent to the 
group in which they belong where, sometimes by one method and sometimes 
by another, such mental and physical treatment as they need is received. 

In a group of fifty children there will be found about thirty-five of nearly 
the same ability and strength, five may be unusually bright and ten may be 
unusually retarded or below the average. 

When a boy fails in his studies the temptation to blame him is strong. 
If he fails to pass from one grade to another at the end of his school year 
his mother (and maybe others) is disposed to blame the teacher. Now, some- 
times the boy should be blamed and sometimes the fault lies with the 
teacher but with our old hit and miss method injustice was the rule. Is it 
not fairer to study the student closely and then measure both him and his 
teacher by the result of the study? 

It has been more than two centuries since we burned women, thinking 
them witches because of some departure from the normal. It has been half a 
century since we punished the insane. 

It will be some years before we fully understand that the abnormal child 
is so because of the sins of his ancestors or because of the contagion, bad hy- 
giene or bad nutrition of his earlier years; that the wise and economical thing 
to do is to study him from the mental and physical standpoint; and, finally, 
that school funds are saved by proper attention to the physical side of the child. 

The provision made by the Board of Education of Chicago for the dis- 
tinctly unusual child is the best in the world. It is done in a bureau called 
the Bureau of Child Study. Its field is that large group of children who are 
so much out of the ordinary that they cannot be cared for in the ordinary 
schoolroom in fairness to the fifty children there and certainly not in fairness 
to the unusual child himself. 

In this bureau unusual children are grouped as follows : 

1. The abnormally bright — about five hundred a year of this type are ex- 
amined. It may seem paradoxical to treat these children in a bureau for sub- 



1254 HOSPITALS— SCHOOLS 

normals but experience has shown that while they are abnormally clever on one 
side of their make-up they are dull or deficient in some direction. They are at 
least so exceptional as to demand individual attention. 

2. Those with speech defects, stammerers and stutterers particularly. 
For these there are four special teachers. 

3. With hearing defects. For these there are thirteen centers. 

4. With eye defects — the blind and those with especially poor vision. For 
these four centers are now established. 

5. Crippled children. For these there are now two centers. Certain 
cases are cared for in town and certain others in the country. 

6. Truants and incorrigibles. For truants there are now three centers. 
The function of these is to take care of the truants and to prevent them 
from developing into the group termed incorrigibles — the group cared 
for at the Parental school. 

7. Subnormals. In this connection is meant the lowest grades of minds 
still subject to improvement through education. This group extends to 
those who have to repeat a grade more than once, to those who are able 
to get no farther than the third grade by the time they have reached fourteen 
years of age. For these there are thirty-two special rooms. 

These defects are not due to chance. Most of them are inherited; many 
are acquired through contagion in early childhood, through summer com- 
plaint in babyhood, through neglected colds resulting in ear infections, 
through drinking milk from diseased cows. Many result from insanitary 
homes. . 

Chicago has found it economical as well as humane to establish a separate 
department for such children, to group them properly and teach them in the 
right way. It saves money and gets results. 

If a city or town has no such department it is wasting money. It 
can be certain that the defectives in its school population are in about the 
same proportion as in Chicago. Of course, a country school must handle 
all of its children together, sound and defective, and put up with the economic 
waste and inefficiency ; but it pays a town having a school population of more 
than a thousand to divide the children into two groups — average and unusual. 
When the school population gets over five thousand the unusual group should 
be still further subdivided and proper treatment given. It is wise — it is just — 
it pays. 

FEEDING THE GROWING GENERATION 

Many mothers, earnestly concerned about the growth of their children, 
call our attention to many instances of underfeeding and failure of growth 
and proper development. They ask for information as to the kind and 
amount of food their boys and girls ought to get. 

The infant has found many champions, but the growing youngsters, 
from 7 to 14 years old, find themselves beset and hemmed in by a multitude 
of don'ts about eating that would dishearten any child were it not for the 
healthy and imperative command of the growing body that makes the child 
see the food only and not the don'ts. There are not lacking narrow, dys- 
peptic, vinegar-hearted individuals who are afraid Young America will eat 
up the earth. 



SCHOOLS 1255 

The healthy child wants to know nothing about the schemes of raising 
it on a nickel or 8 -cent ration a day and getting along on the leavings of 
such a ration the next day. The healthy child wants and ought to get four 
or five meals a day. It wants and needs plenty of milk, eggs, meat, tread, 
and outter. It should get it. It wants and needs vegetables, fruits, soups, 
jellies, and other wholesome and simple foods. 

The weight of the child is u better guide to the amount of food it should 
get than the age. Children of different ages but of the same weight require 
the same amount of food. 

The following dietary for a child of 10 is offered, not to be followed in 
every case but rather as a suggestive guide: 

BREAKFAST 

1. Four ounces of bread or a roll. 

2. One ounce of meat. 

3. Butter. 

4. Cup of milk. i 

NOONDAY MEAL 

1. Plate of soup. 

2. Four ounces of meat. 

3. Vegetables. 

4. Sauce. 

1. Bread or roll. 

2. Milk or cocoa. 

3. Preserves. 

1. Cup of milk. 

2. One egg. 

3. Some meat. 

4. Bread. 

Fruits, jellies, etc., may be added to each meal. If the child wants more, 
let him have it; if it is too much, he will let it alone. 

"The foundation and first condition of a diet is a definite minimum 
amount of proteids, fats, and carbohydrates, capable of sustaining the body 
and insuring a gain in weight." 

During infancy more food is required in proportion than during child- 
hood; during childhood the relative amount of food required is greater 
than in adult life. The reason is that growing children not only have to 
replace the constant wear and tear of tissues but they also have to build 
bone, make muscle, store up nervous energy, and fortify the system against 
strain and disease. 

Underfed children fall easy victims to acute and chronic diseases, have 
weak mentality, and lack the firm, courageous spirit of self-reliance. Don't 
let chronic underfeeding pass for gentility. In feeding growing children, their 
needs and appetites should be consulted and not ours. 

Babies and adults usually are overfed; children usually are underfed. 
Be generous with the loaf. 



AFTERNOON MEAL 



SUPPER 



1256 HOSPITALS— SCHOOLS 

ATTENTION TO NEGLECTED CHILDREN 

On first thought anyone would say that if a school teacher, having noticed 
one of her pupils was not progressing in his studies, had sent him to a school 
physician for examination and the examination had shown that the child 
was a mouth breather, had poor teeth or poor eyes there would be no trouble 
in getting the parents to put the child in good physical condition. One 
would think that upon receipt of a note from the teacher or the physician 
they would at least go to some physician to see what he thought about it. 

What are the facts? 

Cornell's "Health and Medical Inspection of School Children" gives 
many instructive tabulations regarding the relative efficiency of different 
methods of interesting the parent. Intelligent notices written by a good 
inspector to parents in good neighborhoods secure treatment in one case out 
of three in eyestrain and one case out of two of the nose and throat difficulty. 

The average inspector s notice secures attention in about one case in -five. 
An indifferent inspector sending out formal, impersonal notices can get help 
for only about one child in twenty. Written notices to foreigners usually ac- 
complish nothing, since they cannot be read by those who receive them. 

If there is a neighborhood dispensary the chance that the notices will 
be heeded improves materially. When the notice fails to secure help for 
the needy child the school nurse or a social visitor follows it up. She gets 
results from one visit in a little more than half the cases seen. 

A comparison between the results of school inspection in two groups 
of 750 children each — one without nurses, the other with — shows that the 
percentage heeding the advice as to defective vision rose from 25 to 80 
per cent; hypertrophied tonsils, 18 to 65 per cent; adenoids, 14 to 72 per 
cent; defective teeth, 20 to 92 per cent. 

In more than half the cases of this series where the parents paid no 
attention to the note from the school physician they were persuaded by the 
school nurse. 

Another idea of the difficulties may be gleaned from the following 
report on 129 Kussian Jewish and Italian children needing glasses. On 
advice given at the school by the inspector and nurse 18 secured glasses; 
on one visit by the nurse, including 17 cases escorted to dispensary, 42 secured 
glasses; as the result of repeated home visits by the nurse, including 12 cases 
escorted to the dispensary, 48 secured glasses. A total of 108 results and 21 
failures. 

Medical inspection without a nurse follow-up service scarcely pays. 

LARGER USE OF THE SCHOOLS 

In addressing the National Educational Association Professor Ward of 
Wisconsin advocated making the schools the voting places and the school prin- 
cipals the election clerks. This was but a part of his argument that the way 
to democracy lay in the use of the schoolhouse for all sorts of political and 
social functions. 

It does not seem fair to charge the entire cost of the school system against 
the kids. They use the equipment for but a few hours during the day, 



SCHOOLS _ 1257 

a few days during the week and for only ten months of the year. Would 
it not be fairer to devise a way to have the grown people use the buildings, 
libraries, halls, gymnasiums and swimming pools for the rest of the time and 
then split the cost between the kids and the grown-ups ? 

Whenever it is proposed to pay the teachers better salaries up bobs the 
statement that half of the taxes and half of the bond returns now go to the 
schools. It would take some of the force from this argument if the schools 
were made use of as a center of diversion, entertainment and education for 
the grown-ups. 

We need moving pictures. They have gripped the public. Through them 
we can teach health, morals, history, geography, science, life. The privately 
owned places but partly fill the bill. Why not use the schools? 

We are all agreed that health is better than it was ; but it still is not what 
it should be. In America it cannot be greatly improved by coercion, legis- 
lation or government control. Improvement must and will come through 
education. But of whom ? Both children and adults. Then why not use the 
schools ? 

At this meeting of the teachers it was evident that the tendency is 
strongly toward a use of the schools for many community purposes. On 
Wednesday there was a rich program on recreational, social and civic op- 
portunity through the schools. It was valuable both because it told what is 
being done and what should be done; but it was more valuable in that it 
brought out the trend of the times in bold relief. 

The next morning Professor Ward pointed out the enormously expensive 
mistake made in Chicago twenty years ago when the playground system 
was vetoed by the board of education and was forced thereby to grow up 
apart from the schools. That afternoon Professor Allyn told the plan by 
which Westfield, Massachusetts, and several other places had used its school 
laboratories to purify its food supply, and so far from hurting the schools 
as such it greatly improved them — an example that should be followed by one 
hundred towns within a night's ride of Chicago. Several speakers, prominent 
among whom was a Gary school teacher, told of similar activities. Professor 
Shephard told of some valuable related work in the Lucy Flower High School 
in Chicago. Professor Works, formerly of Madison, Wisconsin, told of how they 
made botany practical at Menominee and Professor Eandall of Brooklyn of 
methods of making physics a study of service. 

It was plain that many schools are not in favor of what Allyn calls the 
pupil-alone policy. When men hurrahed about vague political propositions 
the old brass band method was well enough but this is the dawn of the 
health age — the age of men. As I see it, the use of the schools by adults 
is a necessary part of the program of the new democracy. I don't see how 
anybody who attended these meetings could be of any other opinion. 

SCHOOL LABORATORIES 

One of the recommendations of the Standards Commission of the New 
York Mill Committee was that school laboratories examine specimens of 
market milk chemically, bacteriologically and for dirt. 

There are few communities with less than 50,000 inhabitants that have 



1258 HOSPITALS— SCHOOLS 

laboratory facilities for their health departments. On the other hand, even 
country communities have some laboratory facilities in their schools. To 
teach chemistry and bacteriology by teaching milk testing gives just as 
good training as though the analyses were of substances interesting to 
nobody. 

Simple milk analyses are simpler than the usual run~of laboratory tests. 
A fair percentage of the farmers now own small Babcock testers and test their 
milk for fat. This test is not too complicated for grade school pupils. 

The dirt test is still simpler. In fact, it is so simple that it can be used 
as one of the initial exercises given to familiarize the pupils with glassware 
and methods. 

A bacterial count is easily within the reach of high school pupils and, 
possibly, of grammar scholars. It does not require a microscope. It does 
require a magnifying glass, culture media and certain glassware. The equip- 
ment for milk work does not stand in the way nor does technical skill. Thus 
we see that neither the cost of equipment for milk nor the technical skill 
required for milk tests stands in the way of using the school laboratories for 
milk control. 

The guinea pig test for tuberculosis should be easy in a school that teaches 
biology. It requires little equipment and little skill. 

So much for the possibilities. What would be the gain? A good many 
baby lives could be saved and the milk business could be put on a much less 
precarious basis if the school laboratories would supplement the health depart- 
ment work. If the people knew that their milk was being examined their 
confidence in it would grow. The use of milk responds to fluctuations in 
public confidence. At least such an effect would come as soon as publicity had 
forced the insanitary dairies to clean up — and nobody should want it to 
come sooner. 

In high schools the cooperation between local school laboratories and 
health departments could go even farther. Such laboratories could examine 
sputum for consumption, blood for typhoid and possibly cultures for diph- 
theria. Any properly run laboratory sterilizes sputum before it is examined. 
They do this to safeguard the health of the workers. This precaution taken, 
there is no danger. 

The Widal test for typhoid fever is even less dangerous. The drop 
of blood sent in for test contains no bacteria. The equipment for these two 
tests can be bought for a hundred dollars. 

If there is carelessness there is some danger from diphtheria, yet there is 
no question but that making such examination in the school laboratory would 
mean less diphtheria in town. For instance, if the Centralia, Illinois, school 
laboratories examined throat cultures the diphtheria outbreaks in those schools 
would be farther apart and easier controlled than under the present system 
wherein the cultures must go to Springfield. If the school administrators 
assert that the program is too large why not undertake a single part of it — 
say milk examination, or better still, examinations for contagion among school 
children ? 



SCHOOLS 



1259 



VILLAGE SCHOOL HYGIENE 



In Minnesota Dr. E. B. Hoag is concentrating on rural and village 
schools. The plan of the state board of health is to have the rural schools in- 
augurate and carry out school inspection. It is true that they have a plan for 



\ 



ENTRY 



Win. 



w 



w 



w 



Heater 



o 



CHIMNEY 



W 






Boys 



Illinois Dept. of Public Instruction. 

Fig. 510. — Inexpensive Cloakrooms, Entry, and Fuel House. 



1260 



HOSPITALS— SCHOOLS 



large cities like Minneapolis, St. Paul and Duluth — a plan that calls for 
medical officers and school nurses. They have another plan for towns large 
enough to employ school nurses. 

The plan upon which they are now laying most stress is one for non- 




Fig. 511. 






□ □ □ □ □ □ 

DDDDDD 

DDDDDD 

dDDDDDD 

DDDDD 




Illinois Dept. of Public Instruction. 



n 



a 






L *&***"* 



Fig. 512. — Showing Old Style Country School House and Manner in Which Such a One 
may be Modernized at Small Cost. The improvement suggested does away with the 
platform and the double desks. It provides a vestibule and two coat rooms in front, a fuel 
room and library at the side. The lighting is from the left and the rear and is perfect. 



SCHOOLS 1261 

medical health surveys to be made by the teachers. This plan is for communi- 
ties that feel they cannot afford either school physicians or school nurses. 

The essence of their plan lies in this statement: No community need wait 
for the employment of a medical officer in order to begin sensible health obser- 
vation of school children. 

The plan consists in having written answers to a series of simple questions. 
Some of these questions may properly relate to simple matters of schoolroom 
hygiene. Some of them relate to conditions of the pupils themselves. Some of 
the questions can be answered by the teacher and some by the parent; but 
most of them are designed to be answered by the pupil. 

The questions, therefore, are simple and the answers called for express 
the pupil's point of view. The teachers can translate that to the point of view 
of the sanitarian. 

The state board furnishes the questions and answers. Dr. Hoag travels 
about the state visiting schools, installing the system and unraveling the 
snarls that arise in its operation. 

Under the head of Sanitary Survey of Schools such simple questions are 
asked as: 

"Is damp sweeping practiced? Are all windows thrown open at recess? 
Are parents notified of physical defects ?" 

Under the head of Personal Hygiene and Physical Condition are such 
simple questions as: 

"How often do you have headache? Do you snore? Do you breathe 
through your mouth? How many colds have you had since school opened?" 

Professor Wood of Teachers' College, Columbia University, says there is 
something wrong with 15,000,000 of the 20,000,000 American school children. 
Many of these troubles are in schools that cannot hope to have an elaborate 
school inspection. A large percentage of them the pupil can and will tell 
about in his own way if given a chance. 

SAFEGUARDING THE HEALTH OF THE COUNTRY SCHOOL TEACHER 

Will you write an article to help country school teachers living without 
city conveniences to keep well? E. P. B. 

The above request is abstracted from a recent letter. In replying the 
emphasis will be put upon the "how" phase of the question. The questioner 
had in mind the teachers who teach in country and small town schools 
where the buildings are' poorly equipped ; where there are but few conveniences, 
comforts, or safeguards; where the equipment cannot be greatly changed; 
where the water comes from wells, the heat from stoves or hot air furnaces 
and where in bad weather the children bring muddy shoes and wet overclothes 
into the schoolrooms, and where the schools are not connected with sewer 
systems. 

The question is : What can the teacher do to keep herself healthy ? 

I am starting with the assumption that the hundreds of thousands of 
teachers know that the percentage of ill health among teachers is somewhat 
high and want to do what they can to rectify it. They are asking the ques- 
tion "How ?" That question we shall try to answer. 

I should say that first in importance is nerves. In an article written 



1262 HOSPITALS— SCHOOLS 

for that most intelligent group, the school teachers, it is not necessary to go 
into minor details. Nerves results from poor mental methods. The cure 
for nerves is mental training. 

To every explosion there are two factors — the irritating party and the 
irritated party. The teacher works all day trying to control the irritating 
party. She will not succeed unless she devotes some part of the day to 
training the irritated party. 

I have just read a booklet that I think would be of great aid to teachers. 
It is called "Calm Yourself." It is sane, good-natured, poised, clear, scientific, 
and simple ; and it sells for 50 cents. Another excellent book is Arnold Ben- 
nett's "Human Machine." For years I have had benefit from Osier's "Essay 
on Equanimity." 

Poise can only come as the result of training. Bennett sets aside a half- 
hour a day for this self-training. This is enough if the teacher will carry 
its influence on throughout the contacts of the working day. 

We must not lose sight of the fact that the best training of the irritating 
factors is the influence of a poised, irritated factor. A teacher who has 
always been tired and cross and learns how to be tired and good-natured 
will find it much easier to control the tired and cross children. 

The "how" of poise is a matter of training one's mind so that good 
mental habits replace the faulty ones. There is no other way. This should 
not prove difficult to mental trainers — school teachers. 

The exceedingly hard days for the teacher and the pupils are the bilious 
days. Biliousness is usually due to constipation. Therefore, one of the 
"hows" is how to avoid constipation. 

The teacher should keep a pitcher of water and a glass on her desk. She 
should drink from half a gallon to a gallon during the school day. It will be 
better if she makes no particular effort to keep the water cool. It should be 
taken in sips every few minutes during the day. 

She should keep fruit on her desk and eat one or two pieces during 
the day. In the main the fruit to eat is apples, but these should be varied 
with pears, peaches, bananas, oranges, limes, turnips, carrots and radishes. 
The fruit should be washed, then wrapped in clean paper and thus kept in 
the desk. Some of it should be eaten unpeeled. Bananas, lemons, limes, 
and (for most people) oranges should be peeled. This should be supplemented 
by such a change in the food at home as will tend to prevent or overcome 
constipation. 

It has been noticed that contagion is worse in the spring than in the fall. 
In large cities where they plat out diagrams of contagion they find that the 
curve starts low when the children come together in the fall, that it gradually 
rises through the winter and that it peaks in the spring. 

With some forms of contagion this rule does not always hold true 
in the country schools. For instance, a country school may have a run of 
measles in the fall and be free in the spring. The reason is that country 
communities are commonly free from measles and when by accident the 
contagion gets in in the fall it spreads. The city harbors measles all the 
time and the law of growth is not subject to the same exceptions. 

The reason for this gradual rise in the sickness line is that carriers of 
colds, pneumonia, diphtheria, scarlet fever and other forms of contagion 



SCHOOLS 1263 

come into the schools. There is a gradual spread with a gradual rise in severe 
illnesses. 

The point to it is that mild illnesses bear a relation to severe illnesses. 
Their relation to contagion is well proved. In fact, it is easy to demonstrate 
it in schools provided with nursing, inspection and laboratory service. 

The teacher catches some disease from the students. The "how" of the 
situation is as follows: Let her keep her own record of the children's ills. 
In this record she should enter such minor ills as headaches, sore throats and 
colds. For this purpose she can devise her own blank. Possibly she will find 
it to her advantage to make use of the scheme of health survey of pupils got 
up by Dr. Hoag, blanks for which are on the market. 

The teacher will not be highly susceptible to contagion. In this day 
practically all of the teachers worth saving are vaccinated and are, therefore, 
in no danger from smallpox. Most of them have had ordinary forms of con- 
tagion. Some have not. 

Alertness will serve to protect the teacher and her school. In time she 
will be able to suspect from the record of colds scarlet fever or diphtheria; or 
from ,the record of diarrheas to uncover a chain of atypical, typhoids. 

Tuberculosis in children is rarely contagious. If it is open, it is harmless. 
If the child has discharging glands of the neck or a consumption with sputum 
there is some danger to the teacher. If such children remain in school the 
teacher must see that the sputum or pus is burned. 

The schoolroom must be provided with a hygrometer. The usual form of 
hygrometer is also a thermometer. A record of the temperature must be 
kept. This record should show the temperature in different parts of the 
room, at different distances from the window and at different levels above the 
floor. 

The temperature of the rooms should not go above 68°. This is easy 
enough if the floor is kept warm and the windows are tight. The usual com- 
plaint of cold is due to uneven temperature in the room — a temperature of 75° 
at the head level and of 65° at the feet level, a temperature of 80° around the 
stove and of 60° next the window. 

If the school is in a town where there is electric current during the 
school hours electric fans will remedy this defect. The air next to the skin 
is about 90°; the air next to the window may be 55°. Obviously, then, in 
winter time the fans should not play directly on the people. They should play 
on the radiators or stove or the inside wall. 

If fans are not possible what can be done? I am assuming that the 
heating system is in and cannot be changed. The windows must be periodically 
opened and the room blown out. It is better to keep the room at 55° to 60° 
even if the children must continuously w r ear their wraps than it is to keep 
the head in air at 75° and the feet at 65°. 

If the teacher's feet are cold during the day let her provide herself with 
moccasins made of sheepskin tanned with the wool on, the wool on the inside. 
Such moccasins are on the market. 

Let her keep the humidity about 50. This means about ten degrees 
difference between the readings of the w T et and dry thermometer. This means 
frosted windows on a wintry day. There is no health in a school where the 
windows, if single, do not frost on a wintry day. 



1264 HOSPITALS— SCHOOLS 

If the room is heated by a stove a large water pan on the top of the 
stove will furnish moisture enough. The pan must set flat enough on the 
stove to keep the water close to the boiling point. Gallons of water will be 
required, as one who watches the hygrometer will soon learn, and any ar- 
rangement that does not provide gallons to be evaporated will be ineffective. 
If the room is heated by hot air a water tank must be set in the hot air 
chamber above the dome of the firebox. 

To keep down dust Miss Morris of the Louisiana Board of Health 
recommends "dustless sweepers, dust cloths wrung out of kerosene for each 
schoolroom and oiled floors." 

Write to your state board of health about the water supply. Tell them the 
depth of the well ; whether it is cemented or cased ; how far away the well is 
from privies, the schoolhouse and other sources of soil pollution; the type of 
the soil and the direction of flow of ground water (if known) ; whether the 
water rises during rains and falls during drought; and the taste of the water. 
The state board will either examine the water or else it will tell you whether 
water from wells of the type of yours is safe or not. 

Water used by a group, say the school children, to be safe must be purer 
than water used by a single family. If the water is unsafe let the teacher 
make it safe by ( 1 ) heat or by ( 2 ) chlorid of lime. Place the water in a kettle 
on the stove, bring the temperature to 160° and hold it around there for twenty 
minutes. Put it in a clean bucket and allow it to cool, the more quickly the 
better. Water heated in this way will contain no live typhoid or diarrhea 
germs and it will not be so flat as boiled water. 

To sterilize water with lime: Have the druggist prepare a solution of 
chlorinated lime, one level teaspoonful to four cupfuls of water. Use lime 
from one-pound tin cans. Keep the bottles corked well. One teaspoonful 
of this solution added to a two-gallon bucket of water will sterilize it. The 
taste of chlorin will disappear after the water has stood twenty minutes. 

For the ordinary school yard privy should be substituted the McCormack 
type recommended by the Kentucky Board of Health. This consists of an 
ordinary cheap, flyproof frame house. The contents go into an under- 
ground septic tank, 6'xo'x5', and the run-off is through forty feet of unglazed 
tile. If the soil is a loam, a sand or a gravel this tile is laid underground. 
If the ground is clay the tile should come to the surface and the effluent 
should flow in contact with the air. 

Eecesses are good for children. This truth is molded into custom. The 
recesses are good for the teacher. Custom has not recognized this truth. 

The teacher will do well to get a bit of fresh air at each recess period. 
For her short essay out of doors she will be better off if she does not wrap 
up too much. Warm covering for her hands, feet and head and the ordinary 
schoolroom clothes are about enough. In a few minutes her heat making 
apparatus will be equal to the strain. 

A dozen deep breaths will serve to distribute the blood heat well and keep 
the skin warm. To move about briskly not only makes heat by burning up 
muscle but it distributes the heat to those parts of the body where cold is 
appreciated. 

As the teacher's work is mental, unless systematic effort is made her 
muscles will grow flabby and soft. The powers of muscular conformation will 



SCHOOLS 



1265 



also suffer. Therefore, the wise teacher will devote some time each day to 
muscular exercise. 

Some teachers will find a way to go into a cold room, preferably a 
heated room with wide open windows, and use some form of rubber cord 
or weight exercise for fifteen minutes a day. Those who cannot do this 
can exercise while teaching 
reading, taking part in ordi- 
nary conversation, or riding 
to and from school. 

The muscles can be ex- 
ercised by having them pull 
against each other quite as 
well as by having them pull 
against a weight. With the 
hand lying quietly in the lap 
every muscle of the arm, fore- 
arm, and hand can be made 
taut. Wherever in the body 
there is a group of muscles 
there is also an antagonizing 
group. When these two 
groups pull each against the 
other each is exercised and no 
change in posture results. 

The teacher must go to 
sleep at night in a cold room. 
In order to be comfortable 
she must provide herself with 
high, warm slippers and a 
warm wrap. She must pro- 
vide her bed with plenty of 
covering. But these require- 
ments having been met, at 
least one window must be raised to the full 
must be below 50°. 

She must not neglect her minor ills. She must remember that colds are 
contagious. She must keep her distance from children who have contagion of 
one form or another. If, perchance, she contracts a cold she must not 
neglect it. And finally, let her have a care for the comfort of her feet 
and her eyes. 

Heating Schoolrooms. — W. B. writes: "Noticing a few days ago in 
your department some allusion to the heating of and fresh air in school 
buildings, I am impelled to inquire how long is required to empty an ordi- 
nary schoolroom of bad air — that is, how long should the half-dozen win- 
dows with which the average room is provided be kept open to allow the 
escape of all the bad air in it? Being a member of a school board with a 
number of buildings under its care, it often happens that this teacher or 
that has ideas concerning heating and ventilation that do not correspond 
with the ideas of janitors or of members of the board. Recently a teacher 




Virginia Health Bulletin. 

Fig. 513. — Jacketed Stove for Heating and Venti- 
lating One-Room Schools. 



The room temperature in winter 



1266 



HOSPITALS— SCHOOLS 



sent word to a member of the board that her schoolroom was too cold, and 
that unless something could be done at once school would have to be dis- 
missed for the day. Investigation showed that the janitor had livened up 




Dept. of Public Instruction, Springfield, 

Fig. 514. — Double-Flue Chimney Ventilation. A, foul air escape; E, fresh air intake; 
D, door which controls supply of air to the furnace. 

his fire at 6 a.m., leaving the windows open for fifteen minutes. Then 
the windows were closed, and by 8.30 the rooms were warm enough for the 
opening of school. But at the hour named the teacher arrived and imme- 
diately raised all the windows and left them open for fifteen or twenty 



SCHOOLS 



1267 



minutes. When 9 o'clock arrived, Die time for the opening of school, the 
rooms were still cold, it being an unusually cold and windy day. Then the 
complaint was made. The super- 
intendent of schools, a member of 
the board, and a plumber appeared 
at the schoolhouse at about the 
same moment. The janitor was 
away on an errand. When the lat- 
ter functionary returned, the three 
others had succeeded in raising 
the steam pressure in the boiler 
from five pounds to fifteen, with 
steam blowing out of the safety 
valve 'at the rate of forty miles 
an hour! The janitor expostulated 
that it was not possible for him 
to heat the entire landscape sur- 
rounding the school building, but 
that if instructions were given 
teachers as to the length of time 
windows should be left open and 
some restriction made as to when 
they might be opened, he would 
still undertake to warm the build- 
ings, if the supply of coal did not 
give out, and he would do it with 
five pounds of steam. Is it not a 
fact that the demand for fresh 
air which we read about so much, 
and some people talk about all the 
time, is overdone? People who 
know something about physics 
know that the tendency of heat 
to go upward will prevent the 
proper warming of a room if the 
windows are opened for fifteen 
minutes every half hour or so. If 
you can, please tell us how often 
and for how long a time windows 
should be opened in a room hold- 
ing, say, forty pupils." 




•^ 



Reply. — The length of time 
will depend on the wind and the 
temperature. Three to five min- 
utes three or four times a day is 
ample. It is best to have these 
periods come when the children 
are at recess. 

The temperature when the chil- 
dren are in the room should be 
68° F. When the children come in from play the temperature should be 
60° ; fifteen minutes later it should be 68°. Cold school rooms should have 
a temperature of 55°. The windows in such rooms should be wide open. 



Dept. of Public Instruction, Springfield, III. 
Fig. 515. — Single-Flue Ventilation. 



1268 



HOSPITALS— SCHOOLS 



It is quite evident that in the school concerning which W. B. writes 
nobody has made any observations or given much thought to either heating 
or ventilating. In that, however, this school is not peculiar. 

Help for Teacher's Nerves. — E. writes: "How would you prevent 
nervous prostration, if forced to breathe continually the contaminated air 
of a public school kindergarten, and have the care of fifty children, morn- 
ings and afternoons? The ventilation of the schools is said to be 'perfect/ 
which is of course a fallacy. Mrs. Young forced the janitors to open the 




Dept. of Public Instruction, Springfield, III. 

Fig. 516. — Construction of a Double-Flue Chimney. A, foul air flue; B, chimney 
tile; C, opening into foul air flue; D, door which controls supply of air to the furnace. 

windows twice a day, but that is quite insufficient in a crowded room, and 
it only takes a few days or weeks to produce a perfect lassitude and weak- 
ness. 

"Now I do not want to give up my profession, and I want some physical 
force. I never weigh more than 100 pounds and have continual difficulty 
in keeping built up. After a long vacation, I feel better for a little while, 
then begin the fight all over again. Can you recommend any course of 
treatment, or exercise, that might mitigate my trouble?" 

Reply. — The air of schoolrooms in Chicago and elsewhere is far from 
what it should be. The method is not perfect nor even approximately so. 
It is too warm, too dry, too dusty, too still and not freshened often 
enough. 




<3 





Dept. of Public Instruction, Springfield, III. 

Fig. 517. — Heater with Jacket Not Reaching the Floor. This cut illustrates how the 
door controlling the supply of air to the furnace should be placed to take in the air 
from the outside, from within the room or from both. When the door is open it closes the 
outside opening and opens that from the inside. The air is then all taken from the room. 
When the door is closed the air is all taken from the outside. When the door is part way 
open, the air comes from both outside and inside. 



1269 



1270 HOSPITALS— SCHOOLS 

You are evidently not in good physical condition and are justified in 
going to some trouble to get things bettered. We assume that you are 
anxious to teach in this climate. If you can get exchanged to an open-air 
school do so. If that is impossible try for a cold-room school. 

If you must remain where you are proceed as follows : Buy a depend- 
able thermometer. Buy a wet and dry bulb humidity measurer — a hy- 
grometer. Keep an hourly record of the temperature in your schoolroom. 
Do not let it go over 65°. Take the temperature of the room at different 
places. Keep a record of the humidity. Keep this up to 50. Expose 
enough water around the room to keep the humidity up. 

Open the schoolroom windows and blow out the room several times 
during each day. When the room begins to get close and stuffy give the 
children some kindergarten play and while they are moving about air out 
the room. 

You are evidently undernourished. Eat all that you are now eating and 
add two glasses of buttermilk to each meal. When you begin to tire of 
this stop it and take a glass of sweet milk with each meal and one 
at bedtime. Drink a pint of cream a day as a further variation in your 
milk diet. 

Finally you evidently need mental calm. You are probably a worrier. 
You need equanimity ; Christian Science, mental science or the Emmanuel 
teachings will help you here. 

Purpose of School Inspection. — Mrs. J. S. G. writes: "1. Will you 
inform us just how medical inspection in schools should be conducted in 
order to be effective? How frequent should the inspection be? How 
thorough should it be? 2. Have those people who object to it any legal 
right to do so? Has the school board the right to enforce such people to 
submit to it? 3. How is it arranged in the Chicago schools? I live in a 
small town near Chicago, where we hope soon to establish medical inspec- 
tion in our schools, and am anxious that it should be a success" 

Reply. — 1. I cannot answer this question in the space at my disposal. 
Read Gulick and Ayres, Cornell or Hoag, or the Chicago health depart- 
ment report for 1911. Possibly you could get them from your public 
library. 

2. School inspection is for two purposes: to exclude children bearing 
contagion from school and to discover physical defects. Sometimes the 
school inspection in operation in a town applies to the first of these, some- 
times to both. 

3. In the Chicago schools both forms of inspection are practiced. 

Systematic Play for Both. — Mrs. E. McC. writes: "My boy is nearly 
10 years old, more than the average in height and weight, and in the fifth 
grade. He stoops over so much that his head seems to come from his chest. 
I am constantly reminding him of standing up straight, which he does 
for a moment and then forgets. Please advise me what to do for him, 
also about my daughter. She is 15 years old, but is always taken for 
18 or 20. She has headaches almost all the time, and doctors claim they 
do not come from her eyes. She also suffers from extremely cold and wet 
feet, winter and summer, and her hands are always cold. Would woolen 
stockings help to keep her feet warm?" 

Reply, — 1. Have your boy go to the nearest park or playground gym- 
nasium and get the director to lay out some play and work for him. Even 



SCHOOLS 1271 

if his spinal column naturally tilts forward proper play, persisted in, can 
straighten it a good deal. 

2. As to the warm stockings and mitts — yes. Systematic play should 
help her too. 

May Be Due to Dry Air. — G. A. H. writes: "There is a rash or itch 
prevalent among school children in my vicinity that is quite distressing 
to the little folks, and even some of the larger ones have been slightly af- 
fected. There is hardly anything noticeable on the skin, not even redness. 
Sometimes a small red pimple is seen, something like scarlet fever rash, 
but does not make the shot-like feeling under the skin. The children 
do not itch so much in the morning or during the day, but at bedtime and 
afterwards they will scratch almost continually and wake themselves up. 
Their health is fine. The arms and legs seem most affected. Can you 
suggest a salve or liquid preparation that will relieve this condition, and 
also be inexpensive?" 

Reply. — There are two or three kinds of skin diseases which are com- 
monly spread by school children. Control of these is one of the advantages 
gained from having school nurses. 

G. A. H.'s description does not fit these. It is smallpox, not scarlet 
fever, which makes "a shot-like feeling under the skin." Nevertheless, this 
description does not read like scarlet fever. 

My advice to you is to have the city physician exclude scarlet fever and 
the skin diseases frequently spread at schools. If it is not any of these 
then it is due to dry air in the schoolrooms. 

It will get better as the rooms are better ventilated in April and will 
stop as the windows are opened in May. 

The cure is to increase the humidity of the air in the school. Salves 
will not do the job. 

Have Windows Opened. — E. A. R. writes: "I am a high school girl, 
15 years of age. Sometimes during the day my throat gets full of slime 
and I can hardly talk, at least not as I should talk. Is this catarrh? What 
ought I do to prevent it? Will you please tell me if I am small and thin 
for my age. I am 5 feet 2 inches tall and weigh 95 pounds/' 

Reply. — I cannot tell why your throat gets full of slime. Stay in the 
open air all you can ; get your schoolroom windows up during recess time ; 
get them wp on all warm days. If this does not relieve your huskiness 
have your throat examined. You are a little undersized. 

School Session too Long. — A. M. writes: "Will you please state your 
opinion of a high school session of four hours and three-quarters in forty- 
minute periods of recitation and study, with no break for lunch, gymnas- 
tics, or other form of relaxation?" 

Reply. — It is wrong from the health standpoint. Four hours and three- 
quarters of concentration is bad for the adolescent, both mentally and 
physically. It is bad pedagogically. The proper system provides for short 
study periods, with intervals of play and manual training — the Gary 
system. 

Let Boy Remain in School. — Anxious Mother writes: "I have a 13- 
year-old son attending private school where recently diphtheria has de- 
veloped and they have had sixteen cases in quarantine, isolated of course. 



1272 HOSPITALS— SCHOOLS 

Two of these were from the hall my hoy is in, using the same study hall 
and dormitory. They tell me they have quite a few cases of tonsillitis that 
are watched carefully and throats examined each morning to determine if 
they develop diphtheria germs. Antitoxin is administered if such is the 
case, and they are sent to the isolation hospital on the university grounds. 
In the event of a diagnosis of diphtheria the parents are notified. But 
should I wish to go into quarantine to he with my hoy it would he for- 
hidden, and no parent is allowed to he with a child during his isolation. 
They tell me the law forbids it. I do not wish to appear overanxious nor 
to interfere with my youngster's studies unless necessary for his good. I 
am really not thinking he will take diphtheria and would not consider 
taking him out of school on a chance of his developing it, except for the 
thought that were it to happen I should he denied going to him. They 
suggest, realizing my uneasiness, antitoxin heing administered to him to 
eliminate the chance of his taking it, and tell me that should another 
case develop in the hall from which most of the cases came they would 
ask permission of the parents to administer antitoxin to every child in 
the hall. Will you tell me as a physician just what course you would take 
if you had a child situated as mine is? He is an only child and this is his 
first year away from home and diphtheria is the only child's disease through 
which I have not cared for him." 

Reply. — Leave the boy in school. Five hundred units of antitoxin 
would be entirely safe and would make the boy immune for a month. 
This is probably unnecessary but it is advised in part to ease your mind. 
The school is proceeding most wisely and will no doubt hold the epidemic 
down. The only additional procedure to be advised is to culture every 
sore throat in the hall from which the cases came. 

As you do not mention the state I can not say whether it is illegal 
or not for you to go into quarantine with the boy. It would not be in 
Illinois. In fact, parents are sometimes allowed to go with their children 
to the diphtheria hospital in Chicago. 

When antitoxin has been used and proper precautions are taken the 
risk is slight. This privilege occasionally helps the child. Its chief func- 
tion is to calm the parents. 

Let Him Play with Children. — Mrs. M. A. L. writes: "My hoy, nearly 
5 years old, has always been well. He is large and strong, and bright, but 
seems extremely nervous. It appears to he more imagination than nerv- 
ousness. For instance, he will he playing out in the yard, perfectly con- 
tented, when all of a sudden he will begin to cry. When I ask him the 
reason it will be some foolish fear. He is afraid the wind will blow papa 
away; that the house will catch fire, or something equally foolish. He 
sleeps well from 7 P. m. till 5.30 a. m., hut tells me of the strangest dreams 
he has had. He is alone a good deal, as I am busy with the hahy. But 
he has a big yard to play in and a playhouse. I never allow him to play 
with other children. 1. Do you think I ought to let him run the streets 
with the other hoys? He seems happy and contented till he gets a notion 
like those mentioned, then he commences to cry. What treatment do you 
suggest? 2. Would circumcision help? 3. Is it dangerous? 4. What effect 
will it have if I don't have it done (in after life, I mean)?" 

Reply. — 1. This child's mentality and spirit require the best of train- 
ing. Left to himself he will certainly grow up a confirmed neurasthenic. 
As soon as he is old enough get him in a kindergarten run by teachers who 



SCHOOLS 1273 

know something about the psychology of children. Be extremely careful 
in home training. Try to establish poise and balance and banish fear. 
Have him play with wholesome children as much as possible. Encourage 
him to compete in games. 

2 and 3. No. 

4. None. 

School Inspection Barred. — H. J. writes: "1. Is physical examination of 
school children in cities of 7,000 or 8J000 population practicable? 2. Do 
many such towns have anything of the hind? I am led to ask these ques- 
tions by the attitude of the school board of my city toward any form of 
medical inspection. Several months ago a woman member of the board pre- 
sented a resolution providing for inspection, but it was buried in com- 
mittee, and all efforts to revive it have been futile. Later the same member 
offered a plan for medical examination that would be without cost to the 
board. (Every physician in the city had promised to give some time to 
the work, without pay.) This also was rejected. Now, only recently the 
women's club of the city, having made some money by the sale of tubercu- 
losis seals at Christmas time, offered to pay the expenses of a visiting 
nurse for a month, planning for her to give talks on hygiene to the chil- 
dren and their mothers. The offer was refused point blank, and the women 
were told to 'mind their own business, and not butt in.' 3. What possible 
objection can there be to this work? k- Does it scare the children and 
their parents? Is it a kind of slumming project — looking after the chil- 
dren of the 'common people'?" 

Reply. — 1. Yes. 

2. No. 

3. School inspection is for two purposes : (a) To control contagion ; (b) 
to increase the learning capacity of the average student. That it is a good 
investment every one with experience knows. Those without experience 
can know it from reading Gulick or Cornell. Nevertheless school inspection 
is objected to because it costs money. There is no other objection worth 
considering. 

4. No. 



CHAPTEE LXY 

Sex Organs of Woman 

THE FEMALE SEX ORGANS 

The essential sex cell in the female is the ovum. It is the cell which, 
when properly fertilized, develops into the child. The organ which produces 
these cells is called the ovary. The ovary, therefore, is the essential sex 
organ in the female. The other female sex organs exist for the purpose of 
serving the ovum. 

The ovaries, two in number, are located deep in the pelvis on each side 
of the uterus. When the female child is born her ovaries are filled with 
immature ova. These lie quietly in the ovaries until puberty is approaching. 
Beginning with puberty and from that time until change of life, from time 
to time, the ovaries discharge an ovum or more than one, the process being 
known as ovulation. In some girls a few ova mature and are discharged 
before puberty and in some women a few are discharged after the change 
of life but these are the exceptions. The rule is that the discharge of ova 
begins at puberty and stops at the menopause. 

MENSTRUATION 

At twenty-eight-day intervals (in women between puberty and the meno- 
pause) menstruation appears. At this time the blood vessels of the uterus 
fill with blood and the membranes lining the uterus and the fallopian tubes 
swell. Some of the blood oozes from the congested vessels and finds its way 




v 

Fig. 518. — Female Reproductive Organs (two-thirds the natural size), as Seen from Behind. 
u, upper part, and c, neck of uterus (in section); v, upper part of vagina; od, fallopian tubes 
(left one cut off) opening into cavity of abdomen at fi; o, right ovary; po, h, accessory ovarian 
structures; I, 11, lo, supporting ligaments. 

1274 



MENSTBTJATION 1275 

into the interior of the uterus. This blood, with a few of the cells lining the 
uterus, is what is known as the menstrual fluid. 

The amount of fluid lost at each menstrual epoch varies from two to 
fourteen ounces. • The average duration of the flow is about three days. 

At the time of menstruation the mammary glands or breasts enlarge 
slightly, there is a feeling of heaviness in the pelvis, there may be a little 
aching in the hips, there is some congestion of the female generative organs 
and in most cases an ovum is discharged from the ovary and slowly makes 
its way down a fallopian tube, thence into the uterus. 

While ovulation and menstruation usually go hand in hand they 
do not always do so. As has already been stated, in some cases ovulation 
takes place before puberty; in other cases, it occurs after the menopause. 
Sometimes an ovum is discharged between the menstrual periods. 

Therefore, all that we can say is that there is some relation between ovula- 
tion and menstruation. Ovulation is one of the determining factors in men- 
struation but it is not the only one and just how it acts, or why, no one knows. 

NORMAL MENSTRUATION 

In the average woman menstruation appears once in every twenty-eight 
days. However there are many exceptions. Some women menstruate once a 
month; others once in three weeks and others once in five weeks. If a woman 
is free from other symptoms the fact that she menstruates at too short an 
interval, too long an interval, or even at irregular intervals, need occasion 
no alarm. 

As the time for menstruation apj; coaches a woman becomes somewhat 
nervous, her breasts swell somewhat, she has a feeing of heaviness or bearing 
down in her pelvis and perhaps she notices that a slight discharge precedes 
the flow. None of these symptoms means that there is any disease present. 
Any one of them can be moderately exaggerated without indicating the 
existence of any condition which calls for investigation. 

The flow varies in amount. Women generally describe it in terms of 
napkins. But that is not very dependable since one woman will wear a napkin 
until it is thoroughly saturated while another will change as soon as her 
napkins become slightly soiled. To put it rMflierently, the amount of flow 
varies from two to fourteen ounces. Or to state it another way the flow is 
free during from two to seven days. These wide variations mean that there 
is nothing that is very fixed about the amount or the duration of menstrua- 
tion. It does not matter so much as women think. One often hears such 
prophecies as these: "She does not menstruate freely enough; that cannot 
be good for her;" or "She menstruates too freely (or too long); that is 
bound to be pulling her down." The fact is that these prophecies, predic- 
tions and plain statements of fear are not justified. A woman's menstrual 
habit is normal to her. In nine cases out of ten she is too free or not free 
enough, as compared with the average woman, because that is the natural 
way for her. 

Medicines to make her flow more freely or less freely, as the case may 
be, do no good and it is well for the woman that they do not. It is best for 
the woman that she continue her menstrual habit even though she flows 



1276 



SEX ORGANS OF WOMAN 



less freely, or more freely, for a shorter time or for a longer time, than some 
other woman. 

At the end usually of three days the amount of flow begins to lessen. 
The discharge of blood stops and a light discharge of mucus replaces it. 
Then all flow stops. Such is normal menstruation. 

Biologically, it is not a well-established function. No animal lower than 
a monkey menstruates. In monkeys the function scarcely exists. In female 
savages, menstruation, Reed tells us, is by no means well established. Among 
highly civilized races it is most prominent but not even in them does men- 
struation pursue a fixed course. Therefore, an individual woman can men- 
struate differently as to amount, time and symptoms from the average woman 
without the difference indicating that she is abnormal. 



HYGIENE OF MENSTRUATION 

It is well to begin the menstrual period with the bowels open. Probably 
no cause of menstrual disturbance is as productive of symptoms as is con- 
stipation. The bowels should be in order all the time but if the menstrual 
period finds the large intestine full a saline purge or an enema is justified. 

Not only should the napkins be changed as frequently as cleanliness may 
demand but there should be no hesitation in taking local neutral baths 
(neither hot nor cold). In fact there is no harm in taking a general neutral 
bath, a neutral foot bath or a neutral sitz bath if it is desired. 




Fig. 519. — Section of Female Pelvis Showing Location of Organs. A, the pubic bone; B, 
the bladder; C, the vagina; D, the rectum; E, the perineum. 

If there has been exposure to cold or the clothes have been wet by rain 
it is advisable to take a hot mustard foot bath (a tablespoonful of ground 
mustard to two gallons of water) or a general warm bath, and then go to 
bed and remain there for several hours. Cold baths and cold plunges during 
menstruation are not advisable. 



MENSTRUATION 1377 

The amount of exercise taken during menstruation need not be less nor 
more than is the daily habit. 

As soon as menstruation has stopped a local bath should be taken. It is 
the custom of married women to take a cleansing douche of tepid water at 
the end of menstruation. This custom is all right. Probably it is not best 
for the unmarried to follow this custom. 



SCANTY MENSTRUATION 

Within a year after puberty a woman establishes her menstrual habit. 
She may menstruate but very little but that is her habit and it is, therefore, 
not significant of any disease. 

But there are certain conditions which produce scanty menstruation and 
which call for some attention. 

Overfat women do not menstruate freely. Sometimes they do not men- 
struate at all. Fat women are disposed to be sterile, but there are exceptions. 
Occasionally, a woman who does not menstruate on account of obesity or who 
menstruates but little will conceive. Scanty menstruation in obesity is due 
to lack of balance in the secretions of the ductless glands. 

Chlorotic women are very apt to have scanty menstruation. One theory 
is that this is due directly to the poverty of the blood. The other is that it is 
due directly to poverty of ovarian secretion — poverty of the blood being an in- 
direct cause. In chlorosis menstruation is an excellent index of the state of 
the blood. A return of menstruation indicates improvement and vice versa. 

In various profoundly disabling diseases, scant menstruation is a symp- 
tom of value, for instance, in advanced tuberculosis, in cancer and in other 
diseases which profoundly depress vitality. 

Scanty menstruation in one accustomed to menstruate freely is a symptom 
of some form of constitutional disease. It calls for a careful thorough exam- 
ination of the blood and other organs. 

AMENORRHEA OR ABSENCE OF MENSTRUATION 

The rule is that menstruation occurs at intervals from puberty to the 
menopause except during pregnancy. Pregnancy, therefore, is the most 
frequent cause of absence of menstruation. It is, however, not the only cause. 
Occasionally, we find a woman who never menstruates at all. In some cases 
such women are otherwise normal. Some of them have borne children. Not 
infrequently a woman who has a child at breast and who has not recommenced 
to menstruate will become pregnant. These two groups of cases show that 
ovulation may take place without menstruation. 

In some cases of absence of menstruation the trouble is the result of 
tumors or other abnormalities in the pelvis. 

In amenorrhea or absence of menstruation a thorough examination of 
the female organs is advisable. In scanty menstruation it is not, unless there 
is some special indication. 

That worry can prevent menstruation is a well-established fact. The 
professional abortionists gain their riches from women in whom menstrua- 
tion has been stopped by fear. A woman is afraid that she is pregnant. 



1278 SEX ORGANS OF WOMAN 

Her fear possesses her. The day for menstruation comes. No flow appears. 
She goes to an abortionist or she buys some tansy pills or cotton root or 
ergot. She takes a dose and, becoming easy in her mind, the flow appears. 
She gives the drug credit. The credit is due to the fact that her fears have 
been allayed. 

MENORRHAGIA AND METRORRHAGIA 

Discharge of blood between menstrual periods is called metrorrhagia. An 
excessive flow is called menorrhagia. 

Hemorrhage from the uterus not due to menstruation should always call 
for an examination. // a woman past the menopause has uterine hemor- 
rhages ever so slight she should be examined at once. In all probability she 
has cancer and her only hope of life lies in early diagnosis. Next in the 
line of probabilities is fibroma. A fibroma which causes hemorrhage in a 
woman past the menopause is not to be neglected. 

Metrorrhagia in a woman before the menopause is very apt to be due to 
an incomplete abortion. The second most frequent cause is uterine tumor — 
possibly a rather small one. The third most frequent cause is a moderate 
degree of anemia. 

Therefore, a woman who has a hemorrhage from the uterus between periods 
should have an examination. The female organs should be examined for 
evidence of abortion and for tumors. The blood is to be examined for 
anemia. 

In a case of menorrhagia the first point to decide is whether or not the 
free flow of blood is the woman's habit. If it be decided that it is not her 
habit and that something is to be done for it the first step is to find out the 
cause. Among the causes are : ( 1 ) tumors of the uterus ; ( 2 ) tumors of 
some other pelvic organ; (3) inflammations of the uterus or tubes; (4) failure 
of the uterus to reach the proper size after pregnancy — subinvolution; (5) 
constipation; (6) malaria; (7) anemia; (8) various diseases causing moderate 
debility; (9) abdominal tumor; (10) violent emotions. 

The probability is that a given case of menorrhagia is due to some tumor 
in the pelvis or other disease of the female organs. Therefore, the indication 
is to have a thorough examination of the pelvis. If the cause is not in the 
pelvis the most likely cause is distension of the lower bowel with feces. Next 
in frequency as a cause is anemia of moderate grade. 

Many cases of menorrhagia have been operated on locally and the credit 
for cure given the operation, when in reality it was due to the thorough 
cleaning out of the bowels which the woman had while under treatment, 
or the iron and arsenic, cacodylate, or quinin given after the operation. 

To check a flow which is regarded as much too free quiet in bed with 
the head lowered and an ice pack over the lower abdomen is advised. A 
physician may give vaginal injections of ice water but the patient must not 
do this except under advice. 

For the cure of menorrhagia local treatment should be given where it is 
needed. If constipation is the cause it must be remedied. If malaria, quinin 
is to be given. If anemia, iron, arsenic or cacodylate of soda. Ergot and the 
multitude of patent medicines for female irregularities are useless, or worse 
than, useless. '.... .:.. .. . .,- ■. ■: 



MENSTRUATION 



1279 



DYSMENOREHEA 




Dr. Kristine Mann says that "cramps" is the most frequent complaint 
of women who seek relief in the rest rooms of large department stores. I 
am sure that her observation is correct and that among women who do 
housework, stenography, clerical work and light work of that type, cramps 
is very much the most frequent symptom complained of. Every day the 
keeper of every rest room is called upon to do something for cramps. The 
remedy commonly given is whisky. 

Many female whisky users claim that 
they got the habit from taking whisky 
for cramps. 

Another rough and ready remedy for 
cramps is paregoric or laudanum. This 
is the origin of some cases of opium habit. 

Dysmenorrhea is important from 
more than one standpoint. The term 
means difficult menstruation. This is 
usually construed as meaning pain during 
menstruation. The pain may be any of 
several varieties. A frequent statement 
is that the sensation is one of cramping 
in the uterus, the pain being very similar 
to that of cramping in the intestines. 
The cause of this variety of pain is spas- 
modic contraction of the muscles of the 
uterus. 

On the other hand, what some women 
mean by dysmenorrhea is merely an ex- 
aggeration of the heaviness and discom- 
fort in the pelvis, some of which is felt during menstruation by every woman. 
Neurasthenic, hysteric or self-centered women are liable to consider and to 
speak of the sensation as dysmenorrhea or cramps. 

For the relief of dysmenorrhea the best treatment is a hot foot bath and 
local applications of heat or cold. If the flow is scanty apply an icebag to 
the back low down. If too free a hot bag to the same point. If necessary 
give a dose of acetanilid or phenacetin (5 grains) internally or a hot drink con- 
taining some aromatic such as aromatic spirits of ammonia> or camphor. 
None of this group of remedies is better than 10 grains of camphor dissolved 
in cinnamon mucilage water. This can be repeated in an hour. Dr. Mann 
gives 30 drops of fluid extract of viburnum. Neither opium nor whisky should 
be taken. Whisky does not relieve the pain except in the sense that it intoxi- 
cates and thus makes the woman indifferent to pain. 

In some cases the pain can be prevented by 10 grains of salicylate of soda 
taken three times' a day for a week before the period is due. 

In most cases the sufferer should consult a physician with a view to a 
thorough pelvic and general examination to be followed by treatment directed 
against whatever condition is found to be causing the symptom — for dysmenor- 
rhea is only a symptom. 



Fig. 520. — Pelvic Hematoma. Uterus 
pushed forward somewhat by blood 
clot lying in front of rectum. (C. F. 
Adams, "The Post Graduate".) 



1280 SEX ORGANS OF WOMAN 

DIAGNOSING THE CAUSE OF STERILITY 

Duncan tells us that about one marriage out of six is without issue. 
Seven per cent of the women who marry when between 15 and 19 years of 
age are sterile. Those women who marry when between 20 and 24 years of 
age are the most fertile. From the age of 24 the percentage of sterility 
gradually rises until in women who marry at the age of 50 it reaches about 
100 per cent. 

Practically speaking, if no children are born within three years after 
marriage and no effort to prevent conception has been made the marriage 
will be without issue. 

Lespinasse tells us that 7 per cent of fertile couples have their first 
child three years or more after marriage. Among wives between 25 and 39 
years of age this percentage rises to 15.G. 

If a marriage is without issue the fault lies with the husband or wife. 
The only way to discover which is at fault is to make a careful inquiry. 
Dr. Lespinasse starts with the husband. He first wants to know whether 
the husband has had syphilis, gonorrhea, mumps, tuberculosis or profound 
anemia and what injuries he has had. Next, he is carefully examined. This 
examination should include necessary microscopic examinations. 

If the husband is found capable of producing children the inquiry is 
extended to the wife. Is she fat? Fat women are often sterile. Has she 
anemia? Is she soft and flabby? Has she goiter, or too little thyroid, or 
too little pituitary secretion? Certain tests show whether there is too little 
pituitary or thyroid secretion. Has she had gonorrhea or syphilis? 

If the trouble is not with the husband, and the wife is normal in the 
above particulars, he proceeds to make such other physical examinations and 
microscopic examinations as are indicated. 

The responsibility for the difficulty can be located in nearly every case. 
In a very large proportion of cases it can be remedied. Some doctors make 
the diagnosing of the causes of sterility a specialty. 

Baths During Menstruation. — B. B. writes: "Will you "kindly advise me 
regarding baths during the period of menstruation? I am used to taking 
a warm hath every night and a cold plunge each morning. During this 
period I do without the morning bath, but I take the warm bath at night 
as usual. I am told that this is a very unwise habit, but I do not know how 
to do without it. 

"I am thirty-nine, seldom actually ill, but am not strong — that is, I tire 
very easily. I do clerical work and without the stimulus of a cold bath I 
do not feel equal to my work." 

Eeply. — It is not wise to take a cold plunge during menstruation. 
The warm bath at night is all right. 

Change of Life. — O. writes: "I am 53 years old and for the last few 
months I have hot flushes. At times they make me quite faint. I am con- 
tinually tired and my legs at times are very stiff and painful. Can you 
advise me what to do? Do you consider this at all serious?" 

Reply. — You are passing through the change of life. Be calm and 
everything will work out all right 



MENSTRUATION 1281 

Menorrhagia. — P. 8. B. writes: "Will you please advise the proper way 
of living for a woman suffering from excessive menstruation who is pale, 
frequently subject to headaches, lacking in endurance and, as a conse- 
quence, does not take much outdoor exercise?" 

Reply. — I think she should consult a physician. He will probably ex- 
amine her blood and find her anemic. He will probably find her flabby. 
In the event that he finds her anemic and flabby he will prescribe a tonic 
of cacodylate of soda, arsenic, or iron, and tell her that if she wants to 
get well she must get more out-of-door exercise, eat more vegetables and 
fruit, drink more water and take less headache medicine. 

Amenorrhea. — A. B. C. writes: "1. Can a woman of 1+0 who has not 
menstruated for two years become pregnant? 2. Could she consider that 
she has passed the menopause? There have been none of the usual symp- 
toms except some nervousness." 

Eeply. — 1. Possibly. 2. No. 

Too Young for Change of Life. — Mrs. W. M. G. writes : "I am a mar- 
ried woman of 38 and would like to know if the fact that I have missed 
a period proves I am pregnant or can I be starting the change? I am in 
good health apparently but have lacerations unattended to." 

Reply. — You are too young for the change of life. Missing one period 
is not sufficient basis for a diagnosis of pregnancy. 

Normal Menstruation. — A. P. writes: "I am an orphan girl 15 years 
of age. For the past week I have soiled my clothes with blood. Could you 
tell me a remedy for such a thing?" 

Reply. — You are menstruating. Girls of your age, and older, men- 
struate every four weeks. It is normal. That is the way nature works 
in women. In your body there are two glands called ovaries. These form 
cells called ova. About once a month one of these ova is discharged from 
an ovary. Leading from each of your ovaries there is a tube called the fal- 
lopian tube. The ova travel down this tube to another tube called the womb 
or uterus. Once every four weeks some blood oozes into the womb and 
fallopian tubes and then flows to the outside. That discharge of blood is 
called menstruation. After a few days it stops of itself. During this time 
you must keep yourself clean and protect your clothing by napkins. 

Can you get your teacher, some relative or some other good woman to 
tell you all about your sex organs and how to take care of yourself ? There 
are other questions that you will want to ask and other information that 
you will need. 

Leukorrhea. — 8. D. C. writes: "Will you kindly indicate the course for 
a girl of 11 to pursue having constant discharge from ovaries for nearly a 
year? At times very acute pain and increased discharge. Is it possible 
for treatments to restore? Must the ovary be removed? General health 
excellent. Want no examination until condition in a general way is 
understood." 

Reply. — You have leukorrhea, usually the result of infection. If a 
general tonic and hygienic living does not cure you in six months, a pelvic 
examination should be made. 

Very Scanty Menstruation. — T. M. T. writes : "I am a girl 16 years of 
age and would like to have some advice. I hud my menses when lS 1 ^ 



1282 SEX ORGANS OF WOMAN 

years of age and since that time have received them, at intervals of from 
four to seven months and then only for one day. Please tell me what 
to do." 

Beply. — I presume you have no other symptoms since you mention 
none. I presume your general health is good. Probably, therefore, the 
habit described does not mean that you have much trouble or that treat- 
ment will change matters much. However, my advice is that you see a 
physician, preferably a woman. A blood examination may show that you 
need a tonic. Some local condition needing treatment may be found. 

Leukorrhea. — M. S. writes: "1. I have had leukorrhea for several 
years. Have taken Quite a lot of aletris cordial without favorable re- 
sults. Is that usually a cure and would you advise me to keep it up? 

2. Does leukorrhea cause weak spells? 3. If leukorrhea is allowed to run 
on what will be the result?" 

Reply. — 1. No. 2. Weak spells may be one result of leukorrhea. 

3. Among other results there may be peritonitis or pus tubes. You should 
see a physician. It is possible that a tonic and leading a more hygienic 
life may cure you, or you may need some sort of operation or local treat- 
ment. 

Can Ride Horseback During Menstruation. — A. H. writes: " Kindly 
advise me whether it is harmful to ride horseback during the menstrual 
period." 

Reply. — No. 

Scanty Menstruation Not a Sign of Pregnancy. — A. B. Z. writes: 
"Could it be possible for a woman to be pregnant and her menses come 
regularly, but not so plentifully, for four months, or is it just shortage 
of blood?" 

Reply. — I do not think you are pregnant. 

Amenorrhea. — Mrs. D. M. B. writes: "Will you kindly inform me of the 
seriousness of the condition of a young girl of twenty-one years of age 
who has not menstruated for over four months? She passes an albuminous 
substance in her urine, has an enormous appetite and is troubled with 
constipation. She has lost weight in past year but has suffered no pain or 
headaches." 

Reply. — I think she should see a physician. Her constipation needs 
attention. Probably she needs a tonic. 

Complete Recovery After Severe Operation. — S. G. R. writes: "A 
woman nearly forty years of age wants to know your opinion. She has 
had her appendix, right ovary and womb removed. Can she expect ever 
to be well and strong, to do housework as other women? She is extremely 
nervous and has a floating kidney. Can she expect to live as many years 
as though this had never been?" 

Reply. — I cannot answer the question as to you because I do not know 
you. I can only make some general statements as to women in general. 
The removal of the appendix, right ovary and womb very definitely dis- 
turbs the relations of the nerves, vessels and all other structures in the 
pelvis. Therefore, considerable time for readjustment is required. In 
time complete readjustment can be expected. 



MENSTRUATION 1283 

Is Pregnancy Safe? — J. B. writes: "Would you allow a pregnancy in . 
a woman 20 years of age with a urine showing a trace of albumin and a 
few hyaline casts? There is no previous history such as scarlet fever, etc. 
It is not Bright's as there are no symptoms, no swellings; heart is normal 
in size and sounds as attested by a physician. Blood pressure is normal 
also." 

Reply. — If the woman will be carefully watched over and if she will 
lead a thoroughly hygienic life she should pass through pregnancy with 
reasonable safety. 

When Can Pregnancy Be Diagnosed? — Mrs. E. R. writes: "1. Will 
you please tell me how soon a physician can tell if a woman is pregnant? 
2. Can he tell if she is, at two months and a half along, by examining the 
womb?" 

Reply. — 1. By an Abderhalden, and sometimes by other examination, 
in the first month. 
2. Yes. 

Children Desired. — C. W. C. writes : "I write to ash you a question the 
answer to which I feel sure will be of great interest to many others as well 
as to myself. I have been married over a year now and, although my wife 
and I are both anxious for children, we have thus far been completely 
disappointed. We are both wonderfully healthy to all outward appear- 
ances and cannot understand what is the matter. Under these circum- 
stances is there reason to believe that there is something ailing? Should 
either or both of us consult a physician? Is there reason to believe that 
some defect exists which prevents one of us from having offspring? Or 
can we hope that in the natural course of events children will yet come?" 

Reply. — If, at the end of three years, you have no children you can be 
reasonably certain that your marriage will be without issue unless you 
have something done. At that time have a physician make a proper ex- 
amination of you. If you are all right, an examination of your wife 
should be made. 

There are a few physicians who specialize in this branch. 

Phantom Tumor. — E. M. D. writes: "Will you kindly tell me something 
about phantom tumors? What causes them? What are the symptoms? 
And do they leave any ill effects behind? 

"I have been troubled with signs of pregnancy. About the third or 
fourth month my abdomen will enlarge, then all of a sudden it ends. Dur- 
ing this time I menstruate very freely and have great pain, otherwise the 
signs of pregnancy are almost all there. This has happened to me three 
times. The doctor laughs and says they are phantom tumors. That is 
all he will tell me." 

Reply. — In phantom tumor the woman persuades herself that she is 
pregnant. The abdomen enlarges and she has feelings which she interprets 
as movement of the child, pressure of the child on the bladder and as 
other indications of pregnancy. A careful physical examination shows 
that pregnancy is not present. The condition is an illustration of what 
the mind can do. Also of what it cannot do, for examination not only 
shows that no pregnancy is present but also shows that there was no evi- 
dence that should have been interpreted as pregnancy. 



1284 SEX ORGANS OF WOMAN 

An Old Husband and a Younger Wife. — L. L. L. writes: "1. A woman of 
thirty is married to a man past sixty years of age — both perfectly healthy. 
Is she likely to enjoy the blessings of motherhood? 2. If so, are the chil- 
dren likely to be weaker, either physically or mentally, than children born 
to parents who are nearer of an age?" 

Reply.— 1. Yes. 2. No. 

Shall Corsets Be Worn During Pregnancy? — Mrs. G. S. P. writes: "I 
should like your opinion in regard to a point on which I find that women 
and physicians with whom I talk and books that I read differ greatly. 
The point is this — should a pregnant woman wear corsets? By some I am 
told that to support the abdomen is to weaken the muscles which normally 
should support the uterus and its contents, while others say that to go 
without corsets when one is used to them is apt to cause backache and will 
certainly make the abdomen sag permanently. Now, if a woman is anxious 
to do the best thing for both her child and herself, would you advise her 
to wear or not to wear a maternity corset throughout her pregnancy?" 

Reply. — A woman who has been accustomed to corsets should wear a 
maternity corset during pregnancy. 

What is Safe for a Pregnant Woman?— B. L. M. writes: "1, Is a ma- 
ternity corset absolutely safe to wear during pregnancy? 2. Is sewing on 
a machine harmful for a pregnant woman? 3. Is it best for her to read a 
book on care during pregnancy or is it unnecessary?" 

Reply. — 1. Yes. 

2. No, unless work is excessive. 

3. It is best, decidedly so. 

Shall a Woman 42 Marry? — Miss W. T. K. writes: "A woman of U2, 

fair health but nervous temperament, never married, contemplates mar- 
riage. 

"1. Is it advisable? 

"2. Is she liable to become pregnant? 

"3. Would not childbirth likely be fatal (no sign of menopause)?" 

Reply. — 1. Yes. 

2. Possible but not probable. 

3. Not necessarily. 

Childbearing and Diseased Ovaries. — A. V. L. E. writes: "Could a per- 
son, whose ovaries were so badly diseased that it is necessary to remove 
both of them now, have had a perfectly healthy child eight months ago?" 

Reply. — Yes. 

Shall She Marry? — -5T- Y. Z. writes: "Through ignorance, while a 
child, I was addicted to that awful habit, self-abuse, but on getting older, 
about 16 years, I tried and succeeded in breaking myself of this habit. 

"Now, Doctor, what I want to know is will this in any way affect the 
future generation should I get married? I am now a young woman of 21 
and adore children but, if there is any possibility of disastrous results, I 
will immediately give up all hope of marriage" 

Reply. — It will not. 



MENSTRUATION 1285 

Care During Pregnancy. — Mrs. R. D. writes: "Will you please answer 
the following questions: 1. Can a woman that is pregnant sew on the 
machine without harm to all concerned? 2. If a woman in that condi- 
tion catches a very bad cold will she keep that cough and cold till after 
confinement? 3. Is there any danger of having a hemorrhage when cough- 
ing a great deal? If. Is there any danger of having a miscarriage or 
hemorrhage when riding in an automobile across very rough roads?" 

Reply. — 1. Yes. 

2. No. 

3 and 4. The danger is not great. 

Consult a Physician at Six Months' Pregnancy. — R. G. R. writes: "My 
wife has been pregnant for about two months. She feels well in every way. 
At what month should we consult a physician?" 

Reply. — It would be safer to consult one at three months. However, 
at six months would probably be safe enough in a case where everything 
is going nicely. 

Ergot Will Not Cause Miscarriage. — Mrs. R. D. writes: "Will you 
please answer the following : 1. From what is ergot made or obtained? 
2. What amount is necessary to cause miscarriage? 3. Is it a poison? 
That is, can a sufficiently large dose be taken to cause death? If. I read 
in a book published by a Dr. Hollick in 1850 that it is an absolute impos- 
sibility for conception to take place after 16 days after the ceasing of the 
menstruation period. Do you agree?" 

Reply. — 1. A fungous growth on rye. 

2. No amount short of a very poisonous, probably fatal, dose will 
cause miscarriage. 

3. It is. 

4. While not absolutely impossible it is improbable. 

To Overcome Sterility. — Mrs. M. C. D. writes: "1. I am 30, have been 
married three years but am very anxious for a child. I have been ex- 
amined by three different physicians who have said I had no 'female dis- 
orders.' I am healthy and never suffer with pains of any kind. Before 
matrimony, my husband was examined and found 0. K. What is the next 
step you recommend? 2. Can you suggest any tonic which might help me? 
I know very little about medicine as I have taken but little during my 
life." 

Reply. — 1. You and your husband should go together to consult a 
physician who specializes in overcoming sterility. 

2. Nothing in your letter indicates that you need a tonic. 



CHAPTER LXVI 

Venereal Diseases 

VENEREAL DISEASE CAN BE BANISHED 

When a way is found to remedy a bad condition, the importance of that 
condition increases. Society is in a position to end syphilis. It has every 
tool needed. The germ has been discovered. It is easily found in the secre- 
tions of the early syphilitic. For the late syphilitic there are laboratory, as 
well as clinical, tests. The germs are found post mortem in the very late 
manifestations of the disease — those ten to twenty years after. Therefore, 
so far as diagnosis is concerned, every phase is covered. This tool is practically 
perfect. 

The remedies have been found. Preparations of mercury, arsenic and 
iodids are now thoroughly understood. Improvements may be made in these 
preparations but such will be velvet. Under their use, spirochetes may disap- 
pear from the secretions within a week. What the German scientists call "the 
great sterilization" can be accomplished within a few weeks. 

Unfortunately, the spirochetes are in inaccessible as well as accessible 
places. Many are well protected against the blood — therefore, treatment must 
be persisted in. 

The tool treatment is perfect enough for all practical purposes. The 
need is to use it in full instead of halfway. 

Syphilis can be cured completely and permanently — so as to prevent the 
twenty-year after effects ; so as to cure the next generation effects. 

On the other hand, the use of the tools is far from perfect. To secure 
a more perfect use of these tools is the work of the new tool of public and 
private hygiene — education. When there is popular demand for laboratory 
diagnosis of syphilis by health departments, they will make such diagnoses. 
When the patient demands laboratory diagnosis of venereal disease by private 
physicians, by hospitals and dispensaries, it will be done. This is a part of 
the work of public education. 

Much of the harm of syphilis results from half -cures — cure enough only 
to clear the skin and the throat but not cure enough to prevent locomotor 
ataxia, or insanity, or apoplexy, or premature old age, or blindness, or mis- 
carriages, or inherited syphilis. 

To secure a more perfect use of the tool cure — to substitute complete 
cure for half-cure — can be effected only by public education. 

As to gonococcal infections, some of the tools are entirely satisfactory; 
others are in the way of becoming so. The diagnosis of early cases can be 
made by the microscope. The method is perfect. It is easily applied. 

For the late cases, there is the microscope test and complement fixation. 

1286 



SO-CALLED VENEREAL DISEASES 1287 

Neither is perfect, yet each is valuable. The two combined with the clinical 
features, in the hands of physicians, make diagnosis satisfactory. 

The cure of gonococcal infections is not perfect. To those who carefully 
and persistently carry out directions, the results are satisfactory. To those 
who stop when the symptoms decrease, the results of treatment are not satis- 
factory. Then the imperfections of treatment are largely due to the patient. 
No treatment is perfect until it is reasonably foolproof. The treatment of 
gonorrhea is not foolproof. 

The work for the tool — public education — is twofold. To force labora- 
tory examination of gonorrheal secretions as a routine procedure; to bring 
about the handling of gonococcal infections by the health department as in 
other contagious disease ; to bring about complete cure of gonococcal infections 
instead of part cures. 

SO-CALLED VENEREAL DISEASES 

This series of articles deals briefly with different phases of the venereal 
disease question. It will tell the truth, seeking to avoid offense, and striving 
to make the presentation plain enough to be easily understood. 

We advise that, wherever feasible, girls go to their mothers and boys 
to their fathers for further information, or better still, that parents discuss 
these subjects with their children. Family physicians hold an important 
relationship to these questions. Finally, there are a multitude of excellent 
books on these subjects, books that speak frankly, the tone of which is 
thoroughly wholesome. 

These books are of the new style, in that the words employed and the 
ideas and illustrations used are chosen with a view to being easily understood 
by men and women of less than average intelligence. 

In so far as the venereal diseases are concerned, conditions are bad. 
They are bad because the subject has been tabooed. The flood of light that 
has been turned on everything else has been kept away from this subject. 
The medieval method has been abandoned as to every other subject. Here a 
dark jungle island has been left in a sea of light. 

We believe that generalized information will clear out this plague spot 
as it has the others. 

Venereal diseases should be reported, registered, and controlled from 
the health departments ; but these departments will not control them for years 
to come. Occasionally an exceptionally good city health department, such 
as those of New York City and Detroit, and such as California's among state 
departments, will attempt to register venereal disease. But the attempt at 
control does not go beyond registration, with some educational features at- 
tached. Outside the army and navy this is as far as our government will go 
in the near future. 

Where is there hope of relief? 

Thousands of people are killed; tens of thousands are made invalids for 
life. No class escapes. Venereal disease blinds babies; it mutilates innocent 
women; it lays low the men. 

It is called the "red plague." It deserves the name; it is a plague, and 
it is stained red. 



1288 VENEREAL DISEASES 

When the government fails us what remains ? Education — such a knowl- 
edge of the facts as will lead to self-government. 

Much of venereal disease can be prevented by greater morality. There will 
be groups of the young to whom chastity can best be taught by religious teachers. 
Some of the education necessary to prevent venereal disease is properly 
the function of these teachers, as other parts must be given by parents ; others 
by physicians ; others by school teachers ; others by health departments ; others 
by the drama, and still others by the public press. 

Webster's definition of virtue is "rectitude; strength; efficacy; valor; 
chastity." It would be a good idea to remove the semicolons and allow 
strength to flow into the other meanings. The meaning of this suggestion is 
that it is wise to promote virtue by ending the blindness of virtue. 

The problem of morality is not the problem of venereal disease. With 
it, however, it has many points in common. Efforts to promote morality will 
result in bettering venereal disease conditions. 

The venereal diseases should be classed with the contagious diseases. 
They should be reported at the health departments, and measures for their 
control planned by health departments. 

Not every venereal infection results from transgression of the moral law. 
A large part of venereal disease is innocently acquired. Infants' homes, orphan 
asylums, and children's hospitals find it well-nigh impossible to keep free 
from venereal infections. If they think otherwise it is because they have 
never followed the policy of proper examination of their inmates. 

Within the last ten years two up-to-date hospitals in Chicago have had 
experiences with gonorrhea in children. New buildings had been erected; 
every detail represented the last word in hospital construction and main- 
tenance. The intention was to maintain everything so attractively that 
people with homes would prefer to go to the hospital. Each had provided an 
up-to-date children's ward. 

Alas ! within a month after opening venereal disease was epidemic among 
the children. 

A meeting of the hospital superintendents of the city was called by the 
health department. The upshot of this meeting was that the careful, high- 
grade hospitals in the city adopted the policy of inspecting children on entrance 
and sending the gonococcus infected to the county hospital. 

The county hospital, already under great strain in keeping the children 
in separate scarlet fever, measles and other groups, was further required to 
divide each group into two subgroups — the venereally infected and those not 
so infected. 

The superintendents decided that the county could not escape getting 
venereally infected children in its wards. They were compelled to maintain 
separate wards, and it was wise for other hospitals to unload the venereally 
infected children into them. 

The widespread prevalence of gonococcal vaginitis in young girls has 
existed for a long time. It will continue to exist until a definite policy to 
prevent it is inaugurated. 

It is not a local condition. There is about as much innocently acquired 
gonococcal infection amongst young girls and babies in one portion of the 
country as in another. 



SO-CALLED VENEREAL DISEASES 1289 

Nor is the innocent acquirement of gonococcal infection limited to chil- 
dren. Most of the women suffering from pus tubes are not so suffering as the 
result of their own immorality, and many of them not as the result of any- 
body's immorality. 

In order to understand the manifestations of gonococcal infections it is 
necessary to know something about the germ which causes it. The germ of 
gonorrhea is known as the gonococcus. It is one of the pus cocci. As a 
general proposition, we get on comfortably with the pus cocci. They make 
fairly good neighbors. With some of them we live in peace and harmony 
all the time. With most of them the lower animals (horses, dogs, chickens) 
live in complete harmony about all the time. Some of them have but slight 
capacity to harm and then only for a brief season. 

For instance, a pus coccus, the staphylococcus, will crawl down a hair 
and get under the skin. Inflammation is set up ; leukocytes rush to the field ; 
a boil results. Within a week the leukocytes will have whipped out the pus 
germs, and the boil will be well. 

Other cocci are usually bad neighbors, their peaceful states being rarer 
than the belligerent ones. The gonococcus, being of the pus germ family, 
behaves in a similar manner. It has the family traits. 

In its generally known role it produces a violent suppurative inflam- 
mation. This stage starts after a three-day incubation period. This violent 
period lasts two weeks. 

In this period there is a good deal of local soreness and swelling. The 
pus cocci get into the lymph stream and are carried to the lymph glands. 

Occasionally one of these suppurates just as happens in an abscess or a 
boil. There is some fever and some aching. The toxins of the coccus are 
circulating* in the blood. 

Then follow the weeks in which the germs are getting accustomed to 
their neighbors. The suppuration gets less and the swelling passes away. 

This is followed by the stage in which the germ is quite well adapted to 
its new surroundings. The germs have got into some gland or fold that 
does not easily clean itself, and there they may lie, quiet and harmless, for an 
indefinite period. 

The stage of violent infection in the new host is succeeded by the stage 
of mild, latent infection. 

This tendency to become adapted to its surroundings is what makes 
gonorrhea hard to control — that is, as a contagion spreading from person 
to person. As I said before it is this same quality which makes malaria 
hard to control — this tendency to become chronic, to relapse; this tendency 
of the parasites to make themselves halfway at home in the blood of a host. 

More than half the men have gonococcal infections at some time or other 
in their lives. 

A large percentage of the women suffer from such infection. 

A small proportion of the children are infected by it. 

The gonococcus infects the moral about as often as the immoral; the 
innocent as often as the guilty. 

It produces sterility, blindness, and congenital deformity. 

It kills thousands, maims tens of thousands; disables hundreds of 
thousands. 



1290 VENEREAL DISEASES 

It rarely gets into the blood stream. 

Once an infection occurs, the gonococcus is liable to lurk near the site 
of infection for years. When its symptoms are cured it is still there and 
ready to harm; then is the time of the truce of the bear. 

Under a policy of ignoring gonorrhea the community is growing worse 
infected all the time. The policy of reporting and registering it, as with 
other forms of contagion, will come slowly. It will crawl with painful, dis- 
couraging, halting advances. 

In the meanwhile we must hope for escape through education. There 
are other things we had rather learn about. There is nothing that we have 
more need to learn about. 



"NO WORSE THAN A COLD" 

A great many boys are of the opinion that a gonorrheal infection of the 
urethra is "no worse than a cold." They have had several attacks and they 
have cured each one with a mixture compounded by the druggist, or some 
advertised injection. In each instance, after a few days of treatment, the 
discharge has stopped. 

The boy has come to entertain a contemptuous disregard for his dis- 
order. Sometimes he thinks his method is the best ever, whereupon he spreads 
the news and recommends it to his friends. Sometimes he thinks he is a little 
more able to throw off such disorders than the common run of boys. Usually, 
he thinks the infection a thing of no consequence. 

What has resulted from his treatment is that he has stopped the discharge ; 
he has not cured the disorder. He has stopped the symptom of which he 
knew — the discharge. Had he observed more closely he would have noticed 
that not even that symptom was wholly cured and other less striking symptoms 
were present. 

Had he talked with those who knew he would have learned that he was 
just as dangerous as though his main symptom had not lessened. He would 
have learned that what he supposed to be repeated cases was merely his old 
case recurring. 

He had been infecting other people, and, to even things up, from time 
to time he had reinfected himself. 

He had never been cured at all. The treatment that the drug clerk 
had been selling him and that he had been using on himself had stopped the 
only symptoms by which he, with his little information, could judge, and, 
maybe, had made him more dangerous to himself and others than he would 
have been had he left nature to fight the battle alone. 

He had wasted time in treating a symptom when he should have been 
treating the infection underlying the symptom. It was as though he had been 
easing an appendicitis pain with morphin when he should have been having 
the disease attended to. 

There may have been a symptomatic cure, but there had been no real 
cure. 

A real cure is not effected until gonococci are no longer present, not alone 
in the secretions but in the tissues themselves. 



VENEKEAL DISEASES AND BLINDNESS 1291 

The disease would not be so widespread were it not for the advertised 
cures, the drug store cures, the symptom cures. 



VENEREAL DISEASES AND BLINDNESS 

If there were no venereal disease, blindness would not be of great impor- 
tance from the community standpoint. The blindness of old people is due to 
cataract; that can be remedied. Blindness can be caused by tobacco, but the 
blindness from this cause is inconsiderable. The blindness due to the trades 
that endanger the sight should grow less as the use of proper mechanical 
devices becomes universal. 

More than half the blindness is due to two infections; of the outside of 
the eye — the conjunctiva — with gonococcus, and the interior of the eye with 
the spirillum of syphilis. As the blindness from other causes lessens, the 
blindness due to these two causes increases. Of these, the gonococcus infection 
generally occurs at the moment of birth or within a day or two thereafter. 

Some state boards of health and some city health departments now 
supply physicians and midwives with a small package containing nitrate of 
silver solution and cotton. The instructions are to wash the baby's eyes with 
a boric acid solution at the time of the first bath. 

The water used to wash the baby, in case soap and water are used for 
this first cleansing, is not allowed to come in contact with baby's eyes. Instead, 
a pledget of cotton saturated in boric acid is used for that purpose. One 
pledget is used for each eye. 

Under no circumstances is the same pledget to be used for both eyes, 
nor is a pledget that has been used on one eye to be put back into the boric 
acid solution. 

Then, in every case, a drop of the 1 per cent nitrate of silver solution 
is dropped into each eye. The silver solution is strong enough to kill any 
gonococci in the eye, but is not strong enough to inflame the eye. 

This method should be followed with every baby. It is not enough to use 
it in the suspected cases. The infection seldom crops out there. It is in the 
unexpected places that this condition shows. Therefore, the Crede plan should 
be followed in every case. 

The Germans have been following this plan long enough and carefully 
enough to cause us to pay attention to them, when they tell us that this 
measure will prevent nineteen-twentieths of the blindness that comes in 
infancy. 

Occasionally the gonococcus does not destroy the sight in two or three 
days, as it does in newly-born babies. Occasionally the germ seems to be 
mild and to cause an ordinary case of sore eyes, or something a little worse. 

For instance, the little girls who have an innocently acquired infection 
are not much disturbed thereby. The germ shows little disposition to travel 
upward and cause pus tubes and peritonitis, as in women. 

When some of the secretion is carried on their fingers to their eyes, 
rarely does blindness ensue. There is a month or more of sore eyes. 

So the harm done by gonococcal infection of the eyes is not limited to 
blindness; it is somewhat swelled by milder types of eye disease. 



1292 VENEREAL DISEASES 



SYPHILIS 

The gonococcal infection as a rule remains close to the focus of infec- 
tion. The syphilitic infection speedily travels from the focus of infection 
to other parts of the body. 

The germ of syphilis is known. It can be found with the microscope. 
It can be grown on culture media. Eabbits and monkeys can be inoculated 
with syphilitic secretions. 

The gonococcus is fat and round and biscuit-shaped. The spirillum of 
syphilis is long, narrow, and wormlike. The gonococcus cannot move of itself. 
The spirillum is constantly wiggling like a worm and travels rapidly. 

The gonococcus infection stays pretty close to where it starts. It fre- 
quently gets into the lymph channels, and is carried to near-by lymph glands. 
It may, though rarely, get into the blood, and be carried to the joints, causing 
rheumatism, or to the heart, causing heart disease. But when it is carried, 
it is passively carried, as a chip by a current. 

On the other hand, the syphilis spirillum moves of and by itself, and, 
in addition, can be passively transported by the blood, or the lymph, or along 
free surfaces. It wiggles into the blood stream and is carried to any part 
of the body. 

In the stage of syphilis known as the secondary, the spirilla abound in 
the blood. The secondary stage is characterized by fever. In extremely bad 
cases the patient may seem to have measles or scarlet fever. 

I have seen such mistakes made. As a rule the fever and the eruption 
are mild, and sometimes so mild as to be overlooked. After that stage has 
passed — a few months after the infection — the spirilla are never in the blood 
for long. They wiggle in, float around awhile, and then wiggle out. 

It is a mistake to regard syphilis as a blood disease. The blood seldom 
contains spirilla. If the spirilla stayed in the blood, the disease might be 
more easily cured. 

The organisms are out in the tissues, around the blood vessels, the lymph 
vessels, and among the tissue cells. There they live, multiplying slowly and 
dying off at about the same rate, secreting little poison. 

Syphilis is due to infection with a parasite that has the capacity of making 
itself much at home in the human body. Within three months of infection 
it is on neighborly terms with the cells surrounding it. Its harmful activities 
during a single day are immeasurably small, but, when the day's work is 
multiplied by 365, and then the product by ten, the harm is no longer immeas- 
urably small. 

The first point to remember is that syphilis is not a blood disease — in 
any proper sense. 

The second point is that it is not a severe disease. Its mildness makes 
it possible for the germs to keep at their job for a long series of years. 

The third point is that the disease is still actively at work when there is 
nothing to show for it — no eruption on the skin, no ulcers, no mucous patches, 
and no sore throat. 

In order to handle the disease it is necessary to bear these three points 
in mind. 



THE VENEREAL PERIL 1293 

To cure, it is necessary to kill the germs in the tissues, in which loca- 
tions they are harder to get at than if they were in the blood. The secondary 
symptoms, occurring when they are in the blood in numbers, disappear after 
a few weeks, or even days, of treatment. 

It is necessary to bear in mind the mild nature of the disease in carrying 
out the treatment. However, the third point is the one of greatest impor- 
tance. The temptation to consider oneself well — no longer a source of danger 
to others and out of danger so far as one's own future is concerned — the 
tendency to think that all's well when the symptoms disappear is strong. 

In malaria, gonorrhea, and rheumatism we have illustrations of diseases 
that when half cured are even more of a menace than if no part of a cure had 
been effected. 

Syphilis furnishes the best and most striking illustration of the harm 
done by confusing cure of the symptoms with cure of the disease. 

After the spirillum has been crippled by a few months of treatment 
it can still remain in the tissues, crippling them so that ten or twenty years 
later gummata will be found. 

In the unborn babe the disease can become virulent and speedily ter- 
minate life, or it may be fairly latent, producing conditions that do not 
manifest themselves for years after the child's birth. 

The terror of syphilis is due to the lesions which it produces and the 
symptoms which appear after the disease has seemed to lie idle for years. 



THE VENEREAL PERIL 

The only figures as to the prevalence of venereal disease that are at all 
dependable are those of the army and navy. All other figures and statistics 
are guesses, some shrewd, some less so, but only guesses. 

The army finds that venereal disease now disables more men than any 
other cause. Typhoid fever has been banished from the army and navy; 
malaria is under control, and venereal disease, as a producer of disability, is 
without a rival. 

In 1902 the venereal disease rate in the United States army reached 
162. This means that, during that year, out of each 1,000 men enlisted 162 
contracted venereal disease. The rate remained around 150 until 1907, when 
a moderate decline began. 

After several years of experiment and investigation the army surgeons 
adopted a venereal disease policy in 1910 and, in consequence, the rate 
rapidly dropped. In 1912 it was 110; in the last quarter of that year it 
was 91. 

Colonel Kean tells us that the surgeon-general's report showed that in 1911 
there were 11,211 cases of venereal disease, whereas there were but 3,737 
cases of typhoid fever, malaria, smallpox, measles, scarlet fever, diphtheria, 
dysentery and tuberculosis combined. 

The constantly non-effective rate is about 13; out of each 1,000 men 
thirteen are at all times off duty because of venereal disease. Surgeon General 
Rixey, in his 1909 report as to the disablement of sailors in the navy from 
venereal disease, wrote: 



1294 VENEREAL DISEASES 

"This class of disease would have operated to render entirely ineffective 
for over a month three battleships with a complement of 1,000 officers and 
men each/' 

The navy rate in 1909 was 160. I understand that they are controlling 
venereal disease after the same plan employed in the army, and that their 
rates are falling about as rapidly. 

At that, we were several years behind other nations in beginning our 
fight on venereal disease. The British army rate at its worst was 275. They 
had driven it down to sixty-six in 1909. The Prussian army in 1909 had a 
rate of eighteen, and the French army, of twenty-two. No Continental 
army, not even that of Spain, had a rate much higher than our rate at its 
worst. 

In an account of morbidity in the army on the Eio Grande, Colonel Kean 
said that four men from each 1,000 were at all times out of service from 
venereal disease. Syphilitics were not counted, as the disease in them was 
latent. 

If there were any way to discover the conditions in civil life it would 
be found that they do not differ greatly from those in army life. The amount 
of venereal disease in the army at home is a fair index of the amount among 
civilians. 

Judged by this standard, American conditions are worse than those of 
Great Britain, Germany, or France. Are we not called on to do something 
about it ? 

ADVERTISING DOCTORS— MEN'S DISEASES 

In 1911 Dr. , the men's specialist of Los Angeles, advertised that 

he was the only advertising specialist in that city who was going by his right 
name. As a matter of fact, a majority of the medical offices are advertised 
under the names of men who have been dead for years or who never lived. 

When we consult medical directories we find that men of the names used 
are not graduates in medicine at all, or else they have graduated from the 
poorest grade of medical colleges. 

Medical methods employed in these offices are either exactly the same 
as those employed elsewhere, or else they are not up to date. The best that 
can be said of the best of them is that they employ the standard methods. 
The statements that they make use of more advanced or more scientific 
methods, or methods that the regular practitioners know nothing of, are 
entirely without foundation. 

Then, if the methods used are below the average and behind the times, 
and the men hired to run the offices and give the treatment are low grade, 
poorly educated, badly informed, and cheap doctors, how do they take in 
enough money to pay the advertising bills? 

They have two business methods that take well with people who do not 
know the ways of schemers. One is case taking and the other the follow-up 
letter system. 

A good case taker is the keystone of the office. It is his business to 
scare the victim, talk of the gravity of the case, and to promise a cure. His 
tribe has created a lot of diseases that have no existence — varicocele, lost man- 
hood, etc. — bogies with which to frighten. In case there is some disorder and 



MEASUBES FOE CONTROL 1295 

the cure does not come as promised, the objecting patient finds himself in the 
hands of a new case taker. 

The symptoms of venereal disease are easily cured. After a few weeks' 
treatment, the patient in the hands of an advertising doctor finds himself 
without symptoms. He thinks he is cured, that the advertising doctor has 
cured him. 

As to just when he is actually, not symptomatically, cured is a difficult 
point to decide. It is necessary that the infected man should be advised on 
this point. He cannot tell for himself. Here he must have somebody whose 
advice he can accept without question. 

No man can read the wording of the advertisements, no man can pass 
through the hands of a case taker, no man can read one of those medical 
follow-up letters without concluding that the advertisers are not to be 
depended on. 

Why do they hang on? Because nobody has made it his business to 
inform the people. When people become well informed they will be able to 
judge. The men's specialists and private disease specialists will have to find 
other work. 

MEASURES FOR CONTROL 

The rapid improvement in the conditions in the army during 1912 is the 
result of the policy outlined in a general order, as follows : 

"1. It is enjoined upon all officers serving with troops to do their utmost 
to encourage healthful exercise and physical recreation and to supply oppor- 
tunities for cleanly social and interesting mental occupations for the men 
under their command; to take advantage of favorable opportunities to point 
out, particularly to the younger men, the inevitable misery and disaster which 
follow upon intemperance and moral uncleanliness, and that venereal disease, 
which is almost sure to follow licentious living, is never a trivial affair. Al- 
though the chief obligation and responsibility for the instruction of soldiers 
in these matters, rest upon the company officers, the medical officers should 
cooperate by occasional lectures or other instruction upon the subject of sexual 
physiology and hygiene and the dangers of venereal infection. 

"2. Commanding officers will require that men who expose themselves 
to the danger of contracting venereal disease shall at once upon their return to 
camp or garrison report to the hospital or dispensary for the application of 
such cleansing and prophylaxis as may be prescribed by the surgeon general. 
Any soldier who fails to comply with such instructions, if found to be suffer- 
ing from a venereal affection, shall be brought to trial by court martial for 
neglect of duty. 

"3. Commanding officers will require a medical officer, accompanied by 
the company or detachment commander, to make a thorough physical inspec- 
tion twice in each month of all the enlisted men (except married men of good 
character) of each organization belonging to or attached to the command. 
These inspections will be made at times not known beforehand to the men 
and preferably immediately after a formation. The dates on which the physical 
inspections of the various organizations are made will be noted on the monthly 
sanitary reports." 



1296 VENEREAL DISEASES 

Colonel Kean, in "The Venereal Problem in the Army and Navy/' says 
that the campaign against venereal disease in the British army was not the 
least of the victories of Lord Kitchener. That highly successful campaign 
embraced four lines of activity: 

1. The new cantonment rules. 

2. The continuance of treatment in cases of syphilis after discharge from 
hospital so as to prevent recurrence of symptoms. 

3. Putting bazaars out of bounds. 

4. Moral influence — lectures and talks to the men, amusements, etc. 
The new cantonment rules referred to were rules requiring the reporting 

of venereal -disease and providing proper care for those infected. The insist- 
ence upon treatment until fully cured applies to gonorrhea as well as syphilis. 



HOW TO KNOW SYPHILIS 

The . first symptom of syphilis is a small ulcer. This ulcer generally 
begins at the point where the spiral germ entered. It starts three weeks after 
infection. 

In every case of syphilis, an effort should be made to find out from 
whom the disease was contracted. The source in any given case may be 
endangering other people and sometimes there is no suspicion, on the part of 
the person harboring the germ, of the harm that is being done. 

To investigate a case, fix the date of the first appearance of the ulcer 
and then review the happenings of three weeks before. Eemember that the 
ulcer develops at the exact point where infection occurred and nowhere else. 

The ulcer, to begin with, is not an ulcer. The spirochetes are in the 
tissues and around them a hard nodule forms. Presently the nodule breaks 
down on the surface and a punched out ulcer appears. This ulcer does not 
pain greatly, itch or run much. The process is not due to pus germs. There- 
fore, unless pus germs later infect, there is not much pus or pain or much 
swelling. 

It is constantly happening that this ulcer is so small and so painless 
that it is entirely overlooked, or thought to be a fever blister, until the general 
skin eruption comes on two to four weeks later. Then the person, for the first 
time, remembers the almost unnoticed, almost forgotten, ulcer. 

The ulcer has hard edges and a punched out appearance that is easily 
recognized by a physician when typical, but which sometimes is atypical. But, 
fortunately, within the last few years, the germ has been discovered. It is 
easily found in the secretions from the ulcer and from the secretions of any 
secreting patches that develop as secondaries. 

The state and city boards of health are now equipped to examine these 
secretions. The examination is easier made than is the examination for diph- 
theria or consumption. If your department of health does not examine secre- 
tions for the spirilla of syphilis and for the coccus of gonorrhea it is because 
they have never been stimulated to make them. The venereal problem will 
not be started toward solution until laboratory examinations for venereal 
diseases are a matter of daily routine exactly on a par with consumption 
examinations. 



HOW TO KNOW GONORRHEA 1297 

After syphilis has progressed beyond the stage where the secretions will 
show spirochetes — also called spirilla — under the microscope, there are certain 
laboratory tests that are reliable, though not so reliable as the spirochete test. 
One of these is the Wassermann; the other is the Noguchi. These tests are 
especially valuable in that they give light not only when the rashes are present 
or the glands are enlarged but also years after when there is nothing to show 
that infection is present. 

Within the last few years, the spirochetes have been found in the brain 
in paresis and in various other syphilitic diseases that come years after the 
original infection. This information is worth a great deal to the physician, 
but there is no way of proving the case to be syphilis by finding the organism 
in the tissues during life. In these cases, reliance must be put on the Wasser- 
mann and jSToguchi tests, supplemented by what is known as the therapeutic 
test. 

The therapeutic test consists in giving the person under suspicion a course 
of mercury or mercury and iodid, or of the newer arsenic preparation — 
salvarsan. If there are symptoms and these get better very rapidly under 
the therapeutic test, the evidence is sufficient for a diagnosis. 

We have for the diagnosis of syphilis, examination of the secretions 
for the germ — of greatest value in the early stages — to be done by the physician 
or by the health departments. Examination of the patient — to be done by 
the physician. Some communities have dispensaries and hospitals to care 
for those cases not otherwise able to care for themselves, and protect the 
community. Examination of the blood by the Wassermann and Noguchi tests — 
to be done by health department laboratories in some instances and by private 
laboratories. The therapeutic test — to be done by the attending physician. 



HOW TO KNOW GONORRHEA 

The gonococcus is a pus coccus. The first effect of infection is a sup- 
purative inflammation. The test that can be depended on in these early 
stages is the microscopic test. The health department laboratory will make 
this test. In some communities, the test is a routine procedure. It is made, 
in large numbers, every day in the year just as diphtheria tests are. 

A little pus spread on a glass slide is all the material needed. The 
dried pus is just as satisfactory as fresh pus. If your health department is 
not making the test it is because the people have never asked that it be done. 

See to it that your health department adds laboratory examination for 
venereal disease to its list of activities. 

In the early stages, the gonococcus not only attacks the mucous mem- 
branes but it kills off all other bacteria. Therefore, in the pus from such 
cases, no germs are found except gonococci. After a few weeks other germs 
are again found in the pus and gonococci are less abundant. 

Microscopic examination of late cases is not so valuable nor so dependable 
a procedure. 

After the infection has been carried away from the point of entry and is 
infecting tissues that are remote, diagnosis is more difficult. Illustrations of 
what is now in mind are gonorrheal pus tubes, gonorrheal peritonitis, gonor- 



1298 VENEKEAL DISEASES 

rheal rheumatism. For such cases, there is a laboratory procedure called 
complement fixation — a pretty fair test and one that helps out a good deal in 
some hard cases. 

The type of examination made in a segregated district is of no practical 
value. It is a superficial examination. No microscopic tests are made. 



METHOD IN USE IN U. S. ARMY 

A suitable, easily accessible room in the hospital (or dispensary) at each 
post will be selected for this purpose, which should be provided with a good 
light and such medical supplies, basins, and other equipment as may be neces- 
sary. A competent, properly instructed man of the Hospital Corps, or more 
when necessary, will be on duty there between retreat and reveille, and will 
be within call at other hours. 

The procedure in the case of men reporting for treatment will be as 
follows : 

1. The name, rank, and organization of the soldier, with the day and 
hour of treatment, should be entered for record on a card furnished for the 
purpose, which will afterwards be examined and authenticated by the initials 
of the medical officer. These records should be regarded as confidential and 
should be kept in a secure place and not shown to unauthorized persons or 
except upon proper authority. They will not be preserved longer than three 
months. 

2. The genital organs will be thoroughly washed with soap and warm 
water. 

3. An injection will be made into the urethra of 4 c.c. of the standard 
solution of 2 per cent protargol dissolved in glycerin 15 parts, water 85 
parts. This should be retained in the urethra for three minutes. In individual 
cases when the protargol solution is found to produce an irritating effect, a 
20 per cent solution of argyrol may be used. Other solutions or modifications 
of these solutions will not be used for routine administration. 

4. The entire penis will be rubbed with calomel ointment (30 per cent 
in benzoated lard), care being taken that the folds of the prepuce and about 
the frenum are thoroughly covered. If any pimples or abrasions exist about 
the scrotum or the pubic region, these should also receive an application of 
the ointment. 

The parts should be then wrapped in a napkin of soft paper furnished for 
the purpose, in order to protect the clothing. 

A medical officer may for special reasons use other preparations than 
those above specified, but only when he personally gives or supervises the 
administration of them. Eeport will be made in such cases of the drugs used 
and the results obtained, with reason for departure from the routine treatment. 

(Note) Protective packets will not hereafter be issued by the Medical 
Department, but in view of the fact that the hospital method of prophylaxis 
will not be applicable to soldiers on passes or furloughs of more than 24 hours, 
it is recommended that medical officers make the suggestion to the proper 
military authorities that a protective packet be kept on hand for sale at 
post exchanges. A tube containing an ointment which is efficient both as an 



PROSTITUTION IN RELATION TO VENEREAL DISEASE 1299 

injection and for external application is to be preferred. The following 
formula has been found efficient : 

Camphor 3 per cent 

Phenol 3 per cent 

Calomel 25 per cent 

Adeps Lanae 35 per cent 

Benzoinated lard 34 per cent 

The protective packet generally known as the A. & N. (Army and 
Navy) packet is put up by several pharmaceutical firms and can be had at 
drug stores. 

PROSTITUTION IN RELATION TO VENEREAL DISEASE 

There are many opinions extant as to the percentage of venereal diseases 
due to prostitution. These estimates place the figures so high that many 
hold that by regulating prostitution venereal disease will be regulated. These 
figures are but estimates. 

Some of these opinions are entitled to weight; others have little value. 
Based on these opinions, health officials have been advised to work for segre- 
gated, regulated vice as a means of controlling venereal disease. 

Generalizing procedures — dragnet procedures — are in a bad way amongst 
health authorities now. They began to get results in controlling diphtheria 
when they quit watching sewer gas and concentrated on the bacillus. 

The trend of opinion amongst health officials is that no shots count 
except those against the bull's eye. To herd all the women of easy virtue into 
one part of town as a means of controlling venereal disease is ineffective. 
In the first place, they cannot be herded. Segregation does not segregate. 

The method of medical inspection does not, and cannot, protect against 
infection. Even as the plan is worked under such an absolute monarchy as 
Japan, it does not control venereal disease. Under American government, it 
causes venereal disease. 

It is proper to search for venereal disease amongst careless people — both 
men and women — with extra care, and to take adequate pains to control the 
infected. This plan is followed in Detroit. It is proper to placard houses of 
prostitution, where venereal disease in highly contagious form exists, until 
such time as the spreader of contagion comes under control — as has been done 
in Chicago. 

But it is not proper to inspect women and certify that they are incapable 
of spreading contagion and will so remain for a week or a month. Nobody 
can truthfully make that statement as to venereal disease, smallpox or scarlet 
fever. 

That the health authorities coincide in the above opinions is proved by 
the official proceedings of the section on preventive medicine of the American 
Medical Association, June, 1911, and the proceedings of the American Public 
Health Association, October, 1910. 

No health department in the United States advocates segregation of 
prostitutes as a means of controlling venereal disease. 



1300 VENEREAL DISEASES 



GONOCOCCAL INFECTIONS IN CHILDREN 

Every mucous or purulent discharge from the genitals of a child is a mat- 
ter for investigation. Infection is the cause in every instance. In most cases 
the infection is with the gonococcus. 

The microscope will show the organism. It is a good guess that any 
catarrhal — so-called — vaginal secretion in a child is due to gonococcal infection 
and is not to be treated lightly. 

The effects in young girls are very much lighter than in mature women. 
Occasionally, changes are caused which make sterility inevitable. Occasionally, 
the eyes are infected and sometimes blindness results. Frequently the child 
is a focus of infection. 

Contagious disease hospitals can prevent the development of gonococcal 
infections by : 

Systematic microscopic examinations. 

The use of diapers on all children not proved to be free from infection. 

Segregation and treatment of infected children. 



MARRIAGE REQUIREMENTS 

In 1912, Dean Sumner of Chicago announced that he would marry no 
one in his church unless each party brought him a certificate of good health 
signed by a physician. Since that time, many ministers have adopted the 
same rule and many others have indorsed it. 

The opponents of the measure have stated that the examination of the 
prospective bride and groom will be so superficial as to be of no value in deter- 
mining the presence of contagion in a condition capable of becoming active 
under stimulation; that in the latent stages of venereal disease, especially 
gonococcal infections, there is considerable difficulty in deciding that infection 
is present. Furthermore, that human eugenics is not developed enough to 
make expert opinion of great value, while the average run of medical men 
are not well enough informed on this very new subject to make their opinion 
of much value. 

To which advocates of the plan reply, that though the plan may have all 
the shortcomings cited, it is still far better than no plan. It is an initial pro- 
posal and has the right to be judged as such. It lays no claim to perfection, 
but it does claim superiority over the entirely uncontrolled procedure for which 
it is offered as a substitute. 

The opponents argue that those who think themselves sub-standard will 
not abstain from marrying — they will go to other ministers. To which the 
answer is that some will, while others will delay marrying until conditions are 
more propitious. 

But even these arguments pro and con miss the main point. The great 
gain to moral cleanliness and human welfare from the position taken by Dean 
Sumner was through the attention attracted to the subject and the contro- 
versy that his position aroused. 

Havelock Ellis, in his "Task of Social Hygiene," advocates as a positive 



INSANITY AND VENEREAL DISEASE 1301 

eugenics procedure the building up of an aristocracy of good blood. By- 
good blood is meant that the family tree should show freedom from inheritable 
defects such as feeble-mindedness, drug and drink addiction, insanity, crim- 
inality, hemophilia, migraine, epilepsy, neurasthenia and other inheritable 
diseases, and so on through many items. 

The idea of an aristocracy of blood is a positive eugenics suggestion 
capable of great good. Dean Sumner's proposition is one making for an 
aristocracy of cleanness in blood. As great as will be its value along this 
line, its greatest value has been, and will be, in making the subject contro- 
versial ; in making it a matter of discussion and in keeping it such. 



HOSPITALS AND DISPENSARIES 

An essential for the campaign against venereal disease is a hospital and 
dispensary system for venereal disease. We now have consumption dis- 
pensaries, hospitals and sanitaria. We send physicians to homes and we pro- 
vide hospital care for scarlet fever and diphtheria. Venereal diseases are con- 
tagious. They affect the innocent as well as the guilty. To control them, 
there must be hospital and dispensary facilities. It is not enough that there 
are private physicians. They do not and can not cover the field. 

Many people go untreated, many treat themselves, many are treated by 
druggists, many are treated by advertising doctors. None of the members of 
these groups is treated until completely cured. They use the same drinking 
cups and towels and toilet facilities as well people. Many of them, when half 
incapacitated, must stay in lodging houses because hospitals do not want them. 
The conditions for the spread of contagion in lodging houses are excellent. 

It is not enough to insist on complete cure and make -no provision for 
it. Municipal laboratory diagnosis of venereal disease, reporting of venereal 
disease, a campaign for education in venereal disease, are all well, but another 
flank must be provided and that is a hospital and dispensary system. 



INSANITY AND VENEREAL DISEASE 

Justice Hughes says that one-half of the insanity is curable. Using this 
quotation as a text, Homer Folks writes as follows : 

"One kind of insanity is known popularly as 'softening of the brain/ It 
is known scientifically as general paralysis, or paresis. It is incurable by any 
means now known to the medical profession. Those afflicted with it suffer 
gradual mental and plrysical decay. The very substance of the brain becomes 
changed. They usually live but a few years. It is now agreed by the medical 
profession that this disease is caused by an earlier disease known as syphilis. 
Syphilis is a germ disease. It- is usually the result of immoral habits, though 
one may get it innocently. Every man and boy should know that by yielding 
to the temptation to go with immoral women he is exposing himself to the 
probability of getting this disease, which may result, years after, in incurable 
insanity. Over the door of every immoral resort might truthfully be written, 
'Incurable insanity may be contracted "here/- If self-respect, the desire for 



1302 VENEREAL DISEASES 

the good opinion of others, the influence of religious training, and the attrac- 
tions of home life are not sufficient to prevent this kind of wrong-doing, the 
danger of contracting a disease which may result in incurable insanity should 
be sufficient. 

a The number of patients having paresis or 'softening of the brain' ad- 
mitted to State hospitals during the year ending September 30, 1910, was 600 
men, or 17 per cent of all men admitted, and 263 women, 8 per cent of the 
women admitted." 

INHERITED VENEREAL DISEASE 

Syphilis can be inherited; gonorrhea cannot be. The syphilis organism 
can be transmitted to the child by the mother. The organism can infect the 
mother and not infect the child. The spirochetes in the mother, during the 
nine months of pregnancy, have been outside the blood stream — pretty well 
walled off in some isolated area. 

An infected father can infect the mother and thus indirectly infect the 
child. The spirilla may infect the placenta and thus kill the child, producing 
miscarriage. The organisms in the child may be so abundant and so poisonous 
as to destroy its life. 

The organisms may pass into the child and cause inherited syphilis. 
Syphilitic babies look like old men and women. They are weazened and old 
in appearance. Sometimes when less profoundly poisoned, the appearance 
is not greatly altered, but the bones or some of the internal organs are af- 
fected. Sometimes the infection lies latent until later life — a wait of twenty 
years or more, as in other forms of syphilis — the spirochetes have been walled 
off somewhere or other. And then something occurs to permit the escape of 
the organisms, whereupon the disease takes on an active form. 

The person with inherited syphilis harbors the germ of the disease and 
is infectious to others in the same way and for the same reasons as are those 
infected by contact. A case of inherited syphilis is not infectious so long 
as the organisms are walled off and the disease is latent. When there are ulcers 
or patches in the secretions of which are organisms, anyone touched by these 
secretions is liable to be infected — if the point touched is one that can be 
infected. For instance, any mucous membrane, any lining, is easily infected 
by contact. 

The skin is not easily infected. The dead layer prevents infection so 
long as it is unbroken. The skin can be infected whenever there is a cut or 
scratch that permits the organism to get through this dead layer. The or- 
ganism can be carried on the skin of the hands to the mouth. 

A baby with inherited syphilis can infect its wet nurse, provided the dis- 
ease is active in the baby — for instance, if there are patches in the mouth and 
the nurse has some crack or fissure of the nipple. 

While gonococcus infection cannot be inherited, yet this infection is of 
importance in certain inheritance relations. It is largely responsible for ster- 
ility in both the male and female. It may travel to the interior of the uterus 
in a pregnant woman and infect the placenta, causing miscarriage, or it may 
produce deformity in the developing child. And finally, the child as it is 
being born not infrequently has its eyes infected and is blinded therefrom. 



CONTINENCE 1303 



VENEREAL DISEASES IN NEW YORK CITY 

During the month of January, 1913, the Department of Health requested 
7,000 physicians in Greater New York to furnish the department with infor- 
mation regarding the number of cases of syphilis,, gonorrhea and chancroid 
that had been under their care in their private practice during the twelve 
months previous, in order that some idea of the number of cases of venereal 
disease treated during 1912 might be obtained. Only 2,215 physicians re- 
sponded to this request, reporting 13,348 cases of syphilis, 24,980 cases of 
gonorrhea, and 4,431 cases of chancroid, making a total of 42,659 cases of 
venereal disease treated in the private practice of less than one-third of the 
physicians of this city within twelve months. The number of cases of syphilis 
is especially and alarmingly large. A complete census of the cases treated 
in institutions has been unobtainable up to the present time, but the insti- 
tutional cases, without doubt, exceed in number many times those treated in 
private practice. The apparently extensive prevalence of venereal diseases 
in New York City certainly furnishes food for thought. 

During 1912 the Serological Laboratory of the Department of Health 
tested 4,585 specimens of blood for syphilis and 545 for gonorrhea, while 
from January 1, 1913, to June 1, 1913, 5,639 blood specimens were tested for 
syphilis and 846 for gonorrhea. 



CONTINENCE 

Sooner or later every boy must decide whether or not he will permit 
himself sexual indulgence of one sort or another, if not with women, then 
in some irregular way. Every boy must answer for himself the question — 
Shall I yield to my passions? The answer should be — No. 

The first thought that comes into his head is that sexual activity is 
necessary for strength and development. He has heard this from somebody 
and to him it seems rather reasonable. He has been wrongly informed. A 
part of the sex gland secretion is necessary for strength and development 
but that part is absorbed directly into the blood and is never mixed with 
other portions of the gland secretions. Sexual indulgence is not necessary for 
physical development. 

The next question he asks himself .and perhaps others is — How can a 
boy keep his passions down ? And, particularly, is there any medicine he can 
take for the purpose? The answer to the last half of the question is — No. 
No medicine is to be taken because, in the first place, no medicine given for 
this purpose has any virtue and, in the second place, it is not proper 
to be dosing oneself all the time. Taking medicine for this purpose does 
no good and may do harm. 

The scientists who study the conduct of human beings, as other scientists 
study the conduct of bugs and insects, speak of those persons who cannot 
control themselves as the "feebly inhibited." The feebly inhibited have not 
the force of character, the moral force, the self-control necessary to refrain 
from outbursts of anger, the desire to get drunk or to take opium. The 



1304 VENEREAL DISEASES 

feebly inhibited are not insane, but they are weak, and among them many 
cases of insanity develop. The condition, feebly inhibited, varies in degree. 
Some people are able to resist almost every temptation, others can resist 
some temptations, others can resist no temptation which makes any sort 
of appeal. 

When a person has no capacity for restraining himself sexually he is 
clearly feebly inhibited. If he is able to control himself thoroughly, clearly 
he is not feebly inhibited. In between these two extremes are all sorts of 
gradations. 

Sexual indulgence then means not that the boy has a strong character and 
strong will. It means that he has a weak character and weak will. 

If a boy feels himself tempted almost to the point where he cannot 
resist, can he lessen his desires and increase his resistance? Yes — by right 
living. Some of the rules are : 

1. Overeating is to be avoided. A heavy meat and eggs diet is especially 
to be avoided. 

2. The bowels are to be kept regular. 

3. The boy must do hard physical labor either in his daily work or else 
in his play. It is the idler and not the athlete in active training who is 
dissolute. 

4. The boy must keep good company. Boys who tell lewd stories and 
who indulge in salacious gossip are especially to be avoided. 

5. He must cultivate his morals by thinking morally and living morally, 
by associating with moral people. 

6. He must cultivate decision and strength of character. 
The above statements apply to girls as well. 

NIGHT LOSSES AND WET DREAMS 

The spermatozoa manufactured by the testicles are stored in sacs pro- 
vided for the purpose and located in the pelvis at the base of the bladder. 
These sacs are called the seminal vesicles or sacs. When these sacs become 
over-distended with secretion they empty themselves. If they empty during 
sleep the result is a seminal emission, night loss or wet dream. 

For such emptying to take place is natural. When it occurs with mod- 
erate frequency it means that the man is vigorous. It is a sign of health, not 
of illness. Wet dreams do not lower vitality or cause a loss of manhood 
or bring about insanity. 

Then why all the fear on the subject? The people have not had any 
opportunity to read the truth. The plain truth was supposed to be too indeli- 
cate a subject for newspapers and books. But the quacks had no such scruples. 
They have used newspaper space, billboards, pamphlets and books to frighten 
the people about wet dreams. The only chance for education on these sub- 
jects was the writings of the quack. " Everybody wanted to Inow— therefore, 
they read what the quacks wrote. It was tffeir only source of education. In 
consequence, education"" in erro* and in groundless fear is the rule. 

It is only exceptionally that we find a man who knows that wet dreams 
are a^good sign and not a bad one; that they are a sign of strength, not of 
weakness; that in a young man they are natural and not unnatural. 



LOST MANHOOD 1305 

There is nothing specially vital about the seminal fluid. When it is 
discharged there is no special drain on the system. The sex glands do secrete 
powerful chemicals very necessary for the grown person. Those secretions 
are known as the ductless gland secretions of the gonads or sex glands. But 
get this clearly in mind — this secretion passes directly from the sex glands 
into the blood. It is never discharged as is the ordinary secretion. Therefore, 
night losses have nothing to do with that secretion. That part of the secre- 
tion which is discharged has to do with the formation of the child; it has 
nothing to do with the health or strength of the man (or the woman, for 
that matter). 

But the great part of those who fear they are going insane because 
of night losses are even more foolish still. They notice that when they strain 
at stool a few drops of discharge flow from the urethra. They have read that 
this is seminal fluid, that the loss of a drop of it at stool indicates that it is 
oozing away all the time and that insanity and loss of manhood will be a 
necessary result. This discharge is nothing but a few drops of mucous secre- 
tion from the urethra itself. It is composed of about the same chemicals 
as a nose discharge or phlegm from the throat. Such discharge is unimportant 
from every standpoint. 

SELF-ABUSE 

I feel like saying no word for self-abuse. Nothing can be said for it. 
It is not necessary for health or strength as some boys are told. It is filthy 
and immoral. But at that it is not so bad as it is painted. Self -abuse does 
not cause dementia precox or insanity or loss of memory. Here, again, we 
have an effect of that education of misstatement by the advertising doctor. 
He wanted business. The way to get it was to frighten. There is no better 
way to frighten boys and men than to tell them with some show of authority 
that self-abuse causes loss of memory, indecision and, finally, insanity. 

This is the explanation of the present popular view of self-abuse. A 
saner view is that it is somewhat harmful physically; that it leads to even 
worse habits ; and that it lowers a person's self-respect and moral tone. 



LOST MANHOOD 

What these words mean nobody knows exactly. They are mighty good 
words to scare a poor fellow with and, in consequence, the quacks have 
worked them overtime. We have been told that lost manhood means that 
the man's vitality is gone. It means nothing of the sort. It means that 
the man is worried or afraid. The way to cure a man of lost manhood is to 
get fear out of him. If the man who is afraid that he is suffering from lost 
manhood will stop thinking about his sex organs, his sex life, sex matters 
of every kind — will put the subject wholly out of his mind — he will find his 
lost manhood. The best way to find your manhood is to lose all thought 
of it. 



1306 VENEREAL DISEASES 



VARICOCELE 



It would be almost true were one to say there is no such disease as 
varicocele. 

Within the scrotum are the veins which return the blood from the testicles. 
These veins being somewhat loose in the scrotum are without the lateral sup- 
port which most veins have. The walls of all veins are thin and the tissues 
lying next them in part support the thin walls. The veins which return the 
blood from the testicles have no such support. In consequence, in a great 
many men, the veins of the scrotum are somewhat enlarged. In describing 
the feel of these enlarged veins it is frequently said that they feel like a "bag 
of worms." That is the condition known as varicocele and that is all that 
it is. 

Have you ever noticed a crooked, swollen vein on your forehead or on 
your hand? What does that amount to? Or the enlarged veins of piles? 
Whoever claimed that these endangered life, or were liable to be followed 
by dreadful consequences ? The only reason for the fright which some people 
get about varicocele is the campaigns to frighten them which advertising men 
have run for years. 

Varicocele is of no consequence. It does not endanger life, or health, 
or the sexual powers. It does not lead to loss of sexual powers. Let a man 
with varicocele lead a pure life or let him marry and his varicocele disap- 
pears nine times out of ten. 

The only importance of varicocele is that it is a source of fear and 
worry. Varicocele is a prolific source of sexual neurasthenia. In other words, 
the condition varicocele is of trifling importance, is practically non-existent — 
but the bogy varicocele has a lot of men scared to a frazzle. 

What is the best treatment for varicocele? To forget it. 



WHEN CAN A SYPHILITIC MAN MARRY? 

Pusey says that the following rule is safe to follow. A patient may 
marry five years after infection provided that, during the first three years, 
he has been thoroughly treated and during the last two years he has shown no 
manifestations of the disease. Marriage in accordance with this rule is safe 
even though the person gives a positive Wassermann reaction. 

The Wassermann reaction is not of value in settling the advisability of 
marriage. Within the first years after infection marriage is not safe, though 
a Wassermann is negative. Later on, marriage is safe even though a Wasser- 
mann is positive. 

Syphilis is actively contagious in its primary and secondary stages. It 
is not contagious during the tertiary stage. A positive Wassermann is a 
symptom of tertiary as well as of primary and secondary syphilis. Therefore, 
it is not a dependable guide for marriage. 

If syphilis is not contagious during the tertiary stages, what is the danger 
from marrying once the secondaries have disappeared ? The danger is that 
there will be a relapse and that secondaries will appear, during which the 



WHEN CAN A SYPHILITIC WOMAN MARRY? 1307 

disease is contagious. The question then conies down to the danger of a 
relapse. 

Pusey quotes Gennerich as proving that, when the treatment is begun 
very early and kept up very actively, only 5 per cent of the cases relapse. By 
giving full doses of salvarsan, or its equivalent, as soon as the disease could 
be diagnosed, the symptoms disappeared in a few days and all evidence of 
infectiousness was gone in a few weeks. By persisting in active, thorough 
treatment the percentage of relapses was very small. 

Ninety-five out of each 100 cases treated by the Gennerich method 
(salvarsan and mercury in full doses) could marry in three months with 
safety. But nobody can tell which case is to fall in the 95 per cent group 
and which in the 5 per cent group. Therefore, no person with a conscience 
will recommend marriage after so brief an interval. 

So few people make the taking of syphilitic treatment their business of 
first importance or even a matter of great importance. Some stick well all 
the time, some carry out directions for most of the time, some are less careful 
still. It is for this reason that competent authorities are so conservative 
in their recommendations, for there is a vast difference between the theoretic 
safety after a three months' interval and the conservative rule requiring a 
five years' interval. 

Keyes found that the chance that a syphilitic husband, taking no special 
precautions, would infect his wife during the first year of his disease was 
12 to 1. If he did not expose her until the second year of the disease and 
then took no special precautions to protect her, the chance that he would 
infect her was 5 to 2. During the third year the chance was 1 to 4. After 
the fourth year the chance of infection was very slight. 

In former times we spoke of the danger that a man would infect his 
progeny and that he would infect his wife as being separate subjects for 
discussion, on the theory that a man could infect his unborn child without 
infecting its mother. It has been proved that, unless a man infects his wife, 
he cannot infect his children with congenital syphilis. Congenital syphilis 
can only be conveyed to the child through the mother. 



WHEN CAN A SYPHILITIC WOMAN MARRY? 

The question is divided into two parts. First, what is the danger that 
she will infect her husband and how long does that danger last? Second, 
what is the danger that she will infect her children and how long does that 
danger last ? 

As to the first question. The rules are the same as in the case of the 
man. Vigorous treatment may cause her lesions to disappear in a few days. 
She may cease to be infectious in a few weeks. Should she have a relapse, 
she would be infectious during the relapse. 

As to the second question. The danger that a mother will infect her 
child is greater than the danger that the father will. In well-treated cases 
women bear healthy children, in some instances, within a year after infec- 
tion. After four years in such cases there is practically no danger. Irregu- 
larly and improperly treated women have been known to bear infected children 



1308 VENEEEAL DISEASES 

ten years after they were infected. The rule given as a safe, conservative one 
for a syphilitic man is also safe and conservative for a woman. 



MARRIAGE AFTER INFECTION WITH GONOCOCCUS 

A man who has been infected by gonococci can marry with safety when 
all discharge has ceased and cannot be renewed by irritation of the urethra 
by the passage of a sound, provided there is no sign of infection of the 
prostate and testicles and a complement fixation test is negative. 

To be certain no relapse will occur, the interval between the total ces- 
sation of all symptoms as above indicated and marriage should be at least 
three months. 

A woman who has been infected with gonococci can marry with safety 
when all discharges have ceased and cannot be renewed by irritating appli- 
cations to the urethra, vagina or cervix, provided there is no sign of infection 
of the fallopian tubes or endometrium and complement fixation is negative. 

To be certain no relapse will occur, the interval between the total cessation 
of all symptoms as above indicated and marriage should be at least three 
months. 

The gonococcus is prone to locate on the surface of membranes or in 
the lining of glands. It does not infect the deeper tissues as does the 
treponema of syphilis. In consequence, gonococcal infections are less apt 
to relapse in after years than is the case with syphilis. If a person who has 
been infected is free from all discharges and from all symptoms of inflam- 
mation of the genital organs, it is reasonably certain that he or she is cured 
of his or her disease and is therefore not subject to relapse. If there are 
discharges, there should be no marriage. Whether in the man or woman, 
there should be no marriage until microscopic tests and a complement fixation 
test have shown that gonococci are not present. 

Parents cannot transmit gonococcus inflammation to an unborn child, 
except that the eyes of the child being born may be infected by the discharges 
from an infected mother. 

Inherited Syphilis. — Mrs. A. W. C. writes: "My father contracted 
syphilis in youth and died from effects of same a number of years ago. 
My mother has always been in perfect health. I am 32 years old, have 
one boy 9 years old. I have never been sick with the exception of the 
ordinary ailments of life. No eruptions on my shin or anything in fact. 
Am apparently in perfect health. My boy also is in perfect health. 

"What I should like to know is whether or not I run any chances of 
inheriting any bad effects after this number of years and whether or not 
it would be advisable to have a Wassermann test made. Please let me hear 
from you soon, as I have seen two or three similar cases lately which have 
been practically the same although the offspring had shown some symptoms 
of rickets, etc., when babies." 

Eeply. — I do not think you have anything to fear. Your father ap- 
parently never infected your mother, which means that you are not in- 
fected. Even if you were infected the chance is that your boy is not, 
since the blood cleans itself in a generation or so. Then, too, the time 



VENEREAL DISEASES 1309 

that has elapsed without symptoms is in your favor. You and your boy 
are all right, I am sure. 

Insufficiently Treated Syphilis. — Mrs. M. R. J. writes: "About 7 years 
ago my fiance contracted syphilis through the use of a public towel. The 
only symptoms present, beside the original ulcer which formed on the 
neck, were ulcers of the mouth and throat. After a few months treatment 
these ulcers disappeared. Before learning the nature of the ailment I con- 
tracted it through a hiss. I experienced every possible symptom: slight 
fever, falling hair, ulcers in mouth, copper-colored spots and lumps on 
the neck and under arm. After four weeks' treatment every symptom dis- 
appeared. The physician who treated us said that having contracted the 
disease at second and third hand the attack woidd probably be light. We 
were married a year later and have experienced no further symptoms. We 
are rather above the average in health and good family histories and lead 
very regular lives. 1. Is it not possible that the disease is cured? 2. If not, 
what form would a recurrence take and are there no means one could apply 
to minimize the chance of a return?" 

Reply. — 1. It is not probable that you are cured though it is possible. 
I do not know what you mean by catching it at second or third hand. Both 
of you caught it from someone who had it as does everyone who has it. The 
way you caught it does not warrant the prophecy that it will be mild. You 
and your husband should have more treatment. 

2. If you have gone for seven years without relapse you will probably 
not have one now. What you should look out for now is locomotor ataxia, 
paralysis or some disease of that kind. 

Contagiousness of Syphilis. — C. A. G. writes: "I understand that 
there are a great many people in this country afflicted with syphilis. 1. Is 
this disease considered contagious? That is, is the germ carried from one 
to another on articles used that have been used by the diseased person? 
2. If so, what would be the symptoms in taking the disease in this way?" 

Reply. — 1. Yes. The danger of infection through handling objects 
that syphilitics have handled is not great. The danger from drinking 
from a cup used by a syphilitic is greater. 

2. A sore appears at the point of contact. This comes two to three 
weeks after the infection. About two to three weeks after the appearance 
of the sore a rash appears on the skin. 

Safety of Salvarsan. — C. W. D. writes: "1. Is it dangerous for an ap- 
parently well person to take salvarsan? 2. Is there any sure test by which 
a person can detect syphilis? I have been informed by a physician that 
there is a medicine that is injected under the skin and if the proper sore 
develops this is a never failing sign that a person has syphilis." 

Reply. — 1. There is some danger in taking a salvarsan whether one 
is sick or well. 

2. Clinical symptoms, the spirochete test, the Noguchi test and the 
Wassermann test combined are reasonably sure. 

Infection from an Unclean Toilet. — G. D. S. asks: "Will you please 
name the diseases that may be contracted from an unclean toilet?" 

Reply. — Syphilis, gonorrhea and chancroid are possible. Infestation 
with body lice is also possible. 



1310 VENEREAL DISEASES 

Cure of Syphilis. — J. J. J. writes: "A man contracts blood poisoning 
and is given one injection of neosalvarsan when secondary symptoms ap- 
pear. This is followed by 6 months of mercury injections in the muscle 
and patient is taking by mouth at same time. At the end of the six months 
three more injections of neosalvarsan are given followed by nearly one 
year of mercury injected twice each week. During last six months patient 
has been taking mercury by mouth. There have been no visible symptoms 
of the disease at any time during the two years' treatment. 1. Do you think 
enough treatment has been given? 2. Would you stop treatment for a 
Wassermann test? 3. How long after stopping treatment should Wasser- 
mann test be made? Jf. If test is negative how soon should another be 
taken? 5. Does a cure insure a man against locomotor ataxia or paralysis 
later in life?" 

Eeply. — 1. Another year of treatment would be safer. 

2. No. 

3. Say two months. 

4. Two months. 

5. Yes. 

Relapse in Syphilis. — P. writes: "1. How does a relapse in syphilis mani- 
fest itself. 2. Are the symptoms the same as those when the disease first 
made its appearance. 3. If a person has shown no symptoms of any kind 
for several years can he have a relapse?" 

Reply. — 1. By mucous patches, sores and a copper-colored to red, non- 
itching eruption on the skin. 

2. Yes, practically so. 

3. Yes, if he has not been thoroughly treated. However, the danger 
of a relapse lessens as each year passes. 

Curability of Syphilis. — W. H. writes: "1. Is syphilis in the primary part 
of the second stage curable? If so, how long a period does it take to effect 
a complete cure providing the victim is sound otherwise? 2. Is the disease 
so contagious as to compel person afflicted to remain away from family?" 

Reply. — 1. Yes. Treatment under the direction of a physician for 
three years is advised. If the treatment is very active at the start the 
treatment during the last two and a half years of this time can be quite 
mild. 

2. Not if he takes proper precautions. 

Neglected Gonorrhea.— E. L. H. writes: "Please tell me what effect a 
case of gonorrhea will have on a man if allowed to run for say 6 or 8 weeks? 
Does it affect the blood as syphilis does?" 

Reply. — Gonorrhea does not affect the blood. A gonorrhea lasting over 
six weeks may cause rheumatism, suppuration of the glands of the groin, 
prostate trouble, infection of the testicle, sterility, or it may become 
chronic. 

Gonorrhea with Few Symptoms. — A. B. N. writes: "Will you kindly 
tell me if it is possible for a man to contract an apparently gonorrheal in- 
fection from a woman who has no symptoms of that disease and who is 
especially neat in that respect?" 

Reply. — Sometimes a case of gonorrhea is infectious even though there 
are very few symptoms. 



VENEREAL DISEASES 1311 

Gleet. — W. H. B. writes: "Is there a cure for gleet after it is about 18 
months old? If so, what is it?' 

Reply. — Gleet is mild chronic gonorrhea. It is infectious. It can be 
cured by persistent, scientific, local treatment. 

Gonorrhea Not Inheritable. — Reader writes: "If a man marries who 
has been cured from a case of gonorrhea will his children be healthy and 
strong?" 

Reply. — Yes. 

Contagiousness of Gonorrhea. — H. M. S. asks: "1. May gonorrhea be 
transmitted by hissing, or otherwise than by sexual intercourse? 2. Is a 
chronic case of gonorrhea curable?" 

Reply. — 1. No to the first part of the question. Yes to the latter part. 
2. Yes. 

Gonorrheal Rheumatism. — W. S. writes : "Please inform me if there is 
a cure for gonorrheal rheumatism. Have had it for seven weeks. Am 
cured of the gonorrhea. How long will it take to cure it? I feel it in my 
legs and ankles mostly." 

Reply. — I doubt the accuracy of your statement that you are cured of 
your gonorrhea. I think a very careful examination will show that you 
still have a gonococcus infection of your prostate or some other locality. 
When you cure up your local infection your rheumatism will get well. In 
addition to treatment for gonorrhea take massage and baths. A vaccine 
will help you. 

Varicocele. — E. H. S. writes: "During the last two months I have 
noticed the appearance of a knotty growth on my scrotum, as if the veins 
were knotted together. A friend of mine tells me it is known as vari- 
cocele and is cured only by operation. Is this true or is there some other 
method? I am a healthy young man of 21 and a fair athlete. Until about 
three months ago I had taken no interest in girls. Then for about a month 
I 'made a fool of myself with the result that I am sadder but wiser. I 
feel in perfect condition. Would go to a physician but am rather bashful 
and would rather not go unless it was absolutely necessary. Have heard it 
was quite a common complaint." 

Reply. — It is a common complaint and one of no importance. Pay no 
attention to it. Do not talk to people about it. 

A Rupture or Hydrocele.— L. E. G. asks : "I am 50 years old. One of 
my testicles did not come down till I was quite old. Now it gets as big or 
bigger than a baseball. When I lie down it goes back but when I stand up 
it comes down again. Doesn't pain me much but feels rather uncomfort- 
able. What can be done? If operation, would it be dangerous? I am 
very thin but comparatively strong." 

Reply. — I think you should see a physician. It is possible you have a 
rupture or perhaps a hydrocele. 

Varicocele. — R. H. asks: "1. What are the effects of varicocele? 2. Are 
the cases of varicocele few or are there many of them? 8. What danger to 
the health and vitality in after years goes with it?" 



1312 VENEREAL DISEASES 

Reply. — 1. None or nearly none. 

2. Many. 

3. None. 

Undescended Testicles.— N. C. asks : "If the testes in a young man 20 
years old have not yet descended to their natural position what would you 
advise? Is this condition liable to hurt the young man in later years?" 

Reply. — You had better have a physician examine you. The condition 
probably will never harm you but the location of the organs may be of 
some importance. 

Spermatorrhea. — P. B. S. writes: "Is there a cure for a boy of eighteen 
years suffering from spermatorrhea? Would it be advisable to see a doctor 
about it?" 

Reply. — The condition is of no consequence. Do not worry about it. 
You need not see a doctor. 

Circumcision. — L. A. J. writes: "1. Would be pleased to have you in- 
form me the benefit of being circumcised. 2. How long would a person be 
laid up if he were circumcised? I am 21 years old." 

Reply. — 1. It is sometimes advantageous for reasons of cleanliness. 
2. A week or less. 

Night Losses. — M. S. writes: "Kindly inform me if spermatorrhea or 
night losses can be cured. If so, how?" 

Reply. — Probably there is no reason why it should be cured. It is a 
natural condition. Stop worrying. 

Mucus from Urethra. — W. L. A. writes: "1. I have wet dreams about 
once a week. Will the wet dreams hurt me? 2. When I have bowel move- 
ments and if I have to stay on the seat very long a drop or two of semen 
will come out but I have no sensation when it does. I am 20 years old, If. 
feet S 1 /} inches tall, and weigh Ilk pounds." 

Reply. — 1. No. 

2. This is mucus from certain small glands. It is of no consequence. 

Erections in a Child of no Consequence. — L. D. writes: "Erections of 
little boys seem to give many parents much alarm. My boy is nearly four 
years old. He has some indigestion and only weighs SO pounds. Some 
nights he gets several erections. A few nights he had as many as five or six 
at intervals of 30 minutes. These were exceptionably bad nights and were 
after the child had eaten a heavy supper. We are considered as educated 
people and as knowing how to raise a child. We have studied Holt but fail 
to "be able to obtain any advice on the subject of erections. Doctors seem 
to give the matter little attention for I have consulted some of the best. I 
wanted to get your help" 

Reply. — This is a matter of no consequence. Give the boy a light sup- 
per and have him void the urine just before retiring. 

Self -Abuse. — A Friend in Need writes: "I have been a victim of a 
vicious habit for four years but have now stopped. I am now ITV2 years 
old. When a boy starts this habit and then stops the questions which come 



VENEREAL DISEASES 1313 

to his mind are: 1. Will it affect the length of my life? 2. What are its 
effects and can they he cured and how? 8. Will it affect my children if 
I have any?" 

Keply. — 1 and 3. No. 

2. There are no effects that need be lasting. You must cultivate self- 
control as you would cultivate the ability to keep from drinking whisky, 
stealing or giving away to fits of anger. The person who yields shows that 
he is weak-willed and the will becomes weaker from yielding. To help in 
self-control you must not drink nor overeat nor listen to smutty stories. 
Keep in good physical trim and associate with clean, strong-willed people. 

Masturbation in a Child. — Mrs. J. C. C. writes: "1. Would masturba- 
tion in a child necessarily tend to make him or her a degenerate man or 
woman incompetent of being normal? 2. What is the treatment or cure? 
3. Is this condition hereditary?" 

Keply. — 1. No. 

2. The habit is not difficult to break. Either the hands or the legs 
should be fastened, according to the circumstances. Surgical supply 
houses have hand covers and thigh fasteners for the purpose. 

3. It is not hereditary. In most instances, the children are taught the 
habit by their nurses or other attendants. 

Stupidity and Self -Abuse. — Worried writes: "A boy nearly 17 years 
old has supposedly from childhood been dissipating by handling his sexual 
organs. He does not inherit such immoral traits. He is stupid in most of 
his studies, takes no interest in his work and, consequently, is severely 
scolded at all times by his father. His home surroundings are not specially 
pleasant. What will be the result if the practice is continued? Does such 
dissipating have any serious effect on the mind?" 

Reply. — It is more likely that the boy's sex habits are the result of a 
poor mind than that his poor mind is the result of his bad sex habits. My 
advice is that you have the boy examined by someone who specializes in 
children's minds. Perhaps he has dementia precox. Perhaps he is a mental 
defective of another sort. 

A Worrier. — X. Y. Z. writes: "A young man having had considerable 
trouble over which he constantly brooded for the past eight months has 
now reached the stage where he constantly worries over what appears to 
have been an abnormal immoral act committed by himself. The act was 
of no seriousness except that he has magnified it to large proportions and, 
although fully conscious of that fact himself, cannot overcome it. If 
not worrying over this particular act he will revert back to the original 
trouble. He has made several attempts to work but cannot seem to pull 
himself through, until he is now broken in spirit. Do you think it possible 
for one having only small means to cure this condition without resorting 
to a sanitarium, of which place I have a horror. Is this neurasthenia or 
nervous prostration? Will it lead to insanity?" 

Reply. — The man is a worrier or a neurasthenic. Occasionally, such 
a man can cure himself of his bad mental habit by studying daily from 
some such book as "Worry and Nervousness" by Sadler or a Christian 
Science textbook. 



1314 VENEREAL DISEASES 

Fear and Worry. — J. R. T. writes: "Will you please prescribe a remedy 
for partial impotencyf The desire is as great as ever and sterility does 
not seem to be affected. There is so much quackery about this disease, I 
hate to go to the advertising doctors." 

Reply. — Your condition is the result of fear. Quit thinking about 
your sex organs and your sex acts. That is all you need do. 

A Sexual Neurasthenic. — C. 8. L. writes: "I am 23 years old and intend 
to marry soon. This is why I am writing to you for some advice. First 
of all, I have no bad habits. I am 5 feet 8 in. tall, weight, 11+2 pounds. 
My condition is: nervousness (nervous debility), dizzy, continuous head- 
ache, sometimes no ambition to work, cannot gain any flesh although I eat 
everything suitable and retire about 10 p. m. 

"1. For the past few months I get from one to four times a week 
'nightly losses.' Will this, when continued, cause locomotor ataxia or 
other disease? 2. Is chromium sulphate of any aid to stop the losses?" 

Reply. — 1. No. Exercise in the open air, stop worrying, keep your 
thoughts clean and marry. You are and will be all right. 

2. No. 

Doubting Daisy writes: "How is a young girl to know if it is right to 
marry a man in a town who is supposed to have sowed oats once, the wild 
variety, and was laid up sick, so gossip goes, and who is not strong, but 
very nice, kind, generous, and anxious for a home and wife. No one will 
say what he had or what he has and would he ask me to marry him if he 
knew he was diseased? How can any clean girl know what she is getting 
when no one will say and she cant ask him? All I know is learned from 
the movies — 'Damaged Goods' and 'Ghosts' — and one of the older women 
in town told me he was 'unfit for marriage,' and when I asked her why she 
changed the subject. 

"I have no mother and am only 18 and in perfect health. He seems to 
be crazy over me but I don't love him enough to raise idiots and bury a 
lot of innocent babes full of poison. On the other hand, I'd be the happiest 
girl alive today to know for sure he is clean and healthy, for that suspicion 
is the only toad under my rosebush. 

"Please tell me, Dr. Evans, must I leap in the dark, as so many of my 
earthly sisters have done? To me good health and the joy of living make 
life. I can't bear to think of sickness and doctors' offices and undertakers 
and wreaths. It's hateful. I reason out — if he is diseased and I ask him he 
will act the offended stunt and where am I? Do they ever acknowledge 
it? Would I acknowledge it if it meant the losing of wife, home and 
happiness ? 

"Dr. Evans, please tell me as if I was a little sister how I can tell. 
What are the danger signals? And I'm writing in the 20th century, too! 
What a thought! The dogs and live stock are far better off when it comes 
to mating for human intelligence directs. We just blunder along and litter 
up the earth with halfwits. Why don't you doctors help us? Why is it 
charming men with real personalities are so often the ones rumor says are 
poisonous? Oh, I'm so puzzled and so miserable." 

Reply. — A number of questions but no answer. 



GENERAL INDEX 



Abnormal children, grouping of, 1253 
percentage of, 1253 
reasons for, 1253 
Acetanilid poisoning, antidote for, 885 
Acetic acid poisoning, antidote for, 886 
Acid burns, prevention of, in industries, 
894 
treatment of, 894, 895 
Acromegaly, and giantism, 556 
definition of, 556 
symptoms of, 556 
Actinomycosis. See Lumpy jaw. 
Addison's disease, nature of, 580 
symptoms of, 580 
treatment of, 580 
Adenoids, cause of swelling of, 20 
enlarged, prevention of, 21 

removal of, 21 
general understanding of, 20 
narrowing of nose space by, 13 
position of, 15 
removal of, 20 

swelling of, due to absorption from 
nose, 17 
Adhesions, due to ptosis, 1081 

symptoms of, 1081 
Adrenal bodies, Addison's disease from 
destruction of, 580 
effect on, of fright, anxiety, worry, 577 
function of, 576 
location of, 576 
neurasthenia caused by trouble with, 

577 
secretion of, distribution to nerve cells, 

576 
size and weight of, 576 
tuberculosis of, 580 
Adrenalin, proper use of, 580 
Age, relation of, to tuberculosis, 74 
Aging, gradual, and bathing, 953 
and clothes, 952 
and constipation, 954 
and exercise, 952 
care of skin, 953 
diet, 953 
habits of, 954 



Aging, gradual, periodical examinations, 
952 
sleep, 952 
Air route, organs of, 15 
Albino, definition of, 704 
Albuminuria, in pregnancy, 626 
Alcohol, and heat, 340 

food and fuel value of, 339 

justified use of, 339 

overindulgence in, predisposing to colds 

and pneumonia, 61 
place of, in medicine, 340 
predisposing to pneumonia, 56, 60, 61 
relation of, to tuberculosis, 73 
rules for getting drunk, 341 
Alcohol habits, and insanity, 368 
appeal of, 339 
cure of, 340 
effect of, 339 
Alcoholism, and eugenics, 1010 
Alimentary canal, length of, 654 
Alkalies (such as lye, washing powders, 
etc.), antidote for poisoning 
from, 886 
Alkaloids, antidote for poisoning from, 886 
Amenorrhea, definition and causes of, 1277 
Anthrax, and furs, 289 
bacillus of, 289 
carbuncle of, and ordinary carbuncle, 

288, 290 
common in cows and horses, 288 
enlargement of spleen in, 585 
human, description of, 288 
internal, 288 

location of carbuncle of, 288 
symptoms of, 288 
in blood, 288, 289 
of lungs, 288 
Anaphylaxis, 49 
Anemia, and dirty teeth, 747 
Anesthesia, Crile's method of, 987, 988 
Anger, effect of, on body, 366 

"toxins" of, 366 
Anopheles, or malaria-carrying mosquitoes, 

265 
Antifebrin poisoning, antidote for, 885 



1315 



1316 



GENERAL INDEX 



Antipyrin poisoning, antidote for, 995 
Antitoxins and toxins, 489 
Antivaccinationists, 225 
Antrum, 11 

Apoplexy, as a cause of death and dis- 
ablement, 612 

cause of, 613 

improvement of condition in, after fever 
stage, 612 

in families, 612 

order of events in evolution of, 612 

paralysis due to, 614 

premonitory symptoms of, 612 

preventive measures against, 612 

pseudo, forms of, 614, 615 

usual history of, 612 

warnings of, 614 
Arsenic poisoning, antidote for, 886, 901 

prevention of, in industries, 901 

symptoms of, acute and chronic, 901 
Arthritis, rheumatoid, 141 
Arthritis deformans, 141 
Artificial respiration, 874 

Sylvester method of, 875 
Asthma, bronchitis associated with, 44 

definition of, 43 

element of spasm in, 421 

paroxysms of, 44 

relief for, 44 

source of trouble in, 43 

symptoms of, 44 
Asylums, and eugenics, 1013 

"Babies, and heat, 809 

colic in, conditions mistaken for, 814 

due to gas, 814 

prevention of, 815 

treatment of, 814 
cry of, meaning of various kinds of, 
805 

reasons for, 804 
danger sign with, 803 
death rate among, from diarrhea, in cer- 
tain months of year, 809 

in country, 808 
diarrhea in, 803 

its treatment, 813 
dyspepsia in, cause of, 815 

symptoms of, 815 

treatment of, 817 
eyes of, condition of, at birth, 817 

development of, 817 

variations from normal in, 818 



Babies, fat, 807 
feeding of, 801 

after nine months, 825 

amount of food given, 824 

amount of water to be added, 823 

during second summer, 826 

long interval plan for, 823 

making energy by, 822 

simple system and formula for, 821, 
822 

too much, in hot weather, 803 

under three months, 826 

when baby food must be resorted to, 
799, 828 

when sick, 827 
fresh air for, 802 
growth of, 800 

hazards of early life of, 795 
keeping well in hot weather, 809 
lessened death rate among, 797 

in New York City, 798 
main elements in needed care of, 795 
making milk safe for, 830 
need of, for water, 798 
nerves of, after feeding, 805 

and play, 805 
nervous, symptoms of, 806 

treatment of, 806 
nursing of, its importance, 797 

periods of, 798 
orange juice for, 798 
policy of New Zealand on, 798, 799 
sick, feeding of, 827 
summer complaint among, 811 

and flies, 813 
weaning of, diet after, 820 

gradual, 819 

time for, 818 
weight disturbance in, 820 

treatment of, 821 
weight of, at birth, and increase in, 800 
Baby foods, selection of, 828 

merit of, 829 
Baldness, cause of, 755 

location of, 755 
Baths, and skin, 706 
cleansing, 706 
cold, 706 

warm, without soap, 706 

Bed bugs, local applications for, 919 

method of destroying, 918, 919 

transmission of disease by, 918 

Bed-wetting, thyroid extract for, 559 



GENEEAL INDEX 



1317 



3, application for bite of, 920 
Belching, a habit, 652 
acquisition of, 653 
cause of, 653 
effect of, 653 
Benzin, to prevent explosions with, 901, 

902 
Benzin poisoning, 902 

Beriberi, and cooking, prolonged and at 
high temperature, 174 
and rice, 174, 178 
cause of, 177, 178, 489 
definition of, 177 
diet for prevention of, 173, 174 
distribution of, 172 
existence of, in United States, 172, 177 
general lessons from, 175 
government plan to combat, and result 

of, 172 
preventability of, 177 
reasons for interest in, 172 
symptoms of, 176 
treatment for, 178 
varieties of, 176 
Bichlorid of mercury, antidotes for, 887 
Bites of insects, suggestions to mothers 

for, 873 
Black eyes, treatment for, 872 
Black flies, application to bite of, 920 
to destroy larvae of, in breeding places, 
920 
Blindness, and venereal diseases, 1290 
cataract, 116 

due to syphilitic iritis, 126 
in Bright 's disease, 117 
inevitable, preparation of patient for 

oncoming of, 117 
preventable, Crede's method for, 113 
decrease in rate of, 111 
due to accidents, 116 
due to trachoma, 115, 118 
mother's cooperation against, 113, 

115 
ophthalmia neonatorum, or infection 
of eyes occurring during birth 
or within first few days there- 
after, 112 
percentages of, 113, 114 
public education and cooperation 
against, 115 
statistics on, 111, 112 
Blood, Metchnikoff 's study of, 87 

protection of, by lymphatic system, 606 



Blood, sugar in, 159, 160 
Blood cells, 87, 88 
red, 552 
white, 551 
Blood flow, 606 

and lymphatic system, 607 
Blood glands, 583 

Blood pressure, and life insurance, 605, 
606 
relation to, of adrenals, 581 
Blood pressure records, 605, 606 
Blood pressure test, 605 
Blood purifiers, 154, 155 
Body, influence of, on mind, 375, 376 
Boils, cause of, 713 
treatment of, 713 
Bowel movements, normal number and 

time of daily, 655 
Bread, baking of, 453 
constituents of, 451, 452 
food value of, 454 
relative food value of flours used in 

making of, 454 
sanitation in bakeries, 454, 455 
Breads, hot, frequent use of, 454 
Breast, caking of, 966 
cysts of, 966 
fibroma of, 966 
tumors of, 966 
Breathing, difficult, causes of, 12 

object of, 43 
Bright 's disease, acute, apoplectiform, 619 
due to infection, 619 
albumin in urine in, 617 
and diabetes, 627 
and life insurance, 619 
and pregnancy, 625 
chronic, mode of life in, 622 
or gouty form of, 621, 622 
with much albumin, associated condi- 
tions of, 623 
causes of, 623 
symptoms of, 623 
treatment of, 624 
death rate from, 618 
definition of, 617 
due to other diseases, 618 
indication of blindness in, 117 
progressive form of, 621 
testing of urine for, 627 
treatment for, 618 

J. E. Hardy's, 629, 630 
Von Noorden on, 678 



1318 



GENERAL INDEX 



Bright 's Disease, very slow, 624 

warning of, 618 
Bronchi, description and function of, 46 

location of, 46 
Bronchitis, associated with asthma, 44 
cause of, 46 
cough remedies for, 47 
definition of, 46 
differentiated from laryngitis and tra- 

chitis, 46 
symptoms of, cough, 46 

" soreness in the lungs,' 7 46 
Brown-tailed moth, poisoning effect of, 
923 
rash of, 922 
Brown-tailed rash, symptoms of, and 

treatment for, 923 
Bruises, first aid in, 873 
Buildings, sites for, 1121 
Bulgarian bacillus, as preventive of senil- 
ity, 949, 950 
Burns, first aid to, 866 
Butter, made from pasteurized milk, 
479 
tuberculosis from, 478 
typhoid fever due to, 478 
Buttermilk, food value of, 480 

Cabot, work of, in introducing broader 

care for sick, 1026 
Caffein, effect of, summary of conclusions 
from Hollingsworth 's and Rivers' 
tests, 353 
effect of moderate doses of, 351 
Hollingsworth 's tests on, 351 
on general health, 353 
on nerves, muscles and mind, 351, 352 
on sleep, 352 
Caisson disease, cause of, 902, 903 

prevention of, 903 
Caking of breast, 966 
Camp, sensible, plan of, 1130 
Cancer, and eugenics, 1004, 1010 
and heredity, 958, 975, 985 
and rats, 295 
and sarcoma, 972 
contagion of, 958 
curability of, 959 

diagnosis of, methods of, 963, 964 
efforts to cure, 974, 975 
arsenic and zinc paste, 960 
injections into blood of colloidal cop- 
per, 960 



Cancer, efforts to cure, injections into 
blood, of colloidal serenium, and 
eosin, 960 
radium, 965, 975 
surgery, 964 
vaccine, 960 
x-ray, 960, 975 
human and mouse, 961 
importance of early recognition of, 964, 

965 
importance of knowledge of, 962- 

966 
kinds of, relative difference between, 

961, 962 
localized nature of, 965 
of breast, first indications of, pain and 
lump in breast, 966 
indications for operation for, 967 
operation for, 967 
succeeding symptoms of, 966, 967 
of face, and smoking, 967 
course of, 968 
cure of, 967 
lower and upper, 967 
suspicious signs of, 968 
of mouth, and ulcers of mouth, 968 
of tongue, danger of temporizing with, 
969 
location of, 968 
symptoms of, 969 
of skin, symptoms and diagnosis of, 

971 
of stomach, and liver, 969 
diagnosis of, 970 
early signs of, 969 
examination for, 969 
frequency of, 969 
suspicious signs of, 970 
of uterus, and general knowledge, 972 

symptoms of, 972 
operation for, 964 

on suspicion or on positive diagnosis, 
964, 965 
percentage of deaths from, 959, 963 
prevention of, 974, 975 
serum from, in animals and men, 960 
theories as to cause of, 957 
theories as to contributing causes of, 

958 
warding off of, 973 
Cancer cells, 962 
Cancer houses and districts, 958 
Cannabis indica-hashish, antidote for, 888 



GENEKAL INDEX 



1319 



Carbohydrates, 450, 675 

Carbolic acid poisoning, antidote for, 888 

Carbon monoxid poisoning, or being 

" gassed,' ' 897 
Carpet beating, danger from, to janitors 

and carpet beaters, 1136 
Cataract, aging of lens of eye, 122 

and eugenics, 1010 

causes and diitribution of, 116, 117 

first symptoms of, 122 

operation for, old way, 122 
Smith way, 122, 123 

prevalence of, in India, 123 
Catarrh, and rheumatism, 150 

beginning of, 11 

definition of, 35 

inflammation of, and discharge from 
middle ear due to, 35 
Caterpillars, harmless and poisonous, 922 
Centipedes, treatment of bite of, 920 
Cerebral hemorrhage. See Apoplexy. 
Cerebrospinal fever, 258 

cause of, 258, 259 

epidemic of, 258 

symptoms of, 259 

transmission of, 259 
Cerebrospinal meningitis, and infantile 
paralysis, 257 

atypical and typical cases of, 257 

cause of, 257 

epidemics of, 257 

transmission of, 257 
Cheese, constipation due to, 469 

digestibility of, 469 

flavor of, due to bacteria, 470 

food value of, 469 

made from milk first sterilized, and cul- 
ture added, 470 

stored, 469 

tubercle bacilli in, 469, 470 
Chest, narrow, 1064, 1065 

tendency in man to deep, narrow, 1062 
Chest development, relation of, to tuber- 
culosis, 74 
Chewing gum, after overeating, 493 

between meals, effect of, 637 
Chicken, frozen, 460, 461 

purchase of, in city, 460, 461 

rules for purchase of, 460, 461 
Chicken pox, carriers of, 248 

contagion of, 248 

incubation period of, 248 

medical treatment of, 249 



Chicken pox, nature of, 248 

prevention of scratching during, 248 
spreading of, 192 
symptoms and course of, 248 
transmission of, 248 
Childbirth, procedure in case of child ar- 
riving before doctor, 775 
supplies for, 780 
Children, abnormal, 1252 

backward, causes of, poor vision, 841 
correction of, 844 
effect of, on child, 841 
percentage of faulty vision among, 842 
crippled, from tuberculosis, 848 
treatment for, 848 
knowledge to be had by mothers of, 
848 
cross-eyed, discovery of, in first stages, 
842 
effect of, on child, 842 
outgrowing of, 842 
evidence of normality in, at different 

age periods, 845 
feeding of, 1254 

incorrigible, due to physical defects, 843 
neglected, 1256 

poor vision among, causing backward- 
ness, 841, 842 
percentage having, 843 
score cards for entry of, in baby shows, 

846 
training of, 846 

unnecessary losing of, in infancy, 847 
Chloral hydrate poisoning, antidote for, 

888 
Chloroform poisoning (internal), antidote 

for, 888 
Choking, suggestions to mothers for, 872 
Cholera, disinfection after, 208 
Chorea. See St. Vitus' dance, 
acute rheumatic, 423 
Huntington's. See Huntington's chorea. 
Clams and oysters, and typhoid fever, 311 
Coal oil poisoning, antidote for, 888 
Cocain, no warrant for medical use of, 
338 
warning against careless use of, 338 
Cocain habit, and spraying for hay fever, 
338 
cure for, 338 

effect of drug, when deprived of, 334, 
338 
when under its influence, 338 



1320 



GENEKAL INDEX 



Cocain habit, Harrison law against, 329, 
330, 331 
inexcusability of, 337 
in neurasthenics, 337. 
Cocain poisoning, antidote for, 888 
Cock eye. See Squint. 
Coffee, a drug, 350 
effect of, general, 355 
on digestion, 354, 355 
on general health, 353 
on nerves, muscles and mind, as re- 
sult of Hollingsworth tests, 351, 
352 
on sleep, 352 

su mm ary of conclusions reached by 
Hollingsworth and Eivers, 353. 
habit of, 355, 357 
Hollingsworth 's tests on effect of caf- 

fein, 351 
ingredients of, 354 
methods of making, and their relative 

values, 356 
relative amount of caffein in tea and, 

350 
use of, 350 

how and when, 355, 357 
per capita, in United States, Europe 
and Australia, 350 
Cold storage, control of, 509 

rules for, 508, 509 
Colds, and grip, epidemics of, 55 
beginning of, in nose, 29. 

in throat, 29 
causes of, 25 
bacterial, 28, 35 
contributing, 29 
cost of, 29 
dangers of, 28 
discharge of, 11 
drafts and, 30, 31 
earaches due to, 134 
fresh air and cold showers as preventives 

of, 56 
infectiousness of, 25, 28 
inherited susceptibility to, 134 
kinds of, 28 

necessity for prompt care of, 28 
nose infections, 28 
not a necessity, 25 
onset of, 27 
outdoor life and, 25 
pneumonia due to neglect of, 55 
prevention of, 25, 29, 31 



Colds, serious, 27, 28 

symptoms of, 27, 28 

with chronic cough, 28 
Colic, first aid in, 869 

in babies, 814 
Colon, length of, 654 

muscular fibers and motion of, 654 
Color blindness, and eugenics, 1010 
Constipation, and foods, 656 

and senility, 487 

cathartics and laxatives for, 656 

chronic, with pain in certain nerve cen- 
ters, meat in, 459 

definition of, 655 

due to too little fluid in colon, 654 

long-standing, ultimate and permanent 
relief of, 656 

number of natural movements a day, 
and time of, 655 

occurrence of, 654 

prevention of, in children, 655 
Consumption. See Tuberculosis. 
Contagion and infection, 192 

control of, in cities, 195 

in small towns and country, 195 
rules for, 197, 198 

percentage of infants and adults sus- 
ceptible to, 201, 203 
Contagious diseases, apparently sporadic 
cases of, 197 

carriers of, 214 

control of, 201, 203 

harm done by unreported cases of, 195 

immunity to, 201, 203 

incubation period of, 199 

initial symptoms of, 199 

manner of spreading of, 192, 193 

penalty for not reporting, 195 

period between exposure and illness in 
average case, 199 

preventability of, 193 

prime importance of reporting, 195 

to be reported, 193, 195 

tracing of source of contagion of, 197 

transmission of, from pets, 200 
Continence, 1302 
Convulsions, and epilepsy, 419 

and rickets, 419 

and worms, 419 

course of action followed by doctor, in 
case of, 418, 419 

description of, 418 

during course of disease, 419 



GENERAL IXDEX 



1321 



Convulsions, fear of, 418 

first signs of oncoming, 418 
importance of discovering cause of, 419 
in adults, diseases associated with, 420 

gravity of, 420 
restlessness, fever, headache, prelimi- 
nary to, 418 
symptomatic nature of, 416 
ushering in infectious diseases, 418, 419 
Cottonseed food, and pellagra, 477 
Cottonseed meal and flour, food value of, 
478 
recipe for corn cakes made with, 478 
richness of, in protein, protection against 
pellagra, 478 
Cough, danger of ' ' taking something for, ' ' 
41 
doping for, 42 
helpful and useless, 41, 42 
meaning of, 40, 41 

sources of irritations capable of caus- 
ing, 40 
treatment of, 42 
useless, causes of, 41, 42 
sedatives for, 47 
suppression of, 42 
Cough remedies, 42 
containing opium, 42 
expectorants, 47 
for bronchial cough, 47 
sedatives, 47 
Cradle cap, 709 

Cramps, due to difficult menstruation, 
1278 
first aid in, 869 
Cretinism, 561 

and eugenics, 1010 
and heredity, 558 
congenital and acquired, 562 
definition of, 558 
Criminality, due to physical defects, 

843 
Crippled children, causes of physical dis- 
ability of, 253 
percentage of, due to infantile paralysis, 
254 
in United States, 253 
11 Cross eyes," explanation of, 125 

neglected, blindness resulting from, 

125 
See also Squint, convergent. 
Croup, membranous, and diphtheria, 239 
points for recognition of, 239 



Croup, ordinary or spasmodic, treatment 

for, 239 
Crowds in hot places, 915 
Cuts, first aid in, 873 
Cyanid of potassium poisoning, antidote 

for, 888 
Cysts of breast, 966 

Deaf child, knowledge that should be had 

by mother of, 135, 136 
Deaf mutism, and eugenics, 1009 

inheritance of, 134 
Deafness, developing in later life, inheri- 
tance of, 134 
due to middle ear infections, 134 
generally due to nose, throat or ear in- 
fection, in early life, 137 
lip-reading for, 136, 137 
over-sensitiveness in, 137 
Volta bureau for increase and diffusion 
of knowledge relating to the deaf, 
134 
See also Hearing, failing. 
Deaths, in middle age, most important 
contributor to, 951 
percentage of, at different age periods, 
951 
Deformities, present-day decrease in num- 
ber of, 186 
Dementia precox, false diagnosis of, 416 
importance of early recognition of, 416 
nature of, 416 

percentage of cases of, 416, 417 
symptoms of. in early stages, 416 
later, 416, 417 
Dermatitis Shamberge. See Straw itch. 
Dermoids, cause of, 714 

congenital tumors, moles, birthmarks, 
hairy patches, tabs and clefts con- 
stituting, 714 
Diabetes, and Bright 's disease, 158, 627 
causative factor of, 677 
cause of, theories on, 497 
causes of, 158 
definition of, 158 
diet for, 160 
due to deficient secretion of pancreas, 

158 
essential condition in, 677 
liver kind of, 158 
relation of, to tuberculosis, 72 
rendering one subject to infections, 158 
sign for diagnosis of, 159 



1322 



GENEKAL INDEX 



Diabetes, test for sugar in, 159 
treatment for, diet, 677, 678 
Diarrhea, due to lead poisoning, 897, 
898 
in babies, 803 

treatment of, 813 
transient, first aid in, 870 
Diathesis, definition of, 154 
Digestion, action of saliva on food, 637 
and eczema, 708 

importance of chewing food, 637 
influence on, of mind, 373 
of starch, 496, 497 
process of, 638 
Digestive troubles, 639, 640 
Diphtheria, almanac talk on, 237 
and croup, membranous, 239 
axioms for, 238 
cause of, 233 
control of, 236, 238 
definition and nature of, 237, 238 
diagnosis of, by microscopic examina- 
tion, 235 
by throat cultures, 236 
disinfection after, 208 
effect of, on heart, 234 
on nerves, 235 
on kidneys, 235 
initial symptoms of, 235 
location of, 235 
period of incubation of, 235 
poison or toxin of, amount of, 235 
its circulation through body, 234 
rules for exclusion of children from 

school because of, 1250 
spreading of, 192 
swelling of glands on outside of face 

and neck in, 234 
thirty years ago and now, 237 
transmission of, 237 
treatment of, antitoxin, 236, 237 
vaccination against, 237 
Diphtheria antitoxin, disadvantages of, 
236 
dosage of, 237 
nature of, 236 

promptness in administering, 238 
Diphtheria bacillus, 233 
action of, 234 
entrance of, into body, 233 
follicular tonsillitis due to, 235 
presence of, in throat, without causing 
symptoms, 236 



Diphtheria bacillus, site of, 234 

sore throat due to, 536 
Diphtheria toxin, 234, 235 
Discharge from ear, due to catarrh, 35 
Disease, and insanity, 368, 369 

lowered rates of, 172, 173, 184 
Disinfection, by air and sunlight, 209 
for all infectious diseases, 208 
futility of, in room occupied by pa- 
tient, 208 
nature's agencies, sun, air and drying, 

208 
of excretions, in cholera and typhoid 

fever, 208 
of mouth secretions, in consumption, 
pneumonia and diphtheria, 208 
Dislocations, first aid in, 866 
Dissaccharid, 496 
Dog days, 300 
Drafts, and colds, 30, 31 
definition of, 30 
morbid fear of, 31 
regulation of, 30 
Drug habit, and eugenics, 1010 
and insanity, 368 
cure for, Sceleth drug treatment, 333 

Towns morphin cure method, 332 
effect on, of Harrison law, 331 
in one city, 328 

legislation against, and its weaknesses, 
329, 330 
Harrison law, 329, 330, 331 
starting points of, 327, 329 
Drugs, habit-forming, percentage of, con- 
sumed, 327 
Drunkenness. See Alcohol habit, Alcohol- 
ism. 
Ductless glands, 555 
adrenal bodies, 576 
effects of changes in, 567, 568 
extracts from, made from castrated ani- 
mals, 579 
growth due to secretions of, 556 
pituitary body, acromegaly disease of, 

556 
thymus, 567 

thyroid, maladies of, 556 
Dumps, rubbish, 1215 
Dust, in shoe factories, 905 

kinds of, 903 
Dusty trades, and tuberculosis, 904 
effect of, 903, 904 
shoe factories, 905 



GENERAL INDEX 



1323 



Dysentery, and armies, 358 
Dysmenorrhea, definition and importance 
of, 1279 

thorough examination advised for, 1279 

treatment for relief of, 1279 
Dyspepsia, in babies, 815 

Ear, middle, 9 

Ear disturbances, due to nose diseases, 35 
Earache, danger of neglect of, 134 
due to catarrh, 35 
due to colds, 134 
failing hearing due to, 134 
ordinary treatment for, 134 
Ears, proper care of, 35 
Eczema, and digestion, 708 
cause of, 708 
definition of, 707, 708 
in babies, cradle cap, 709 
on chest, 708 
on face and head, 708 
tetter or milk, 709 
treatment of, 709 
skin changes in, 708 
Eggs, advantages of, as food, 464 
basic principles for producer, 466 
cold storage, 469 
country held, 467 

diagram of composition of food mate- 
rials of, 465 
fertile and infertile, 466 
flavor of, 467 
fresh, 464 

difficulty of obtaining, 465 
keeping of, 508 
keeping and marketing of, 466 
keeping qualities of, 466 
market classification of, 466 
refrigerated, 507 
retailing of, 468 

season of greatest scarcity of, 468 
stale, for cooking, 468 
storage, 467 
Electric shock, first aid to, 867 
Emergencies, minor, first aid to. See 
First aid. 
suggestions to mothers for, 872 
Emotion, influence of, on body, 366 

on heart, 375 
Enlarged tonsils, narrowing of nose space 

by, 13 
Epidemics, in small towns and country, 
control of, 198 



Epilepsy, after effects of attacks of, 425 

and consanguinity, 424 

and heredity, 424 

and occupation, 426 

and sleep, 425 

and society, 426 

beginning in childhood, with convulsions, 
419 

causes of, 424, 427 

colony plan for, 426, 427 

famous people with, 427, 428 

forms of, 423 

little known of, 423 

mental aura of, 425 

night attacks of, 425 

not inconsistent with life of utility, or 
even with important career, 428 

percentage of, 423 

percentage of cures of, 425 

signs of oncoming attack of, 425 
Epileptic manifestations, 423 
Ergcgraph, 1035 
Ergot, 489 
Erysipelas, and seasons, 262 

blood examination in, 262 

cause of, 259 

course of poison of, in body, 262 

distribution of, 260 

dread formerly held in, 259, 260 

effect of, on insanity, 413 

hospitals foci for disease, 261 

liability to, increased by former attack, 
262 . 

recovery from, 263 

streptococcus of, 262 

symptoms of, 259, 262 

transmission of, by people, not things, 
261 

treatment for, 263 , 
Ethnoid cells, 11 

Eugenics, Adami on results of one's liv- 
ing, 1007 

age of science of, 1009 

and alcoholism, 1010 

and asylums, 1013 

and becoming hard of hearing with age, 
1009 

and blue eyes, 1010 

and cancer, 1010 

and cataract, 1010 

and color blindness, 1010 

and cretins, 1010 

and deaf mutes, 1009 



1324 



GENERAL INDEX 



Eugenics, and determination of heredity 
of each human trait, 998 

and drug addiction, 1010 

and exophthalmic goiter, 1010 

and genealogy, 993 

and inheritance, clearing of in four gen- 
erations, 999 

and insanity, 1010 

and multiple sclerosis of nervous sys- 
tem, 1010 

and neurotics, 1010 

and small families, 1015 

and St. Vitus' dance, 1010 

and " Survival of the Fittest/ ' 1005, 
1006 

and the immigrant's child, 1014 

and the only child, 1016 

and tuberculosis, 1010 

collecting data for, 987-1001 

conclusions on, cancer, 1004 
criminality, 1004 
Ewart's, 1003 
hemophilia, 1004 
memory, 1004 
mental defects, 1003 
Mongolians, 1003 

Salaman, on facial expression of Jews 
and Gentiles, 1003 

Dr. Goddard's study of a family, 990, 
992 

environment and inheritance, 1015 

family studies in record office of, "The 
Hill Folk," 1011 
the Nam family, 1012 

Galton, father of, 989 

literature on, Galton, Sir Francis, 1008, 
1009 
Mendel, 1008 

man made laws and nature's laws in, 
1009 

marriage of Jews and Gentiles, 1003 

meaning of term, 989 

medical examination and certification as 
a basis of marriage, 1009 

negative and positive, 990 

optimism of, 1001 

plan for keeping family histories, 
999 

practical problem of, 996 

problem of the feebleminded, 1002 

standard and normal line for, 996 

tendency of bloods, 100*4, 1005 

tendency to return to mediocrity, 993 



Eugenics, "Unto the Third and Fourth 
Generation," 1007 
Weismann, on environment and heredity, 
1007 
Eugenics Eecord Office, Family History 
Book issued by, 999 
schedule of, for recording family traits, 
987 
Eustachian tube, 9 

Exercise, and athletics, advantage of, 1046 
and play abidingness of, 1046 
importance of, 1044 
Maria Montessori on, 1044, 1045 
need of child for, 1046 
archery, 1040 

athletic games, baseball, 1037 
golf, 1037, 1038 
handball, 1036 
tennis, 1036, 1037 
avoidance in, of stiffness and soreness, 

1035 
billiards, 1038 
for children, 1043 
for convalescents, 1042 
for old people, 952 
for sedentary workers, 1034 
horseback riding, 1047 
important aims of, 1045 
on all fours, argument against, 1033 

Shock's theory of, 1032 
overdose of, 1035 
swimming, 1041 

to straighten spinal curves, slide shoul- 
ders back and eliminate hollows 
about collar bone, 1033 
walking, correct method of, 1036 
Exophthalmic goiter, and eugenics, 1010 
Expectorants, 47 

Eye disturbances, due to nose diseases, 35 
Eye fatigue, types of, due to trades, 120, 
121 
miners' nystagmus, 121 
Eyes, affections of, pink eye, 126 
apparatus of, 121 
blindness, preventable, 115 
color of, and eugenics, 1010 
conditions of, tending to blindness, 117 
dangers to, from industrial poisonings, 

121, 122 
inflammation of iris of, iritis, 125 
lens of, 122 

soreness of, trachoma due to, 118 
iritis due to, 125 



GENERAL INDEX 



1325 



Fat, as sign of age, 681 

Fats, 450 

Fear, abnormal, foundation and effect of, 

372 
Feebleminded, problem of, 1002 
Feet, and low heels, 764 

care of, 761 

effect on, of tight shoes, 1060 

flat, 763 

metal arches for, 762 

pigeontoed, 762 

slew-footed, 762 

use of, 766 
Fermentation, intestinal, dieting for, 641, 

642 
Fever, meat in, 459 
Fibroma of breast, 966 
First aid, artificial respiration, 874 

in black eye, 872 

in bruises, 873 

in burns, 866 

in colic and cramps, conditions causing, 
and treatment of, 869 

in cuts, 873 

in diarrheas, transient, 870 

in dislocations, 866 

in electric shock, 867 

in fracture, 861, 862 

in hiccough, 871 

in insect bites, 873 

in internal hemorrhage, 865 

in nausea and vomiting, 870 

in neuralgia, 871 

in nose bleed, 865 

in poisoning, 883 

in rescues from fires, 866 

in rusty nail wound, 873 

in sunstroke, 876 

in wounds, 864 

application of tourniquet, 865 
hemorrhage from, 864, 865 

keeping away from patient of unneces- 
sary people, 860 

list for household emergency box, 868 

materials for, 860 

moving of patient, with fractures, 861, 
862 

position for patient, 860 

teaching of, 859 

treatment in profound shock, 861 

water and stimulants, 860 
First aid outfits, 880 
First aid requirements, 877 



Fish, diagram of composition of food 
materials of, 462 

fresh, 461 

frozen, 463 

keeping of, 461 

purchase of, 463 

refrozen, 462 

thawed, 461 
Flat feet, cause of, 763 

effect of, 761 

prevention and cure of, 764 
Fleas, disease transmitted by, 919 

lotions and fumigation against, 919 
Flies, and food, 926 

and removal of screens, 940 

and typhoid fever, 924 

averting menace of, 936 

breeding of, prevention of, 931 

campaign against, Flyless Havana, 93b 

danger from, in fall of year, 934, 
936 

defense against, 933 

door fans for, 938 

household trap for, 937 

keeping down of, on garbage dump, by 
covering with sand, 924 

new trap for, 938 

open season for, 928 

stable, 940 

stables and, 934 

"swat the fly" and "starve the fly," 
941 
Fly catechism, 927 
Fly family, description of, 927, 928 
Fly trap, household, 937 

new, 938 
Food, and flies, 926 

chewing of, and taste nerves, 637 

cooking of, prolonged, and at high tem- 
perature, 174 

over-refining and over-repairing of, 
175 

proper adjustment between work and, 5 
Food economics, 485 
Food preservation, benzoate for, 506 

methods of, 507 

spices for, 507 
Food route, organs of, 15 
Food values, 493, 494, 495 

of economical dishes, 494, 495 
Foods, and constipation, 656 

animal and vegetable, as sources of 
protein, 450 



1326 



GENEKAL INDEX 



Foods, animal foods and dairy products 
most important sources of fats, 
450 
bread, baking of, 453 
constituents of, 451, 452 
food value of, 454 
hot, frequent use of, 454 
relative food value of flours used in 

making of, 454 
sanitation in bakeries, 454, 455 
butter, pasteurized, 478 
cheese, 469 
classes of, 450 
cold storage of, 508, 509 
cottonseed, 477 

diagram of composition of food mate- 
rials, in apple, dried fig, straw- 
berry and banana, 475 
in breads, oat breakfast food and 

macaroni, 452 
in eggs, cream cheese and cottage 

cheese, 465 
in fish, 462 
in grapes, raisins, grape juice, canned 

fruit, and fruit jelly, 472 
in meats, 456 
in nuts, 473 
in olive oil, bacon, beef suet, butter 

and lard, 477 
in parsnip, onion, potato and celery, 

474 
in shelled bean, fresh, navy bean, 
dry, string bean, dry, corn, green, 
476 
in sugar, molasses, stick candy, maple 

sugar and honey, 488 
in various flours, 453 
in whole milk, skim milk, buttermilk 
and cream, 481 
diagram of dietary standards, 490 
diagram of functions, uses and constitu- 
ents of, 451 
digestibility of, 486 
economical dishes, 494 

food values of, 494, 495 
effect of cold storage on dietary habit, 

450 
egg, 464 
fish, 461 
fruit, 471 

greater consumption of, by Americans 
than by Europeans or Asiatics, 
450 



Foods, inorganic, 450 

insects infesting, 921 

methods of control of, 922 

meat, 455 

meats and poultry as chief sources of 
protein, 450 

milk, 480 

mushrooms, 470 

organic, carbohydrates, 450 
fats, 450 
proteids, 450 

overeating at dinner, 491 

oysters, 463 

quantity of, 490, 491 

refrigeration of, 507 

relative values of, 490, 491 

rules for Thanksgiving dinner, 492 

salt in, 498 

starch, digestion of, 496, 497 

toxins in, 489 

typical dinner, food values in, 491 
Foot, structure of, 761 
Foot and mouth disease, cause of, 322 

danger of, to children, 323 

easily avoided, 323 

geographical distribution of, 322 

incubation period of, 322 

procedure for prevention of spreading 
of, 323 

symptoms of, 322 

transmission of, 322 
Foreign bodies in nose, suggestions to 

mothers for, 872 
Formaldehyd poisoning, antidote for, 

889 
Fracture, 001168', 1028 

of long bone, and massage, 1028 
Fractures, healing of, 1027 

massage and exercise for, 1027 

use of X-ray in, 1027 
Frost, keeping off windows by electric 

fans, 1188 
Fruit, digestibility of, 486 

food value of, 471, 472 

"grape cure" for obesity, 475 

making a meal of, 471 

nutritive value of, 471 

preserved, for winter use, advantages 
of, 487 

proper use of, 476 

rules for eating of, 474, 475 

time of eating, as a laxative, 
473 



GENERAL INDEX 



1327 



Fruit, time of eating, for appetizing value, 
472 
for nutritive value, 473 
Fumigation, agitation against, 207 

formaldehyd (formalin) method for de- 
stroying bacteria, and description 
of, 206, 207 
losing ground, as a means of destroying 

bacteria, 206 
seldom required, 209 
sulphur fumes, method for killing in- 
sects, 207 

Garbage, and stable manure, 1221 
burning of, 1218 
disposal of, by burning, 1218 
by destructors, 1219 
by dumps, 1214 
by feeding to hogs, 1219 
by plowing into ground, 1219 
by reduction method, 1216 
commissions on, 1220 
St. Joseph's report on, 1220 
Garbage dumps, harm resulting from, 1214, 

1215 
Garbage reduction, 1216 
Gas, illuminating, antidote for poisoning 

from, 889 
Genealogy, heredity of feeble-mindedness, 

993, 996 
Genius, 365 

Giantism, and acromegaly, 556 
Girth, to decrease, 682 
Goiter, and constipation, 567 
and cretinism, 563, 564 
and digestion, 566, 567 
and inheritance, 563 
and rats, 566 
battling with, 566, 567 
cause of, 563 

cough or suffocation due to, 560 
definition of, 558, 565 
due to water, 563, 566 
endemic or epidemic, 565, 566 
enlargement of, due to disturbance 

elsewhere in body, 560 
importance of medical supervision in, 

566 
meat in, 459 
occurrence of, 562 
percentage of cases of, 564, 565 
size of, 562, 563 
toxic, 561 



Goiter, treatment of, 560, 561 
by surgery, 563 
in inoperable cases, 563, 564 
without symptoms, 560 
Gonococcal infections, cure of, 1286 
diagnosis of, 1286 
education against, 1289 
evil effects of, 1289, 1302 
importance of, in inheritance relations, 

1302 
in children, 1299 
marriage after, 1307 
percentage of, among men, women and 

children, 1289 
public education against, 1286 
stopping symptoms of, without curing 

disorder, 1290 
symptoms and course of, 1289 
tendency in young boys to regard as of 

no importance, 1289 
tendency of, to remain close to focus of 
infection, 1291 
Gonorrhea, diagnosis of, 1297 

method in use in U. S. Army, 1297 
germ of, 1288, 1291 
method of treatment of, in army, 1297 
symptoms and course of, 1289 
Gout, and meat, 458 

atypical cases of, in evidence in spring, 

142 
diseases resulting from, 142 
inflammatory joint type of (rich man's), 

142 
living to avoid, 142 
treatment for, 143 
Gouty aches, 142 

Gouty diathesis, and consumption, 154 
disposition accompanying, 154 
mode of life determined by, 154 
prevention of, 155 
11 Grape cure," for obesity, 475 
Grip, and colds, epidemics of, 55 
epidemics of, 55 

personal protection against, 55 
Growing pains, custom of giving medicine 
for, its danger, and proper treat- 
ment, 144, 145 
Growth, and thymus gland, 568 

due to secretions in ductless glands, 
556 

Hair, need of caring for, 701 
purpose of, 700 



1328 



GENERAL INDEX 



Hay fever, absence of cure for or preven- 
tion of, 47, 51 

as an anaphylaxis, 49 

attributed to pollen of different kinds of 
grasses, hays and sedges, 48, 51 

due to condition of nose and cavities 
leading from it, 50, 53 

effect of, 49 

not imaginary disease, 47, 53 

prophylaxis for, 51 

"running away," 51 
time for, 52 
where, 52 

sufferers from, poisoned by substances 
not poisonous to most people, 48 

symptoms of, 49 

treatment of, condition of nose and cavi- 
ties leading from it, 50, 53 
temperamental makeup of patient, 49 
washes, snuffs and cures, 51 

vaccination against, 52 

warning against cocain, morphin and 
adrenalin and preparations not 
known to be free from them, 51 
Head noises, causes for, and some sugges- 
tions for cure of, 442 

training one's self to forget, in incur- 
able cases of, 442 
Headache prevention method, 445 
Headaches, causes of, 443 

danger of coal tar products for, 443, 
444 

danger of headache powders for, 443 

danger of medicines for, 446 

due to biliousness-overeating-constipa- 
tion, 443 

due to eye strain, 443 

due to infections, 443 

due to neurasthenia, 444 

due to oncoming of Bright 's disease or 
arteriosclerosis, 443 

due to rheumatism, 444 

due to sinus trouble, 444 

importance of diagnosing cause of, 443, 
444 

migraine, 444 

prime necessity of treatment for, 444 
Health, and carpet beating, 1136 

buying of, 3 

definition and nature of, 2 

general rules for, 369 

necessary contributing factors to, 4, 7 

public, and dumps, 1215 



Hearing, failing, due to earache, 134 
incapacity resulting from, 135 
lip-reading for, 136, 137 
test of, for extremely early stages, 133 
simple, 133 
with age, and eugenics, 1009 
ordinary method of, 133 
re-education of, 135 
Heart, and circulation, influence on, of 
mind, 374, 375 
and exercise, 592, 593 
beating of, 591 • 
throbbing of, 591 
Heart £ic3ase, and failing compensation, 
590, 591 
and rheumatism, 590 
cause of, 590 

relation of, to tuberculosis, 71 
Heart leakage. See also Heart disease. 
Heat, and alcohol, 340 

using of, 1185 
Heating, and temperature of incoming air, 
1157 
and thermometer habit, 1185 
and ventilation, 1147 
factors, varying principles involved, 1173 
need of human body for changes in 

temperature, 1185 
normal temperature of rooms without 

fans, 1185 
of house, by direct-indirect heating, 1175 
by hot water, 1174 
by steam, 1175 
healthful, 1173 
of incoming air, before it reaches occu- 
pants of room, 1148 
of living room, 1161 
problems of, 1175 
raising or maintaining of, 1176 
temperature of air in different parts of 

room, 1148 
types of, central plant, 1184 

direct-indirect heating and ventilation, 

1183 
gas heaters, 1176 
gas logs, 1177 
hot air, 1182 
hot water, 1179 
open fireplaces, 1177 
steam, 1179 
stoves, 1178 
Height, and correct standing, 1068 
and good feeding in childhood, 1068 



GENERAL INDEX 



1329 



Height, and inheritance, 1068 

and regulation of sway in back, 1068 
increase or decrease in, of our popula- 
tion, 1069 
increasing, 1069 

internal glandular secretions for, 1068 
long-bodied people, 1070 
Hemorrhage, from uterus, not due to men- 
struation, 1278 
internal, first aid in, 865 
Hernia, acquired, 665 
cause of, 665 
congenital, 665 
due to accident, 667 
explanation of, 667, 668 
history of, 668 
importance of, 666 
in families, 665 
kinds of, 665 

percentage of each, 666 
strangulation or rupture of, 666 
symptoms of, 668 
treatment of, 667 
in infant, 666, 667 
Heroin habit, effect on user of withdrawal 

of drug, 334 
Hiccough, first aid in, 871 
Hives, nature of, 717 
" poison of, 717 
treatment of, 717 
Hodgkin's disease, cause of, 551 
nature of, 551 
origin of name of, 551 
vaccine for, 551 
Hogs, inspection of, in stockyards, 547 
Hornets, application for bite of, 920 
Hospitals, advantage of, for consumption 
cases, 1229 
confinement cases, 1228 
for contagious cases, 1230 
for ordinary illnesses, 1229 
for typhoid fever, 1229 
in cases of emergency, 1227 
and broader care of sick, introduced by 

Cabot, 1026 
as contributing to mental well-being of 

patient, 1228 
care of teething babies in, 1229 
certainty of efficient care in, 1228 
contagion in, 1230 

headquarters for latest and most im- 
proved methods for caring for 
sick and injured, 1226 



Hospitals, lessons of sanitation and hy- 
giene from, 1226, 1227 
operations in, as opposed to ill-prepared 

surroundings, 1228 
prejudice against, 1226 
role of, in education of medical profes- 
sion and public in general, 1226 
system and regularity of, 1227 
value of, 1226 
Hot places, crowds in, 915 
Hot weather, » advice for, 911 
disease in, 913 
liver in, 914 
sleeping in, 916 
work in, 912 
House fly, female, journal of, 927 
Houses, and cold walls, 1127 
and curtains and carpets, 1129 
and damp walls, 1128 
and heating, 1173 
and humidity, 1193 
and ice boxes, 1127 

and improperly ventilated rooms, 1128 
and kitchens, 1127 
and living rooms, temperature and 

humidity of, 1161 
and pantries and closets, 1127 
and porches, 1131 
and sanitary bathrooms, 1125 
and spring cleaning, 1135 
and sunlight, 1125 
arrangement of, questions and answers 

in regard to, 1131-1135 
bedroom, ventilation of, 1163 
choice of building site for, and high 
ground, 1121 
and land, 1122 

and other considerations, 1122 
and soils, 1121 
disease history of, 1107- 
keeping of, 1126 

selection of, and basements, 1124 
and bath room, 1125 
and bedroom, 1122 
and height of ceilings, 1124 
and ice box, 1123 
and insulation of walls and floors, 

1124 
and kitchen, 1123 
and pantries and closets, 1123 
and sitting-room, 1123 
and window leakage, 1124 
large rooms or small, 1123 



1330 



GENEKAL INDEX 



Housing, and congestion of population, 
1109, 1110 
and fatalism among poor, 1101 
and general dirtiness, 1100, 1101 
and price of land, 1110 

preventing land sweating, 1111, 1112 
and rehousing financial plan, 1104 
and rehousing, in Liverpool, 1105 
and town planning, 1113 
and use of rooms, 1092 
and ventilation, 1144 
bad, and congestion, 1099, 1100 

and effect of, on standards of occu- 
pants, 1103 
direct causes of ill effects from, 1097- 

1099 
ill effects of, 1092 
punishment for, 1106 
bad conditions of, formerly prevailing 

in New York City, 1095 
better, need for, 1085 

plans proposed for, 1085 
Charles Dickens on, 1084 
consideration of health in choice of, 

1084 
flat and cottage, 1116 
good, effect of, 1103 
houses and, 1084 
ill effects of overcrowding, 1100 
improving sanitation of, 1107 
influence of, 1099 
neighborhood standards, 1101 
new building code for Chicago and dis- 
agreements of commission for, 
1094, 1095 
of poor people, 1095 
problems of, in America, 1086 

and suggested ordinance against, 
1090" 
evils of city life, 1087, 1088 
factory location, 1090 
financing of small home, 1090, 1091 
in large and small cities, towns, vil- 
lages, etc., 1088 
overcrowding, 1089 

due to need or greed, 1089, 1090 
relay bed system, 1089 
setting of house, in city, 1093 

in country with regard to points of 
compass and sunlight, 1092, 1093 
sunlight and shade, 1093 
tenement house commission and law of 
New York City, 1095 



Housing, too much of, 1092 
Housing plans, 1096, 1097 
Humidifying, method of, 1194 

suggestion for, in steam heated room, 
1196 
Humidity, and frosted windows, 1193 
and hygrometer, 1195 
and plants as gauge of fitness of rooms 

for human occupancy, 1195 
measuring of, 1195, 1196 
of living room, 1162 
raising of, 1199 

relative, of hot out-door air in summer 
and hot indoor air in winter, 1197, 
1198 
Huntington's chorea, absence of cure for, 
432 
and marriage, 434 
first symptoms of trouble, 432 
hereditary nature of, 432 
history of, 432 
origin of, 432 
origin of name of, 432 
Hydrocarbons, 675 
Hydrophobia, a disease of dogs, 301 
absence of laboratory test and of treat- 
ment for, 301 
due to infection excreted by saliva, 301 
incubation period of, 301 
standard plan for prevention of, 301, 
302 
Hygrometer, 1195 
Hyperthyroidism, 558 
Hypnotism, function and use of, 379 
Hypochlorite (bleaching powder), antidote 

for poisoning from, 889 
Hypothyroidism, 558 

giving of thyroid extract for conditions 
supposed to be due to, 558, 559 
Hysteria, and neurasthenia, causes of, bad 
inheritance and home training, 
404 
faulty education, 403 
definition of, Bridger's, 404 
influences predisposing to, 406 
mind caused and mind cured, 379 
symptoms of, 406 

and organic changes, 377, 379 
treatment of, 406, 407 
Bridger 's, 407 

Ice box odors, 510 
cure for, 511 



GENERAL INDEX 



1331 



Ice cream, regulation of manufacture of, 
536, 537 

Idiosyncrasies, 49 
Industrial poisonings, to eyes, 121 
Infantile paralysis, and cerebrospinal 
fever, 258 
and cerebrospinal meningitis, 257 
and flies, 249, 250 

contagion of, from nose secretions, 250 
control of, 250, 251 
distribution of, 250 

importance of play in open air in, 254 
incubation period of, 250 
initial symptom of, fever, 254 
suggestions for prevention of, 250, 251 
transmission of, by flies, 249, 250 
by nose secretions, 250 
by well persons, 250 
treatment of, by exercise, 252 
virus of, its nature and location in body 

of sick person, 249 
wasting of muscles in, no restoration for, 
254 
prevention of, 254 
Infantile scurvy, and diet, 176 

symptoms of cases not definitely sick, 
176 
Infection, and contagion, 192 
cause of, 158 

conditions increasing sensitiveness to, 
159 
Inheritance, clearing of, in four genera- 
tions, 999 
qualities that cannot be bred out, 999 
Insanity, and alcohol habit, 368 
and drug habit, 368 
and diseases contributing to, 368, 369 
and eugenics, 1010 
and venereal diseases, 1301 
effect on, of erysipelas, 413 
of sudden shock, 414 
of typhoid fever, 414 
mind in, 377 
percentage of, 413 
prevention of, knowledge necessary for, 

413 
symptoms and organic changes, 377 
Insects infesting food, 921 

method of control of, 922 
Insomnia, causes of, 408 
occurrence of, 408 
remedy for, 408, 409 
Instinct, following of, 1059 



Insurance, health, effect of, 1223 
industrial, 1225 
social, 1224 
Intestinal fermentation, dieting for, 641, 

642 
Intestinal stasis, effect of, 1079 

Metchnikoff 's and Lane's work on, 1079, 

1080 
Intestines, effect on system of retention of 

waste in, 1080 
Iodin poisoning, antidote for, 889 
Iritis, 125 
Iron workers, accidents and diseases of, 

896 
Itch, transmission of, 716 
Itch parasites, treatment of, 917, 918 

Joints, inflammation of, treatment of, 
147 
stiff, due to lack of movement, 147 
due to neglect of inflammation, 147 



Kidney, of pregnancy, 625 
Kidney cures, 628 
Kidneys, and diabetes, 158 

best stimulant for, 628 

drinking water for, 621 

infections of, 620, 621 

transmission of infection to, 620 
1 ' Klondyke bed, ' ' making of, 1163 

Lead colic, first aid treatment of, 889 
Lead poisoning, different trades subject to, 
900 
preventive method for, 898 
recognition of, 899, 900 
sources of, in children, 897, 898 
symptoms of, 897, 899, 900 
Lead salts poisoning, antidote for, 889 
Leprosy, a disappearing disease, 300 
and rats, 295 
cause of, 587 

contagiousness of, 715, 716 
degree of danger from, 299, 300 
enlargement of lymph glands in, 551 
enlargement of lymph glands and of 

spleen in, 552 
enlargement of spleen in, 583, 587 
increase in number of white cells in, 552 
number of cases in United States, 300 
use of term in biblical times, 299 
Leukocytes, 87 



1332 



GENEKAL INDEX 



Lice, typhus fever and Brill's disease 
transmitted by, 918 
varieties of, and treatment for, 918 
Life, duration of, 5, 7 
ending well, 5 
eternal, Metchnikoff on, 5 
living of, 2 

starting and stopping points of, 1 
Life insurance, and blood pressure, 605, 
606 
and Bright 's disease, 619 
Lip-reading, 136, 137 

for deafness, methods of, 137 
Liver, in hot weather, 914 
Liver spots, due to ptosis of abdominal 

organs, 1082 
Lockjaw, action of poison of, on body, 303 
bacillus of, 303 
incubation period of, 303 
percentage of cures of, 303 
symptoms of, at onset, and course of, 

303 
treatment for, 304 

wounds most liable to infection of, 
303 
Longevity, and Bulgarian bacillus, 949, 950 
and heredity, 951 
percentage of deaths at different age 

periods, 951 
plans for, 955, 956 
procedure to attain, 951 
Lost manhood, 1305 
Lumbar curve, purpose of, 1062 
Lumpy jaw, a disease of man as well as 
cattle, 547 
cause of, 547 
organs attacked by, 547 
Lupus, contagiousness of, 716 
Lymph flow, 552 
Lymph nodes, 12 

Lymphatic glands, and lumpy jaw, 547 
chronic suppurative condition of, due to 

rickets, 550 
diseased conditions of, Osier on, 548, 

549 
enlargement of, due to infectious dis- 
ease, 549 
in and about neck and jaw, 549 
in leukemia, 551 
under arm, 549 

under tongue just back of chin, 549 
gateway of all lines of disease invasion, 
550 



Lymphatic glands, general inflammation 
of, in infectious disease, 550 
history of, 548 
normal size of, 607 

protection of, by discovering and re- 
moving cause of enlargement of, 
552 
structure and distribution of, 550 
swelling of, due to Hodgkin's disease, 

551 
tenderness or pain in, 607 
Lymphatic system, function of, 607 
Lymphocytes, 88 

Malaria, as a bar to prosperity, 276 
cost of, on a plantation, 276, 277 

cause of, 265 

control of, 265, 266, 267 

danger of autumn for those infected 
with, 275 

enlargement of spleen in, 583, 587 

eradication of, by control of mosquitos, 
274 

half-cured, its danger, 276 

importance of curing, before winter, 275 

malignant, 275 

manner of spreading of, 271 

meaning of term, 265 

method of controlling, by preventing 
breeding of mosquitoes, 273 
by preventing infection of mosquitoes 

by people, 273 
by preventing infection of people by 
mosquitoes, 273 

mosquito policy in prevention and con- 
trol of, 272 

mosquitoes causing, day and night bit- 
ing, 266 

obstacle to eradication of, 271 

prevention of, by oiling, 282 

for following spring, by curing pres- 
ent cases, 275 

prophylactic administration of quinin 
for, 278 

quinin policy in cure and control of, 272 

rapid decrease in, 275 

transmission of, 265, 271, 277 

treatment for complete eradication of, 
272 

treatment of, 271 

use of quinin for prevention of, 277, 
278 
Manhood, lost, 1305 



GENERAL INDEX 



1333 



Marriage, after gonococcus infection, 1307 
and Huntington's chorea, 434 
and mental and physical fitness, 367 
and syphilis, 1306 
for syphilitic woman, 1307 
of feeble-minded, imbecile or epileptic, 

367 
of intemperates, 367 
of the closely related, 366, 367 
Marriage requirements, and venereal dis- 
eases, 1299 
Massage and exercise, for fractures, 1027, 
1028 
for rheumatism, 1030 
Matches, poisoning from. See Phosphorus. 
Measles, contagion of, 240, 716 
control of, 240 
death rate due to, 240 
epidemics of, daily examination of school 

children during, 240 
initial symptoms of, 199, 200 
mortality from, in nursing babies, 

240 
rules for exclusion of children from 

school because of, 1251 
spreading of, 193 

symptoms of, and their course, 240 
Meat, amount of, consumed in America, 
455 
amount of lean, fat, and waste per pound 

in every cut of, 457 
and gout, 458 
and milk, 460 
chicken, frozen, 460, 461 

rules for purchase of, 460, 461 
containing purin bodies, 458, 459 
cost per pound of the nutritious elements 

in every cut of, 457 
diagram of composition of food mate- 
rials in, 456 
in chronic constipation, 459 
in fever, 459 
in goiter, 459 
" tastier " portions of, 456 
Medical profession, fifty years ago and 

to-day, 362 
Medicine, preventive, advent of, 1, 2 
Melancholia, effect on, of erysipelas, 413 

no physical basis for, 414 
Meningitis, and pneumonia, 258 

burning or boiling of nose and throat 
secretions for years after recov- 
ery from, 258 



Meningitis, cerebrospinal. See Cerebro- 
spinal meningitis, 
epidemic, 257 
Menorrhagia, 1278 
causes of, 1278 
checking of, 1278 
cure of, 1278 
Menstruation, absence of, or amenorrhea, 
1277 
causes of, 1277 
amount of flow during, 1274, 1275 
and ovulation, 1275 
bathing during, 1276 
difficult, or dysmenorrhea, 1278 
discharge of blood between periods, of 

metrorrhagia, 1278 
duration of flow during, 1274, 1275 
excessive flow during, or menorrhagia, 

1278 
exercise during, 1276 
exposure to cold or wet during, 1276 
hygiene of 1276 
local douche after, 1276 
medicines to increase or decrease amount 

of flow, 1275 
normal period of, 1274 

exceptions to, 1275 
scanty, as symptom, 1277 
conditions producing, 1277 
menstrual habit of, 1277 
symptoms accompanying, 1274 
symptoms preceding, 1275 
termination of period of, with discharge 

of mucus, 1275 
variation in amount, time and symptoms 
of, 1276 
Mental disorders, mind. in, 377-380 
Mental equilibrium, and present-day high 

pressure, 369 
Mental healing, and medicine, of old-time 
family physician, 362 
basis for credence in, 364 
of various new cults, 362 
Mental hygiene, advantage of, 380 
and habits, 368 
and marriage, 367 
and training of children, 367 
circular of Massachusetts Society for, 

367-369 
general advice, 369 
Mercury poisoning, acute and chronic, 900 
prevention of, 901 
symptoms of, 901 



1334 



GENERAL INDEX 



Metchnikoff, and Bulgarian bacilli, 949 

and longevity, 949 

belief of, 949, 950 
Metrorrhagia, 1278 

causes of, 1278 
Middle ear, 9 

infection of, 10 

inflammation of and discharge from, due 
to catarrh, 35 
Middle ear infections, deafness due to, 134 
Migraine, 444 
Milk, action on, by stomach, 481 

age of, 514 

an infant diet, 515 

and meat, 460 

as food, 513 

at summer resorts, 527 

buttermilk, food value of, 480 

canned or concentrated, advantages and 
disadvantages of, 484 

certified, 521 

city delivery of, 517 

clean and dirty, 522, 523 

condensed, 484 

constituents of, 480 

cooling of, and keeping cold, 529 

desiccated, 484 

deterioration of, with exposure to air, 
514 

diagram of composition of food mate- 
rials in whole milk, skim milk, 
buttermilk and cream, 481 

epidemic of streptococcus sore throat 
from, 531, 532 

evaporated, 482 

flyless, odorless dairy for, 523, 525 

government's position on, 531 

harm done by, bad, 520 

when sold under unsanitary condi- 
tions, 523 

harm done, when not fresh, 521 

infections in, increasing with age of, 513 

La Salle, 525 

ordinances for, 525, 526 

pasteurization of, time and temperature 
for, diagram of, 535 

plain talk to producers of, 533 

products of, 513 

Eichmond, Va., 526, 527 

rules for infants', 528 

skim, food value of, 480 

sold in bulk, 519 

sold in small cities, 532 



Milk, sold under proper conditions, 526, 527 
sour, 480, 481, 482 
standards for, 518, 519 
sweet, 480 

tainted, treating of, 534 
warm and dirty, 530 
Milk production, 515 
Milk report, indorsed, 518 
Milk store score card, 519 
Milk transportation, 515 

city delivery, 517 
Mind, and emotions, 366 
and genius, 365 
and heredity, 363 
and level-headedness, 365 
and prenatal influence, 363 
care of, between ages of seven and sev- 
enteen, 1233 
feminine type of, 404 
groups of, 404 
normal average, 405 
in mental disorders, 377, 379, 380 
influence of, on body, anger, 366 
emotions, 366 
equanimity, 366 
on body generally, 365 
on digestion, 373 
on disease, 363 

conclusions on, 365 

and mental healing, 364 
contagious, 364 
element of fear, 363 
its course and symptoms, 365 
symptoms, 364 
on heart and circulation, 374, 375 
on life and death, 363 
on nutrition, 374 
on offspring, 363 
influence on, of body, 375, 376 
isolation of, leading to neurasthenia, 405 
masculine type of, normal, 405 
"The Human Machine," 365 
untrained, waste due to, 365 
Mineral acids, antidotes for poisoning 

from, 890 
Miners' nystagmus, 121 
Monosaccharid, 496 
Morphin, amount of, consumed by addicts, 

327 
Morphin habit, acquisition of, 327 
cure for, Sceleth drug treatment, 333 
Towns' morphin cure method, 332 
curing of, 328 



GENERAL INDEX 



1335 



Morphin poisoning. See Opium poisoning 
Mosquito campaign, Herms' "Malaria," 
as guide in, 271 
in New Jersey, 280, 281 
outline for, 278, 279 
Mosquito repellants, efficacy of, 269 
Mosquitoes, breeding places for, 285 
control of, 267, 268 
directions for easing hurt of bite of, 

269 
directions for preventing the bite of, 

269 
malaria due to, 265 

method of catching those in room, 269 
methods for prevention of, 267, 268 
mixture for killing young of, in breed- 
ing places, 268 
non- traveling nature of, 269 
prevention of breeding of, 273 
prevention of breeding places, 287 
prevention of infection of, by malarial 

people, 273 
prevention of infection of people by, 273 
to keep pools free from, 269 
yellow fever due to, 264 
Mouth, cleaning of, 21 
Mouth breathing, dangers of, 20 
effect of, 738 
predisposing to colds, 60 
Moving pictures, need of, 1257 
Multiple sclerosis of nervous systems, and 

eugenics, .1010 
Mumps, contagion of, 247 
epidemics of, 247 
incubation period of, 247 
injection for prevention of, after ex- 
posure to, 247 
Muscle sagging, 1079 

Muscles, abdominal, plan of exercises for 
development of, 1082 
ptosis of, liver spots due to, 1082 
arrangement of, 1079 
as reason for dyspepsia and indigestion, 

1073 
building and training of, 1075 
exercise of, open-air, 1076 
formation of fatigue toxins and anti- 
toxins by exercise of, 1077 
need of, for air, 1073 
for exercise, 1073 
for food, 1073 
for play, 1076, 1077 
of abdomen, 1079 



Muscles, of leg and arm, and six exercises 
for building up of, 1077 
plan for development of, 1074 
ptosis of, 1079 

and effects of, 1079 

intestinal stasis due to, and its effects 

on system, 1079, 1080 
kinks and adhesions due to, and effect 
of, on system, 1081, 1082 
Mushroom poisoning, antidote for, 890 
Mushrooms, canned, 471 
cultivation of, 470 
food value of, 470 
how to tell edible varieties of, 470 
Myxedema, partial, French's six groups 
of people suffering from, 558 

Nails, purpose of, 700 
Nasopharynx, 9 

Nausea and vomiting, first aid in, 870 
Nerves, purpose of, 65 

visceral, 370 
Nervous disorders, convulsive, 418 

functional, symptoms and organic 
changes, 377 
Nervous habits, wisdom of overcoming, 422 
Nervous system, sympathetic, and persist- 
ing neuralgias, 381-383 
disturbance areas of, 371 
outline of, 370 
referred pains of, 371 
Nervousness, prevention of, in child, 371 
Neuralgia, definition of, 383 

distinguished from neuritis, 384 

first aid in, 871 

nature of pain of, 384 

painful or tender points in, 384 

persisting, location and removal of cause 

of, 381-383 
relief for, 384 

treatment of underlying cause of, 384 
Neurasthenia, among poor as well as rich, 
395 
and capacity, 579 

and hysteria, causes of, bad inheritance 
and home training, 404 
faulty education, 403 
and indecision, 372 
and inheritance, 578 
basis of, 379 
causes of, 395, 396 

change in attitude of physician to and 
of sufferer from, 577, 578 



1336 



GENEKAL INDEX 



Neurasthenia, cure for, 404 
definition of, 394 
Bridger's, 404 
due to trouble with adrenal bodies, 577 

typical cases of, 577, 578 
foundation in type for, 394 
headaches due to, 444 
letter of typical sufferer from, 395 
mind caused and mind cured, 379, 380 
need of spiritual help in, 393 
symptoms of, 394 
treatment of, 396-398 
Bridger's, 407 
Neurasthenics, and the physician, 393 
Neuritis, distinguished from neuralgia, 384 
Neurotics, and eugenics, 1010 
Newborn infant, care of, 780 
Night losses and wet dreams, 1304 
Nose, baby's, 12 

causes of narrowed space in, 13 
causes of obstruction in, 12, 13 
cleaning of, 17 
ear, eye and other disturbances due to 

diseases of, 35 
function of, 12 
infection of, frequency of, 9 

through eustachian tube to middle ear 
cavity, 10 
lymphatics of, 12 
midbone of, 13 
mucous membrane of, 12 
' openings into, eustachian tube, 9 
from antrum, 11 

from cavity in bones of forehead, 11 
from ethnoid cells, 11 
from sphenoidal sinus, 11 
number and purpose of, 9 
tear ducts, 9 
preparation of air for lungs by, 11, 12 
size of, 12 

turbinated bones of, 12 
Nosebleed, first aid in, 865 
Nursing mother, foods for, 798 
Nutrition, influence on, of mind, 374 
Nystagmus, miners', 121 

Obesity, and thinness, 672 

treatment of, and factors in, 673, 674 
causes of, 672, 673, 680 
disadvantages of, 680 
due to senility of thyroid gland, 568 
11 grape cure" for, 475 
predisposing to pneumonia, 61 



Obesity, prevention of, 681 

reducing in, Van Noorden on, 675, 676 

tendency to, and factors in, 680 

treatment of, 681 

weight, according to age and height con- 
stituting scale of, 679, 680 
Obesity cures, 683 

Occupational diseases, accidents and dis- 
eases of ironworkers, 896 

acid burns, 894 

arsenic and benzin poisoning, 901 

caisson disease, 902 

carbon monoxid poisoning, 897 

due to working in wet air, 906 

from dusty trades, 903 

lead poisoning, 897 

mercury poisoning, 900 

phosphorus poisoning, 895 

poisoning from wood alcohol, 896 

preventive movement against, 893 
Old age, reasons for disease and death in, 

951 
Ophthalmia neonatorum, 112 

percentage of blindness due to, 113, 114 
Opium habit, addiction to, by neuras- 
thenics, 328 

Harrison law against, 329, 330, 331 
Opium poisoning, antidote for, 890 
Ovaries, 1274 
Overeating, at dinner, 491 

at Thanksgiving dinner, 492 

relief for, 492, 493 
Ovulation, 1274 

and menstruation, 1275 
Ovum, 1274 
Oysters, and seasons for, 464 

and typhoid fever, 463 

safety of eating, 463, 464 

and clams, and typhoid fever, 311 
Oxalic acid (salt of lemon, ink eradicator), 

antidote for poisoning from. 890 
Ozone, and germs killed by, 1161 

definition of, 1160 



Pancreas, definition and function of, 158 
Pantry pests, 921 
Paralysis, due to apoplexy, 614 
Paralysis agitans, cause of, 431 

common test for, 430 

muscular rigidity of, 431 

treatment of, by extract of parathyroid, 
431 



GENERAL INDEX 



1337 



Paralysis agitans, tremor of, 430 
Parasitical pests, bed bugs, 918 
fleas, 919 

itch parasites, 917 
lice, 918 
red bugs, 917 
straw itch, 917 
ticks, 919 
Patent medicines, and drug habit, 327 

worthlessness of, 329 
Pellagra, ability of change of diet to cure 
individual case of, 165 
amount and spread of, 167, 168 
and diet, 165 
cause of, 165 
diagnosis of, common mistakes in, 168 

necessity of, 168 
diet list, to avoid disease, 165 

to cure disease, 166 
eventual eradication of, from South, 165 
noncommunicability of, 165 
prevention of, and cottonseed food, 477, 

478 
symptoms of, 168 

treatment of, climate and altitude, 169 
diet, 166, 168 
drugs, 169 

general hygienic, 168 
Pets, dangers from, anthrax, 201 
consumption, 201 
glanders, 291 
hydrophobia, 201 

in spreading contagious disease, 200 
itch, 200 
plague, 201 
tapeworms, 200 
Pharynx, lining of, 15 

location and purpose of, 15 
Phosphorus poisoning (matches, some rat 
pastes), antidote for, 890 
deformities of, 895 
legislation for, 895 
Phrenology, 441 

Pimples, cause and prevention of, 707 
Pink eye, causes of, 126 

danger from, in formation of ulcers, 

126 
infectious nature of, 126 
symptoms of, 126 
Plague, and ground squirrels, 292 
and Panama Canal, 295, 296 
and rats, 292 

primarily disease of rodents, 294, 295 



Plague, forms of, and their respective 
symptoms, 297 
harboring of, among rats and small ani- 
mals of field, 292 
history of, in California, 291, 292 
importation of. into civilized countries, 

290 
sources of epidemics of, 290 
spread of, 297 

its prevention, 297 
transmission of, from rats, by means of 
fleas, 294 
Play cure, 1044-1047 
Pleura, description of, 64 
functions of, 65 
location and nature of, 64 
nerves of, 65 
Pleurisy, associated with tuberculosis, 67 
conditions mistaken for, 65 
dry, symptoms of, 67 
following pneumonia, 68 
forms of, mild, 65, 66 

serious, 66 
how to differentiate from hard cold, 67 
mistakes in diagnosis of, 66 
porous plaster for, 65 
prognosis of, 68 
suppurative, 68 
with effusion, 67 

how to suspect presence of, 66 
symptoms of, 66, 67 
Pneumococci, causing heart disease, 62 
causing meningitis, 62 
causing pleurisy, 62 
elsewhere than in lungs, 62 
Pneumonia, after-treatment of, 61, 62 
and meningitis, 258 

burning or boiling of nose and throat 
secretions for years after recov- 
ery from, 258 
causes of, bacterial, 58 

meteorological influences, 59 
predisposing and contributing, 59 
contagious nature of, 57, 58 
disinfection after, 208 
due to neglected colds, 55 
enlargement of spleen in, 585 
epidemics of, 58 
fresh air and cold showers as preventives 

of, 56 
geographical distribution of, 56 
number of deaths due to, 56 
open-air treatment of, 61 



1338 



GENERAL INDEX 



Pneumonia, other diseases due to germ of, 
62, 63 
pleurisy following, 68 
possible cure for, Dr. Roseuow's, 63 
predisposing effect to, of food gorging, 

56 
predisposition to, in obesity, 61 

of overindulgence in alcohol, 56, 60, 
61 
prevention of, 57, 58 
susceptibility to, in age, 56 
in sex and race, 56 
in town or country, 56 
of rich, 56 
symptoms of, 58 
wide prevalence of, 56 
Poisoning, first aid in, 883 
Poisons, antidotes for, 883 
Pollantin, 52 
Polynuclears, 87 
Polysaccharid, 496 
Porous plasters, for pleurisy, 65 
Posture, as expression of character and 
intelligence, 1060 
correct, vertical line test for, 1066 
incorrect, inefficiency of, 1066 

sciatica and leg pains due to, 1062 
influence on, of disease, 1060 

of occupations, 1060 
upright, advantages and disadvantages 
of, 1063 
not natural for man, 1063 
origin of, 1059 
Pregnancy, albuminuria in, 626 
and Bright 's disease, 625 
and confinement, treatise on, " Prenatal 

Care," 781 
and sore breasts, 1016, 1017 
kidney of, 625 

relation of, to tuberculosis, 72 
Prenatal influence, 363 
Preventive medicine, advent of, 1, 2 
Prickly heat, treatment of, 714 
Prophylaxis, 49 

Prostitution, and venereal diseases, 1298 
Proteids, 450, 675 

Prussic acid, poisoning, antidote for, 890 
Psoriasis, due to too much protein, 712 

treatment of, by diet, 712 
Pus cocci, 1288 

Pyemia, enlargement of spleen in, 585 
Pyorrhea, and constitutional diseases, 746 
cause and treatment of, 741 



Pyorrhea, cure of, 746, 747 
stages of, 746 

Race, relation of, to tuberculosis, 74 

Rat-bite disease, 295 

Rat fleas, as agent transmitting plague 

bacillus, 294 
Rats, abundance of, 293 
and goiter, 566 
black, 293 
breeding of, 293 
common or brown, 293 
cost of, 298 

diseases of, fleas, lice and mites, 295 
leprosy, 295 
parasites, 295 
plague, 294, 295 
rat-bite disease, 295 
trichinosis, 295 
tumors, including cancer, 295 
ferocity of, 293 
importance of, 292 
migration of, its significance, 293 
prevention and eradication of, 298 
Raynaud's disease, forms of, 581 

symptoms and course of, 581 
Red bugs, prevention and treatment of, 

917 
Refrigerators, odors in, 510 

cure for, 511 
Rescues from fires, first aid to, 866 
Rheumatic and gouty pains, 142 
Rheumatism, acute, advice for, 142, 143 
definition and causes of, 142 
infectious nature of, 149 
and catarrh, 150 
and climate, 147 
and heart disease, 590 
and hygiene, 150, 151 
and massage and exercise, 1030 
and teeth, 740 
cause of, 740 
chronic, causes of, 143 

diseases commonly known as, 143 
treatment of, 143 
conditions commonly known as, 143 
condition known as "full of rheuma- 
tism," 143 
effect of, on heart, 141 
examination of mouth, throat and nose 

in, for focus of trouble, 141 
false popular ideas upon, 149 
gout mistaken for, 143 



GENERAL INDEX 



1339 



Bheumatism, headaches due to, 444 
in children, custom of giving medicine 
for, its danger, and proper treat- 
ment, 144, 145 
inflammatory, causes of, 141 

definition of, 141 
joint affections akin to, 141 
prevention of, 150 
pus cocci found in tonsillar crypts in 

cases of, 15 
rheumatoid arthritis distinguished from, 

148 
so-called, bad consequences of, if allowed 

to run, 143 
treatment of, 143 

by prevention or correction of stiff- 
ness of joints, by massage and 
exercise, 1030 
for control of gateway of infection, 

1029 
for relief of pain, 1029 
mineral springs, 1031 
ridding body of poisons, and increas- 
ing resistance, 149 
surgical, 150 
vaccines, 150 
use of term, 141 
Eheumatoid arthritis, 141 
causes of, 145 

distinguished from rheumatism, 148 
focus of trouble in teeth and gums, 141 
pus cocci found in tonsillar crypts in 

cases of, 15 
symptoms of, 149 

treatment of, by treatment of cause, 145, 
146 
by vaccines, 146 
trouble in bone, 148 
Eice, and beriberi, 174, 178 
Eickets, and fat babies, 187 
bone changes in, 186 
convulsions with, 419 
due to fattening foods, 187 
early diagnosis of, 185 
early signs of, head formation, 187 
peevishness, not otherwise explainable, 

187 
"potbelly," 187 
slowness in walking, 187 
sweating of head, 186 
teeth, 186 
medical direction for, 188 
treatment for, 188 



Eingworm, transmission of, 716 
Eocky Mountain spotted fever, distribution 
of, 325, 326 

epidemic standpoint of, 325 

eradication of, 325 

transmission of, by wood ticks, 325 
Eusty nail wound, first aid in, 873 

Salt, in foods, 498 

Sanitation, in bakeries, 454, 455 

in cloak industry, 906 
Sarcoma, and cancer, 972 
Sarcomas, nature of, 973 

recognition of, 973 
Scarlet fever, and atmospheric tempera- 
ture, 230 
and hot houses, 229, 230 
and the throat, 229 
cause of, not known, 230 
contagiousness of, 716 
development of, 229 
exclusion of children from school because 

of, rules for, 1250 
higher death rate from, in north than 

in south, 230 
initial symptoms of, 199, 200 
spreading of, 193 
symptoms of, 229 
transmission of, 228 
School children, care of mind of, between 
ages of seven and seventeen, 1*233 
working at low efficiency, 1232 
School efficiency report, 1231 
School hygiene, 1235 
School laboratories, 1257 
School nurse, 1252 

Schools, and feeding of growing genera- 
tion, 1254 
and neglected children, 1256 
and teaching in cold air, 1242 
care in, of child, mental and physical, 

1234 
cold room and open air, 1243 
compulsory education and compulsory 

attendance laws, 1236 
country, safeguarding health of teach- 
ers of, 1261 
ventilation standards of, 1242 
efficiency for, 1232 

exclusion of children from, because of 
diphtheria, 1250 
because of measles, 1251 
because of scarlet fever, 1250 



1340 



GENEKAL INDEX 



Schools, exclusion of children from, be- 
cause of whooping cough, 1252 
health observation of, 1261 
larger use of, 1256 
medical inspection of, 1244 
abnormal children, 1252 
benefits of, 1245 
cooperation of parents in, 1256 
for contagion, 1248, 1249 
for physical defects, 1249 
in Chicago, 1246 
justified demands of parents from, 

1249, 1250 
work of inspectors, 1248 
one room, heating and ventilation of, 

1241 
proposed lines for heating and ventila- 
tion of, 1240 
regulations of health department for ex- 
clusion of children from, 1250 
tendency to unload all burdens in con- 
nection with, on teacher, 1231 
value of medical and lay cooperation 
in advancement of school health, 
1231 
various improvements in hygiene of, 

1232 
ventilation of, and blowing out during 
play periods, 1240 
and constantly moving air, 1239 
and humidity, 1238 
and temperature, 1238 
deflection of hot air, 1240 
faulty mechanical systems of, 1237 
improvements in, 1238 
location of radiation, 1239 
village plan for, 1259 
yearly sum spent by people of United 
States for, and its application, 
1231, 1232 
and its misapplication, 1233 
Sciatica, classification of cases of, into 
groups, 385 
definition of, 385 
due to incorrect posture, 1062 
location and removal of underlying 
cause, 385 
Scorpions, bite of, and treatment for, 920 
Scrofula, 740 

and operation, 185 
and tuberculosis, 184, 185 
cause of, 185 
meaning of, 184 



Scrofula, mode of infection by, 185 

symptoms of, 185 
Scurvy, a disease of winter and spring, 179 
and diet, 180, 181 
for babies, 183 
cause of, 179, 180 
diet for prevention of, 183 
former prevalence of, and its decrease, 

180, 181 
infantile, age for development of, 182 
symptoms of, 183 
treatment of, 183 
prevention of, by diet, 181 
susceptibility to, of babies, and their 

symptoms of, 179 
symptoms of, 183 
"a touch of," 179 
old-fashioned, 179 
treatment of, 183 
Seasickness, prevention of, 664 
physical and somatic, 663 
treatment of, 664 
Sedatives, 47 
Self abuse, 1304 

Senility, and Bulgarian bacilli, 949 
and rheumatism and gout, 155 
constipation and, 487 
Septicemia, enlargement of spleen in, 585 
Septum, 13 

Sex organs, female, 1274 
Sexual indulgence, in boys, 1303 
Sexual manifestations, self abuse, 1304 
lost manhood, 1305 
night losses and wet dreams, 1304 
rules to be followed for, 1303 
Shoulders, broad, cultivation of, 1062 
sagging, pressure of, on other structures, 

1061 
stooping, 1063, 1064 

cure of by breathing, 1065 
Silver solution, Grede's method of use 
of, for prevention of blindness, 
113 
Sinus, sphenoidal, 11 
Sinus trouble, headaches due to, 444 
Skin, 700 

and bathing, 706 
and digestion, 707 
and goose-flesh, 703 
and pimples, 707 
and boils, 710 
and sunshine, 704 
and sweat, 702 



GENEKAL INDEX 



1341 



Skin, and wind, 704 
bronzing of, 709 
carbuncles, 710 
care of, in tropics, 701 
diseases contagious through, itch and 
ringworm, 716 
leprosy, 715, 716 
lupus, or tuberculosis of skin, 716 
smallpox, 716 
diseases which show themselves in, 709, 

710 
effect on, of climate, 701, 702 

of tropics, 701 
faint lemon hue in, 710 
glands of, 702 
grease glands of, 703 
layers of, 706 
marked yellow in, 710 
pale, white, 710 
pigment of, 701 
protection of, 705 
purpose of, 700 
structure of, 700 
sunburn of, without exposure to sun, 

709 
sweat glands of, 702, 703 
tanning of, 704 

the process and effect, 705 
typhoid patches on, in typhoid fever, 716 
Skin diseases, boils, 713 
causes and origins of, 703 
dermoids, 714 
Skin diseases, eczema, 708 
pimples, 707 
prickly heat, 714 
Skin eruptions, in spring, treatment for, 

155 
Sleep, for old people, 952 
Sleeping, in hot weather, 916 
Sleeping porches, 1131 
Slew-footedness, 762 
Smallpox, and cleanliness, 216 

and reliability of city health authorities, 

216, 217 
and vaccination, 213 

statistics on, 219, 220 
cases developing in town or city a sure 
indication that measures for con- 
trol are being neglected, 218 
contagion of, 216, 716 
control of, 214 

its difficulty, in mild cases, 215 
cost of protection against, 220 



Smallpox, epidemics of, 216, 217 
incubation period of, 216 
initial symptoms of, 200 
mild cases of, contagion of, 216 

symptoms of, 215 
spreading of, 192 

symptoms of, and their development, 
216 
in mild cases, 215 
transmission of, 214 
treatment of, 216 
Sneezing, and colds, 30 

causes of, 30 
Snoring, causes of, 22, 23 

curing of, 23 
Soils, in selection of building sites, 1121 

unhealthy for building sites, 1122 
Sore throat, causes of, 37 
dangers of, 37 

particularly in children, 37 
importance of calling in physician for, 

37, 38 
prevention of, 37 
symptoms accompanying, indicating 

need of immediate attention, 37 
uselessness of certain home remedies for, 
37 
Spasmodic tics, 421 

Spasms, general, or convulsions. See 
Convulsions, 
local, associated with many disorders, 
420 
remedy for, 420, 421 
Sphenoidal sinus, 11 
Spiders, application to bite of, 920 
bite of, 919 

varieties of, dangerous to life, 919 
Spine, curves of, 1062 

lumbar curve of, 1062 
Spleen, a blood gland, 583 
and surgery, 589 
blood flow in, 585 
blood vessels to, 585 
enlargement of, in anthrax, 585 
in consumption, 587 
in leukemia, 583, 587 
in malaria, 583, 587 
in pneumonia, 585 
in septicemia and pyemia, 585 
in syphilis, 585 
in typhoid fever, 585 
function of, 585, 587 
location of, 583 



1342 



GENEKAL INDEX 



Spraying of nose, Setter 's or Dobell 's solu- 
tion for, 35 
Spring cleaning, 1135 

and carpet beating, 1136 

and pests, 1138 

and outhouses, 1138 

considerations in, 1139 

custom and instinct of, 1136 

method of, 1137 

necessity for, 1138 

object of, 1137 
Squint, acquired, causes of, 124 

congenital, 124 

convergent, 124 

development of, in early childhood, 124 

explanation of, 124 

non-paralytic, 124 

paralytic, 124 

treatment of, by wearing of glasses, 125 

with eye turning out, 125 
St. Vitus' dance, and eugenics, 1010 

causes of, 420 

course in treatment of, 420, 421 

premonitory signs of, 422 

treatment for, 423 
Stable manure, as breeding place for flies, 
1221 

disposition of, 1221 
Stammering, cause of, in mental processes, 
437> 

facts associated with, 436, 437 

physical additions present with, 437 

schools for, 439 

study and analysis of, by Bluemel, 438, 
439 

treatment of, 436 

See also Stuttering. 
Starch, digestion of, 496, 497 
Sterility, diagnosing of, 1279 

disposition to, of fat women, 1277 

percentage of cases of, in marriage, 1279 
Stiff legs, 146 

Stinging pests, bees, hornets, wasps and 
yellow jackets, 920 

black flies, 920 

centipedes, 920 

scorpions, 920 

spiders, 919 
Stomach, and exercise, 640, 641 

chief function of, 638 
Stomach trouble, influence on, of mind 

and proper food, 373, 374 
Strabismus. See Squint. 



Straw itch, cause of, 711 
origin of, 710 
prevention of, 711, 917 
treatment of, 711, 917 
Stuttering, causes of, 435 
remedy for, 435 
See also Stammering. 
Sugar, in blood, excessive, 160 

normal, 159 
Sugar eating, 642, 643 
Sunstroke, first treatment for, 876 
Sweat, composition and purpose of, 702 
Sweating out poisons, common idea of, 

1035 
Sylvester method of artificial respiration, 

875 
Syphilis, actively at work, when no symp- 
toms exist, 1292 
and marriage, 1306 
and spleen, 585 
banishment of, 1285 
confusing cure of symptoms with cure 

of disease in, 1292 
cure of, complete and permanent, 1286 
curing of, 1292 
diagnosis of, 1295 
effects of, 369 

first symptom of, and time of appear- 
ance of, after infection, 1295 
germ of, 1285, 1291 

greatest harm of, due to half -cures, 1286 
in unborn babe, 1292 
inherited, 1301 

harboring of germ in, 1302 
mild nature of, 1292 
not blood disease, 1292 
iritis due to, 125 
preventability of, 1285 
public education against, 1286 
secretions from ulcer of and other secret- 
ing patches, 1296 
symptoms of, in second stage, 1292 
tests for, laboratory, Wassermann and 
Noguchi, 1296 
spirochetes, 1296 
therapeutic, 1296 
ulcer of, 1295, 1296 
Syphilitic infection, tendency of, to travel 
to other parts of body from focus 
of infection, 1291 

Tanning, effect of, on skin, 705 
process of, 705 



GENERAL INDEX 



1343 



Tarantulas. See Spiders. 
Tea, and war, 358 
beneficial effects of, 357, 358 
habit of drinking, 357 
rate of consumption of, 350, 351 
relative amount of caffein in coffee and, 

350 
use of, how and when, 357 
Teachers, safeguarding health of, consti- 
pation, 1262 
contagion, 1262, 1263 
fruit and water, 1262 
muscular exercise, 1265 
nerves, 1261 
recesses, 1264 
sleep, 1265 
temperature and humidity of room, 

1263 
ventilation, 1263 
water supply, 1264 
Tear ducts, 9 

Tears, cleansing nature of, 9 
Teeth, and importance in digestion, 742 
and irregular jaws, 744 
and rheumatism, 740 
and tooth brushes, 747, 748 
as field of pollution, 17 
as harborers and transmitters of infec- 
tion, 742 
cause of decay of, 740 
cavities in, causes and prevention of, 

743, 744 
cleaning of, 17, 21 
dirty, and anemia, 747 
erosions of, 745, 746 
functions of, 742 
horses', 738, 739 
importance of, 738, 741, 742 
infections due to, 739, 740 
meeting of, 744 
need for care of, 743 
pyorrhea, 741, 746 
Tetanus. See Lockjaw. 
Thermometer habit, 1198 
Thermometers, advantage of, 1185 
Thinness, and fattening, method of, 695, 
696 
Von Noorden on, 676, 677 
and obesity, 672 

treatment of, and factors in, 673, 674 
Throat cultures, in suspected diphtheria, 

236 
Throbbing pains, 592 



Thumb-sucking, effeet of, 738 
Thymus gland, growth impulse in, 568 
Thyroid deficiency, 564 
Thyroid extract, for bed- wetting, 559 
for obesity due to senility of thyroid 

gland, 568 
giving of, for conditions supposed to be 
due to hypothyroidism, 558, 559 
for partial myxedema, 559 
in case of woman with symptoms sug- 
gestive of Bright 's disease, in- 
toxication and dropsy, 559 
Thyroid gland, conditions of, 561, 562 
diseased, definite intoxication from, 568 
enlargement of, conditions causing, 565 
in ancient Egyptian worship and Greek 

art, 562 
influence of secretion of, on rest of body, 

561, 562 
location of, 561 

number of cases in Switzerland of thy- 
roid out of balance, 565 
obesity due to senility of, 568 
relation between, and conditions of 

adenoids and tonsils, 565 
secretion of, 561 

undersecretion of, complicating many 
diseases, 560 
Thyroid poisoning, 561 
Ticks, 919 

as cause of Rocky Mountain spotted 

fever, 325 
to rid a region of, 325 
Tissues, 1073 

Tobacco, and mental stimulation, 343 
cigarettes, main objections to, 343 . 
excretion of, from pores, by heavy users 

of, 343 
for young people, 344 
juice of, in mouth, not antiseptic, 343 
relative harm in cigarettes, cigars and 

pipe tobacco, 343 
use of, by women, 343 
uselessness of, 343 
Tobacco blindness, 343 
Tobacco heart, 343 
Tongue, cleaning of, 17, 21 
Tonsil, lingual, 20 

pharyngeal, 20 
Tonsillar crypts, cleaning of, 21 
description of, 15 

pus cocci in, in cases of rheumatism 
and rheumatic arthritis, 15 



1344 



GENERAL INDEX 



Tonsillar crypts, theories as to purpose 

of, 15 
Tonsillitis, follicular, due to diphtheria 

bacillus, 235 
Tonsils, cause of frequent inflammation of, 
16, 17 
cleaning of, 17 

crypts of. See Tonsillar crypts, 
effect of removal of, 16 
enlarged, due to uncleanliness, 21 
outgrowing of, 16 
prevention of, 21 
removal of, 16, 21 
eustachian, 20 
faucial, 20 

indications for removal of, 16, 21 
lymph gland portion of, 16 
number of, 20 
position of, 15, 20 
purpose of, 16, 17 
Tooth, arrangement of, 745 
Tourniquet, application of, for wounds in 

limb, 865 
Town planning, and housing, 1114 
and width of street, 1115 
diagonal and rectangular streets, 1116 
division into zones with respective regu- 
lations, 1114 
health department, 1113 
law of excess condemnation, 1114 
Toxins, in food, 489 
Trachoma, and cleanliness, 116 

as cause of preventable blindness, 115 
definition of, 119 
difficulty of cure of, 116 
distribution of, 118 
infection of, 118, 119 
nature of, 118, 119 
origin of, 115 
prevention of, 116 
results of, 119 
surveys for, 118 
symptoms of, 119 
Trades, danger to eyes resulting from, 
121 
eye fatigue resulting from, 120 
Training of child, advice on, 367, 368 
and food, 372 
and habit of blaming, 373 
and influence of fear, 372 
and mental hardening, 372 
and play, 372 
and tantrums, 372 



Training of child, effect of association 
with neurasthenic parents, 371 
overprotection of its nervous system, 373 
study and attention given any unnatural 
differences from other children, 
417 
Trichinosis, and rats, 295 
Tuberculosis, absence of actual cure for, 
79 
and altitude, 88 
and blood cells, 87, 88 
and climate, 86, 87 
choice of, 90, 91 

consideration of individual needs, 90 
for advanced cases, 91 
and dusty trades, 904 
and eugenics, 1010 
and gouty diathesis, 154 
and scrofula, 184, 185 
and weight, 71 
care of, at home or in other climate, 89 

at home or in sanitariums, 86 
conservation of energy in, 82 
cure for, if taken in time, 70 
custodial care of patients with, 92 
death rate from, and insurance legisla- 
tion, 75 
in city and country, 74, 75 
disinfection after, 208 
due to butter, 478 
earliest signs of, cough, 77 
temperature, 76 
unwarranted tire, 76 
elements of cure for, 88, 89 
enlargement of spleen in, 587 
folly of leaving home without sufficient 

resources, 89 
frame of mind in, 81 
heading off of, when suspected, 79, 80 
history of having been thrown in close 

contact with, 77 
indications of presence of, 82, 83 
indications of progress, of disease in, 84 
infant's nurse with, 95 
mode of life in, 85 
diet, 85 

medical direction, 85 
sleep, 85 
work, 85 
necessity of early diagnosis, 76, 82 
night camps for patients with, 92 
of skin (lupus), contagiousness of, 716 
percentage of people interested in, 86 



GENERAL INDEX 



1345 



Tuberculosis, prevention of, 71 
progress in control of, 70, 93 
to protect one's fellow men from, 77 
to protect uninfected parts of one's own 

body from, 77 
relation to, of age, 74 
of alcohol, 73 
of chest development, 74 
of diabetes, 72 
of heart disease, 71 
of inheritance, 70, 92 
of occupation, 74 
of pregnancy, 72 
of race, 74 
resistance to, 71 
test for, 80 
treatment of, 79 
tuberculin for, 79 
war against, 75, 94 

Captain Baoul's example, 94 
Tuberculosis day, 93 
Tuberculosis surveys, 94 
Tumors, and cancers, comparison of, 983 
benign and malignant, 982 
importance of prompt diagnosis of, 984 
nature of, 982 
no limit to growth of, 983 
of breast, 966 
studies being made of, 984 
Thyroid gland, description of, 557 

effect of secretion of, on rest of body, 

557 
enlargement of, conditions causing, 557 

or goiter, 558 
history of, 557 
location of, 556 

oversecretion of, or hyperthyroidism, 558 
temporary or persistent slight under- 

secretion of, or myxedema, 558 
undersecretion of, or hypothyroidism, 

558 
undersize and undersecretion of, or cre- 
tinism, 558 
Typhoid bacillus, 304 
Typhoid carriers, 304, 308 
Typhoid fever, activity of, 315 
and flies, 924 
and milk, 313, 314 
and water, 315, 316 
blood culture in, 305 
cause of, 304 
complications in, 306 
contact infection of, 313 



Typhoid fever, contact of finger, 311, 313 

contagion of, 311, 313 

course of action, for prevention of, 
308 
on contraction of, 308 

decrease of, 308 

diagnosis of, 305, 310 

diarrhea in, 305 

disinfection after, 208 

due to butter, 478 

due to oysters, 463 

effect of, on insanity, 414 

enlargement of spleen in, 585 

epidemics of, 313 

foods causing, 311 

how to get, and how to prevent, 309 

immunity to, 307 

importance in, of good nursing and good 
medical care, 307, 308 

in city and country, 315 

incubation period of, 305 

number of days allowed in figuring out 
source of contagion, 305 

old-fashioned type of, 306 

onset and course of symptoms of, 305 

peculiar to man, 304 

preventability of, 304 

rate of, winter and summer, 315, 316 

spreading of, 193 

transmission of, 313 

by excretions from bowels and kid- 
neys, 307, 308 , 

vaccination against, 304, 308, 310 

walking, 310 

Widal test in, 305, 307 

winter, 315, 316 
Typhoid patches, 716 

Typhus, as a disease of war and bad sani- 
tary conditions, 326 

campaign against, 326 

transmission of, by lice, 326 
Twilight sleep, danger to child in, 779 

demand for, 779 

method of, 778 

objections to, 778 

opinions on, 776-778 

Ulcers of mouth, aphthous stomatitis, 968 
cancerous, 968 
dental, 968 
dyspeptic, 968 
forms of, 968 
syphilitic, 968 



1346 



GENERAL INDEX 



Urine, routine examination of, in all con- 
ditions throwing strain on kid- 
neys, 620 
testing of, forBright's disease, 627 

Urticaria. See Hives. 

Vaccination, against diphtheria, 237 

against smallpox, 213 
compulsory, 213 

and Sir Alfred Wallace, 213, 214 

and varioloid, 220 

anti-vaceinationists, 225 

discovery of, 222 

method of, 225 

result of, 224 

when to vaccinate, 224 

where to vaccinate, 224 
Vaccination creed, 221, 222 
Vaccination scar, 224 
Vaccine, for hay fever, 52 

smallpox, production of, 222 
Varicocele, 1305 
Varioloid, and vaccination, 220 

definition of, 220 
Vegetables, digestibility of, 486 
Venereal diseases, 1285 

and advertising doctors for men's dis- 
eases, 1294 

and blindness, 1290 

and insanity, 1301 

and marriage requirements, 1299 

and prostitution, 1298 

classification of, with contagious dis- 
eases, 1287 

epidemics of, in children's institutions 
and hospital wards, 1288 

evil effects of, 1287 

figures as to prevalence of, 1293 

gonococcal infections, 1286 
in children, 1299 

gonorrhea, 1288 

hospital and dispensary system for, 
1300 

in New York City, 1302 

innocently acquired, 1288 

inherited, 1301 

measures for control of, in army, 1295 

peril of, 1293 

prevention of, by education, 1287 
by greater morality, 1287 

public and general education on, 1287 

reporting, registering and controlling 
of, from health departments, 1287 



Venereal diseases, so-called, 1286 

syphilis, 1285, 1291 
Venereal infections, gonococcal vaginitis 
in young girls, 1288 
pus tubes, innocently acquired, 1288 
Ventilation, and air movement, 1151 
and efficiency, 1145 
and ozone, 1160 

and philosophy of fanning, 1159 
and temperature, problem of, 1147 
and temperature of incoming air, 1157 
by windows, 1159 
country school, standards for, 1242 
• diseases due to lack of, 1152 
effect of wind on, 1158 
effects of lack of, 1144 
errors in, 1149 
for fresh air duet, 1162 
gravity, definition of, 1157, 1158 

limitations of, 1158 
importance of, in trades and industries, 

1144 
of bedroom, 1163 
of living room, 1161 
of offices, schools and stores, 1154 

requirements for, 1156 
poor, remedies for, 1156 
principles now accepted as sanitary, 

1151 
reasons for failure of, 1152 

in architects, 1154 

in people, 1153 

in sanitarians, 1154 

in ventilating engineer, 1154 
schoolroom, 1237 

improvements in, 1238 

Waldeyer's ring, 20 

Walking typhoid, 310 

Wasps, application for bite of, 920 

Water supply, goiter due to, 566 

Weight, reducing, 683, 684 

reducing, strain of, 684, 685 

scale of, according to age and height 
for normal and obese, 679, 680 

to increase, 695, 696 
Wet air, conditions resulting from work- 
ing in, 906 
Wet dreams and night losses, 1304 
Whisky, and heat, 340 
Whooping cough, prevention of transmis- 
sion of, 244 

quarantine for, 244 



GENERAL INDEX 



1347 



Whooping cough, rules for exclusion of 

children from school because of, 

1252 
Wood alcohol poisoning, preventive of, 

897 
remedy for, 897 
symptoms of, 897 
Work, proper adjustment between food 

and, 5 
Workday, too long, 910 
Working under unsanitary conditions, 910 
Workingman, duty of, in trade, 907, 

908 



Wounds, lessons on, from European war, 
304 

Yellow fever, army surgeons who demon- 
strated mosquito to be carrier of, 
264 

cause of, 264 

control of, 264 

diagnosis of, 264 

last region of, 263 

onset of, 264 

symptoms of, 264 
Yellow jackets, application to bite of, 920 



INDEX TO QUESTIONS AND ANSWERS 



Abdomen, reducing, 691 

Abdominal pain, possible causes of, 38 

Abortion, legal and moral right in, 786 

Acetone, 162 

Acidity of stomach, due to apples, 648 

Acne, serum treatment for, 735 

treatment of, 734 
Acne vaccine, 734 
Adenoids, cause of, 21 

due to dryness of air, 22 

prevention of, 21 

removal of, 22 

treatment of, 21 
Agar, 501 

definition of, 663 

procuring of, and dosage, 611 
Air, bad, effects of, 1201 

dry and moist, 1203 

dry, bad effects of, 1201 

of high altitudes and of heated rooms, 

1201, 1203 
winter itch due to, in school children, 
1271 

humidifying of, 1203, 1206 
Albumin in urine, as sign of Bright 's dis- 
ease, 632 

cause of, 632 
Alcohol and rheumatism, 152 

and whisky, 342 
Alcohol habit, cures for, 343 

nature and cure of, 342 

periodic, 342 
Amenorrhea, case of, 1281 

definition of, 784 
Agina pectoris, probable case of, 599 
Ankles, weak, aid for, 850 
Antikamnia and codein tablets, danger of 

use of, 334 
Ants, to get rid of, 944 
Aorta, leaky, avoiding "remedy" for, 599 
Apoplexy, accompanying high blood pres- 
sure and chronic Bright 's disease, 
632 

and meat, 615 



Apoplexy, cause of, 615 

in families, 615 

prevention of, 615 
Appendicitis, chronic, and diet, 649 
Arteriosclerosis, and interstitial nephritis, 
631, 632 

cause and treatment of, 603 
Arthritis, definition of, 152 

rheumatoid. See Rheumatoid arthritis 
Aspirin, habit of, 337 
Aspirin tablets, for headache, 449 
Asthma, and air, 44 

as symptom of heart or kidney disease, 
44 

associated with goiter, 44 

bronchial, climate for, 45 
curability of, 45 

curability of, 45 

dependent on cause, 45 

incipient, to prevent becoming chronic, 
44 

not form of tuberculosis, 44 

resulting from hay fever, 54 

shortness of breath and, 45 
Astigmatism, glasses for, 130 

Babies, avoidance of drugs for, 835 
bowlegs in, causes of, and remedy for, 

839 
broken tooth, 833 
carriages for, 839 
climate of southern California for, 

833 
colic in, treatment of, 835 
constipation in, fruit for, 837 
cross-eyed, correction of, 834 
dandruff on head of, 836 
feeding of, advice on, 836 

amount of certified milk to be given 
in twenty-four hours to 6-month- 
old infant, 839 
boiled milk, 837 
fruit, 837 
improper, 837 



1349 



1350 



INDEX TO QUESTIONS AND ANSWERS 



Babies, feeding of, measures to enable 
nursing of, 833, 838 
potatoes, 857 
when breast fails, 837 

giving of saccharine to, 834 

gritting of teeth by, 840 

left-handedness in, 835 

measurements for, at 32 months, 833 

overfeeding of, 838 

passing of undigested food in, 834 

second summer of, 836 

shape of heads of, 832 

sleeping out of doors all year round, 
835 

sleeping with older people, 835 

soft spot on head of, 832 

sty in, cause, prevention and treatment 
of, 840 

thumb-sucking in, 840 

uninterrupted sleep for, 833 

weaning of, and "the sign of the 
moon," 838 
on becoming pregnant, 838 
time for, 838, 839 
Bacillus Bulgaricus, in diabetes, 161 
Backache, causes of, 162 
"Bad habits," disease of, 652 
Baked beans, as a food, 503 
Baldness, covering head in cold weather, 
757 

in men and women, 756 

in spots, causes of, 758 
Bananas, food value of, 347 
Barber's itch, treatment for, 724 
Bathrooms, keeping clean, 1142 
Bedbugs, ridding community of, 944 
Bedrooms, sunlight in, 1141, 1142 
Belching, and nervousness, mental hygiene 
for, 654 

cause of, 653 

excessive, 654 
Bicarbonate of soda, use of, 652 
Birth, best time of year for, 189 
Birth marks, 1020, 1024 

See also "Marking," prenatal. 
Blackheads, alcohol for, 735 

treatment of, 733 
Bleeding gums, causes of, 752 

conditions indicated by, 750 
Blindness, and heredity, 1021, 1022 

infant, cause of, 128, 129 

oncoming. See Sight, failing. 

prevention of, at time of birth, 129 



Blood, spitting of, from nose, 14 
Blood builders, 499 
Blood pressure, and anemia, 610 
and paralysis, 608 
high, 600, 601 

and interstitial nephritis, 631, 632 
at forty, 610 
cause and effect of, 609 
conditions caused by, 608 
symptoms of, 610 
treatment for, 609, 610 
normal, 608, 610 
Bloodshot eyes, 129, 130 
Bloody discharge, from mouth, while sleep- 
ing, 753 
"Blue" baby, 793 
Boils, cause of, 732 
treatment of, 733 
Boric acid solution, directions for use of, 

in infant's eyes, 129 
Bowel obstruction, 660 
Bran, for constipation, 661 

for human food, 501 
Bran gems, for constipation, 503 

recipe for, 661 
Brass chills, 908 
Breast nodules, 977, 978 
Breath, of dyspeptic, 645 

shortness of, due to asthma, 45 
Breathing, deep, exercises for, and benefit 
of, 1083 
mouth. See Mouth breathing. 
Bright 's disease, and diabetes, 636 
and salt, 635 
and water, 631 
diet for, 631, 632 
incurable case of, 633, 634 
symptoms of, 632 
treatment for, 632, 633 
Broken arch, relief for, 772 

remedy for, 768 
Bronchitis, chronic, change of climate for, 
43 
curability of, 45 

due to underlying cause, 45 
coughing up of gray pus with, 43 
treatment of, 47 
Buckwheat cakes, nutritive value of, 

650 
Burning leaves, 1222 
Bunions, and corns, relief for, 772 
cure for, 769 
easy shoes for, 770 



INDEX TO QUESTIONS AND ANSWERS 



1351 



Butter, annatto coloring in, 503 

and olive oil, relative food values of, 

338 
daily ration of, 339 
Butterine, and butter, 500 

to distinguish, 500 
Buttermilk, 502 

and arteriosclerosis, 608 
and sweet milk, as articles of diet, 
544 
relative nutritive value of, 545 
and weight, 692 
disagreeing with one, 546 
fattening effect of, 697 
for intestinal putrefaction, 546, 608 
formula for, 546 
length of time remaining fit to drink, 

545 
not an infant's food, 545 
relative value of freshly churned or ar- 
tificially soured, 545, 546 
value of, 546 
Buttermilk tablets, 501, 502 

Caffein, danger of, as stomach and nerve 

bracer, 336 
Cancer, and contagion, 979 
and fish, 980 
and heredity, 979 
and pork, 981 

and senseless worry about, 978 
and x-ray, 979 
cause of, 978 

injury as contributing cause of, 978 
length of time for development of in- 
ternal, 979 
need of knowledge of, 980 
of bladder, 980 

of breast, and operation, 976, 977 
causes of, 978 
when to judge of, 981 
of stomach, salts of potash for, 979 
symptoms of, 977, 979 
Cancerous growth on face, 976 
Candy, concentrated food, and when to 
avoid, 504 
giving of, to children, 849 
Canker sores, and diet, 752 
Carbuncles, cause of, and treatment for, 

733 
Cataract, dissolving treatment for, 126, 
131 
operation for, 130 



Catarrh, advertised remedies for, 36 

as a symptom, 36 

bad breath due to, 36 

chronic, meaning of, 35 

nasal, and weak eyes, 36 
vaccine for, 36 

of head, meaning of, 36 

of stomach, 647 

spraying of nose for, 35 

treatment of, 36 
Catarrh snuffs, danger of, 350 
Catarrhal jaundice, cause of, 727 
Cerebrospinal meningitis and infantile 

paralysis, 256 
Cerebral hemorrhage. See Apoplexy. 
Change of life, artificial, 789 

hot flashes and mental condition of, 794 

symptoms of, 1280 

thirty-eight too young for, 1281 
Chapped hands, 728 

cure for, 728 
Chest, pain in, 14 
Chest expansion, exercise for, 1049 
Chickenpox and smallpox, 221 
Chicken-breastedness, exercise for, 1055 
Chiggers and butter, 948 
Chilblains, treatment for, 768, 770 
Childbearing, and build, 782 

and diseased ovaries, 1284 

and gonorrheal infection, 782 

and nervousness, 784 

at forty-eight, 787, 794 

at forty-three, 786, 791 

at thirty-eight, 790 

at thirty-nine, 793 

no age limit for, 782 

menstruation six weeks after, 791 
Children, and contagious diseases, 852 

bilious attacks in, 854 

candy for, 849 

celluloid toys for, danger of, 856 

chafing and irritation in, 855 

cleft palate in, 857 

daily bath for, 850 

earache in, 855 

eating of mud, cause and treatment of, 
856 

eating of starch, 856 

feeding of, after measles and mumps, 
850 
and economy, 853 
at one year of age, 857 
at four years of age, 855 



1352 



INDEX TO QUESTIONS AND ANSWERS 



Children, feeding of, bananas, 855 
potatoes, 857 
promiscuously, by other people, 855 

fitful sleeping in, 851 

giving of calomel to, 854 

growing pains of, 854 

harelip in, cure for, 858 

needlessness of contagious diseases in, 
852, 853 

night sweats in, 850 

nodding spasm in, 857 

sleep for, 856 

sniffling habit in, 854 

sugar for, 849 

worms in, cause of, 834 
Chin truss for mouth breathing, 19 
Cholera, and flies, 942 

winter, and typhoid fever, 319, 320 
Circumcision, advisability of, 670 

and length of time disabled by, 1311 
Cleft palate in children, 857 
Climate, change of, beneficial for bron- 
chitis, 43 
Coca Cola habit, 361 

danger from person addicted to, 338 
Cocain habit, cure for, 338 

danger of hay fever sprays, 339 
Codein, and morphin, 336, 337 

danger of, 336 
Codein tablets, danger of use of, 334 
Coffee, and caffein, 360 

and fatigue, 359 

and nervousness, 361 

and sleep, 359 

and tobacco, 360 

effect of, 361 

harm from, 360 

over-stimulation of, 359 

with cream and sugar, 360, 361 
Colds, and ventilation, 1170 

care of, 34 

cause and cure of, 33, 34 

contagious nature of, 33 

frequency of, due to habits, 33 

in children, treatment of, 852 

in head, treatment of, 32 
chronic, 32 

prevention of, 33, 34 

to cure, 32 

treatment of, 33, 34 

vaccination for, 608 
Cold feet, exercise for, 1053 
Cold hands and feet, 392 



Cold sores. See Ulcers of mouth. 
Colitis, diet for, 543 

due to appendicitis, cured by operation 
for, 608 
Complexion, bad, cause of, 727 
Conception, between menstrual periods, 
1285 
occurrence of, before menstruation, 782 
Constipation, and drinking of water, 659 
and pregnancy, 659 
bran gems for, 503 
calomel and castor oil for, 659 
chronic, and diet, 649 

treatment of, 658, 659 
food in, 662 

from bowel obstruction, 660 
grapes for, 500 
in young children, 659 
internal bath for, 657 
laxatives for, 660 
not caused by liver, 658 
patent medicines in, 663 
treatment of, 645, 660 
bran, and agar, 661 

uncooked, 662 
bran bread, 661 
bran gems, recipe for, 661 
enemas, 662 
flaxseed, 662 
oatmeal, 660 
paraffin oil, 663 
pumpernickel, 661 
senna, 660 
suggestion for, 662 
wheat, 660 
wheat bran, 661 
when to seek medical advice, 662 
Contagion, danger of, from clothes of party 
coming from sick room, 206 
from passing money or touching ob- 
jects touched by persons with, 
206 
in regard to scarlet fever, diphtheria 
and similar diseases, 206 
vigilance against, price of safety, 206 
Contagious diseases, and children, 852 
barring child from school, 205 
laws preventing traveling of persons 

with, 246 
needlessness of, for children, 852, 853 
whooping cough, 243 
Corns, and bunions, relief for, 772 
and electricity, 769 



INDEX TO QUESTIONS AND ANSWEES 



1353 



Corns, and nitric acid, 768, 769 

easy shoes for, 770 
Cottonseed meal, nutritional value of, 504 
Cottonseed oil and olive oil, 504 
Cough, chronic, 43 

due to chronic bronchitis, and change 
of climate for, 47 
coming on when exposed to drafts or 

air, 633 
due to bronchitis, 43 
due to goiter, 43 
raising of gray pus with, 43 
Coughing in theaters, reason for, 1171 
Cramps, exercise to prevent, 1054 

in swimming, remedy for, 1083 
Cretinism, definition of, 1017 
distinguished from idiocy, 1017 
length of life in, 575 
treatment for, 575 
Croup, and diphtheria, 239 
nature and symptoms of, 238 
possible causes of, 238, 239 
Crying, continued, cause and effect of, 

849 
Cuban itch, 221, 724 
Curvature, of legs, due to rickets, 189 
of spine, 97 

and child bearing, 98, 190, 191 
and marriage, 97, 98 
causes of, 97 
due to rickets, 190 
Cystic tumor, 986 

Dandruff, causes of, 128 

definition and treatment for, 757 

removal of, 757 

treatment of, 128 
Deafmutism, and heredity, 1025 

and intermarriage, 1025 
Deafness, and catarrh, 139 

and coffee, 139 

approaching, warding off of, 138 

due to running of ears, 139 

in one ear, due to perforated ear drum, 
137 

partial, heredity of, 138 
Death rate, diminishing, and improved 

hygiene and sanitation, 499 
Debility, general, advice for, 359, 360 

hyponuclane tablets for, 388 
Dementia precox, definition and relief for, 

417 
Dental tools, unclean, 751 



Diabetes, and age, 163 

and " Bacillus Bulgaricus, ' ' 161 

and bread, 163, 164 

and Bright 's disease, 636 

and diet, 162, 163 
buttermilk, 163 

and heredity, 162, 163 

and liver, 162 

and medicine, 161 

and saccharin, 163, 164 

and tuberculosis, 98 

cause and amount of sugar in urine, 162 

cause and treatment of, by diet, 160, 161 

cause of, most general, 162 

curability of, 161, 162, 163, 164 

diet for, 160, 161 

first symptoms of, 609 

length of life with, 161 

loss of flesh in, 161 

nature of, 163 

progress of, 162 

stage of acetone, 162 

symptoms of, 162 
final, 162 
first stages, 163 

teeth in, 164 

use of term, 162 
Diabetic bread, 164 
Diarrhea, winter, and typhoid fever, 319, 

320 
Diet, mixed, 500 

vegetable and milk, 500, 501 
Diphtheria, and croup, 239 

carriers of, 238 

epidemic of, in school, 1271 

transmission of, 238 
by animals, 238 
Diphtheria bacillus, to "get rid of," 239 
Dirt bands on ceiling, cause of, 1212 
Discharge from ovary, due to leukorrhea, 

1281 
Discharging ear, meaning of, 242 
Disease, transmission of, through cigar 

ends, 349 
Disinfection, after scarlet fever, 232, 233 

of pantries, by formalin, method of, 203 
Dizziness, after eating, 449 
Dog bites, 302 
Dreaming in children, 851 
Dreams, cause of, 410, 411 

effect of, 386 

mental training for, 411 

nightmares, cause and treatment of, 412 



1354 



INDEX TO QUESTIONS AND ANSWEES 



Drink habit. See Alcohol habit. 
Dropsy, and heredity, 636 
cause of, 636 
cure of, 636 
Drug habit, formation of, by codein tablets 
or antikamnia and codein tablets 
for headache, 334 
moral degeneration from, 337 
Drunkenness, periodic, 342 
Dry air, winter itch due to, in school 

children, 1271 
Dust, danger from, 908 
Dysentery, raw milk prohibited in, 540 

Earache, due to tonsillitis, remedy for, 138 
in children, 855 

suppuration of middle ear, caused by 
infection from tonsils or adenoids, 
138 
treatment of, by hot salt bag to ear, 
138 
Ear drum, perforated, apparatus for, 137 
due to infection in early childhood, 
137 
Ears, custom of putting cotton in, on re- 
tiring, 138 
ringing in, 162, 163 

cause and treatment of, 139, 140 
running of, cause and danger of neglect 
of, 138, 139 
deafness due to, 139 
throbbing in, due to Meniere's disease 
and other causes, 139 
Eczema, and cleanliness, 717 
and muriatic acid, 718 
cause of, theories on, 718 
definition of, 720 
flour, 721 
noncontagious, 718 
of head, in babies, treatment of, 717, 

718 
of scalp, treatment of, 719, 721 
recurrence of, 718 
seborrheic, treatment of, 719, 721 
transmission of, 718 
treatment for, 718, 720 
Eggs and cream, acting as physic, 501 
Electric, treatments and massage, for weak 

muscles, 1054 
Empyema, definition and nature of, 68, 69 
English disease. See Eiekets. 
Enlargement, of glands, Bobo's cure for 
goiter, 570 



Enlargement, of glands, of neck, causes 
and treatment of, 101, 102 

of liver, and diet, 156 
Epidemics of scarlet fever, control of, 

203, 204 
Epilepsy, and "worm spasms," 429 

curability of, 428, 429, 430 

institutions for care of, 430 

states containing colonies for, 429 

treatment of, 428, 430 
by rattlesnake venom, 429 
Erections in children, 1312 
Ergot, and miscarriage, 1285 

effect of, 1024 

nature of, 1285 
Eugenics, advice on, 1023 

and blindness, 1021, 1022 

and deafmutism, 1025 

and difference in age, nationality and 
physique, 1020, 1021 

and marriage of cousins, 1018, 1019, 
1021, 1022 
doubly related, 1022 

and marriage of niece and uncle, 1022 

and size of family, 1017, 1018, 1019 

and twins, 1024 

definition of, 1020 

literature on, 1023, 1025 

Mendel theory of, 1023 

seriousness of, 1025 
Eugenics Laboratory, service of, 1023 
Evaporated milk, 500 
Exercise, after operation, 1052 

and fatigue, 1049 

bathing, and minimum temperature for 
lake bathing, 1055, 1056 
and reaction, 1056 

before breakfast, 1054 

bicycle riding, 1052 

effect of, on figures of women, 1052 

for blind spells and dizziness, 1058 

for chest expansion, 1049 

for chicken-breastedness and prominent 
right shoulder blade, 1055 

for cold feet, 1053 

for keeping in prime condition, 1053 

for muscle, 1049 

for students, 1050 

for tired feeling, 1049, 1052 

for too frequent yawning, 1057 

gymnastic dancing, 1051 

horseback riding, 1050 

horseback riding astride, 1051 



INDEX TO QUESTIONS AND ANSWEBS 



1355 



Exercise, in middle age, 1057 

in open air, and nervousness, 1050 

motorcycling, 1049 

out of doors, 1055, 1057 

overdose of, 1050, 1055 

roller skating, 1056 

rowing, 1055 

running, 1054 

skating, 1051 

swimming, 1054, 1055 

tennis, 1051 

to develop arms, 1051, 1052 

to increase weight, 1052 

to prevent cramps, 1054 

to strengthen ankle, 1057 

walking, 1056 
Expectoration of clear mucus, 163 
Eye drops for baby, directions for, 129 
Eyelids, granulated, 128 
Eyes, astigmatism of, 130 

bloodshot, 129, 130 

closed ducts of, 130 

floating spots before, 128 

infants', directions for using eye drops 
in, 129 

rings before, 128 

senile changes in, 131, 132 

styes, 131 

watery, 130 
Eye-strain, 132 
Eyewashes, 131 

Faintness and weakness, causes of, 162 
Falling womb, operation for, 788 
Families, size of, and eugenics, 1017, 1019 
Fasting, to reduce weight, 501 

until noon, 501 
"Fattening up," 19 
Fears, sudden, advice for, 390 
Feet, aching, 767 

and hands, cold, 772 

and high heels, 769 

burning, 767 

cold, causes of, 771 
treatment of, 772 

itching, 771 

perspiring, 769 

and mattering between toes, 771 

sore, cure for, 773 

swollen, 774 

tender, 769 
Fever blisters, cause of, 721 
Fibroid lungs, 106 



Fibroid tumors, and radium, 788 

exterior to uterus, 986 

nature of, 787 

operation for, 788 

treatment for, 787 
Finger ends turning white, 582 
Finsen method of nonactinic light as cure 

for smallpox, 220 
Fish and cancer, 980 
Fistula and tuberculosis, 98 
Flat-dwellers, beating of rugs on back 

porches, 1129 
Flat feet, aid for, 770 

reason for, 770 

shoes for, 773 
Fleas, to get rid of, 944 
Fletcherizing and pyorrhea, 751, 754 
Flies, and cholera, 942 

and electric mixers, 946 

and fly traps, duty of city, 946 

barring of, from manure, 943 

formula for iron sulphate prepara- 
tion for, 943 

fungus on, 944 

in screened porches, 943 

removing of screens, 945, 946 

ridding basement of, 943 

ridding community of, 942 

small, plague of, 942 

smudge plan to kill, 943 
Floating kidney, facts about, 635 
Floating spots before eyes, 128 
Flour bugs, elimination of, 840 
Flyless Havana, 945 
Food, bulk of, 501 

kept in refrigerators, 347 
Foods, eating organs of animals to 
strengthen corresponding organs 
in people, 499 
Foodstuffs, feeding of certain organs by 

certain foods, 505 
Foot and mouth disease, prevalence of, 
324, 325 

procedure on recovering from, 324 
Fruit, dried, 503 
Fumigation, after tuberculosis, 212 

by sulphur fumes, for insect life, 211 

directions for, 209, 210, 211 

hydrocyanic gas for, 211 

of book, 211 

of cars, 211, 212 

of filthy houses recently occupied, 209, 
210 



1356 



INDEX TO QUESTIONS AND ANSWERS 



Fumigation, unnecessary, 211 

with permanganate of potash and for- 
maldehyd, directions for, 210 
Furnace heat, treatment of, 1187 
Furnace troubles, 1188, 1192 

Garbage, as compost, 1222 

disposal of, 1222 
Garbage cans, burning out of, 1222 
Gas heaters, chronic headaches due to, 1187 
Gas ranges and fresh air, 1191 
German measles, and common measles, 243 

contagion of, 243 

isolation for, 243 

period of incubation of, 243 
Girth, reducing, 691 

Glands, of neck, enlargement of, causes 
and treatment of, 101, 102 

tubercular, 105 
Glauber salts, 36 
Gleet, cure of, 1310 

Glycerin, composition and effect of, 633 
Goiter, and children, 572 

and contagion, 574 

and marriage, 572 

and operation, 575 . 

and thyroid extract, 574 

and water, 573 

Bobo's cure for, 570 

causes of, 573, 574 

cough due to, 43 

diminished, 573 

indication for operation for, 573 

treatment of, 572, 574 
by medicine, 575 
by operation, 571, 573 
by sheep serum of antithyroidin, 571 
Goiter heart, 574 
Gonorrhea, and childbearing, 782 

contagiousness of, 1310 

neglected, 1310 

not inheritable, 1310 

with few symptoms, 1310 
Gonorrheal rheumatism, 1310 
Gout, and diet, 156 

and rheumatism, 156 

lumpy fingers due to, 156 
Graham flour and whole wheat flour, 650 
Granulated lids, meaning of, 128 
Grapefruit, before breakfast, 506 

with milk, 539 
Grapes, eating of seeds, skin and pulp, 500 

food value of, 500 



Grapes, for constipation, 500 
Graves' disease, 573 
Grip, transmission of contagion, 210 
Growing pains of children, 854 
Growth in breast, 981, 986 

with pain at intervals, 985 

without pain, 985 
Growths, operation for, and its effects, 

788 
Gum-chewing, effects of, 651 
Gums, and lime water, 754 

sore, 753 

soreness and bleeding of, and falling 
away from teeth, 184 

tumor of, 753 
Gymnastic dancing, 1051 

Hair, care of, 757 

dyes for, 759 

falling, growing in light, 756 

gray, 758, 759 

premature graying of, 759 

promoting growth of, by salt on scalp, 
756 

superfluous, 757 

thin, 758 
Hair tonic, cantharides in, 760 

sage tea and sulphur for, 731 
Hardening of arteries, blood pressure in, 
601 

cause and treatment of, 602 

nitroglycerin for, 608 

premature, 603 

prevention of, 601 

symptoms of, 604 

tissue change in, 602 

treatment of, 604 

water in, 602 
Harelip in children, cure for, 858 
Hay fever, antitoxins for, 53 

asthma resulting from, 54 

causes of, 53 

cures for, climate and serum, 54 

no physical danger from, 53 

sprays for, containing cocain, and dan- 
ger of, 339 

vaccines for, 53 
Head noises, 138 
Headaches, and aspirin tablets for, 449 

and paraffin oil, 449 

causes of, 447 

chronic, due to gas heaters, 1187 

coal tar products for relief of, 448 



INDEX TO QUESTIONS AND ANSWERS 



1357 



Headaches, danger of codein tablets or anti- 
kamnia and codein tablets for, 334 
from stomach, suggestions for, 447 
kinds of, and medical advice for, 139 
lemon and salt not preventive of, 448 
medicines for, free distribution of, for- 
bidden by law, 448, 449 
sick (migraine), 446, 447 
causes of, 447 
relief for, 448 
with tired feeling and temperature, sig- 
nificance of, in small boy, 1273 
Heart, and altitude, 595, 609 

leaking, definition and symptoms of, 593, 

594 
nervous. See Nervous heart, 
palpitation of, 596 
weak action of, in small boy, 853 
Heart beats, irregular, 598 

rapid, 391 
Heart disease and rheumatism, 609 
Heart leakage, and tobacco, 348 

heart specialist recommended for, 594 
Heart murmur, 594, 600, 601 
Heart sounds, 597 
Heart symptoms, 601 
Heart trouble, 595 
and marriage, 599 
in sixteen-year-old boy, 600 
Heartburn, cause and cure of, 649 
Heat, furnace, treatment of, 1187 
Heating, and furnaces lacking capacity, 
1188 
and steam heat itch, due to low humid- 
ity, 1192 
for flats, 1191 
by gas stove, 1192 
hot water or steam as means of, 1166 
outside air necessary in, 1189 
recirculating system, 1191 
ventilation and humidifying indoor air, 
idea for, 1189 
Heels, high, 769 

Height, increasing of, 1071, 1072 
and thyroid, 1071 
in children, 858 
rules for, 1072 
Hemophilia and heredity, 611 
Henoch's spasm of head, 857 
Heredity and deaf-mutism, 1025 
Hernia, and life insurance, 668 
and marriage, 669 
and pregnancy, 791 



Hernia, cause of, 668 

condition after operation for, 668 
double, treatment of, 669 
in infant, 670 
operation for, 670, 671 
second operation for, 669 
treatment of, operative, 669 
band or truss, 669, 670 
by lymphol, 670 
truss or operation, 670 
Heroin, danger of, 336 

derived from opium, 336 
Hives, cause of, 736 

and treatment of, 737 
cure of, 736 
prevention of, 736, 737 
treatment of, 736 
Hoarseness, cause and treatment of, 38 
Hodgkin's disease, incurability of, 553 

symptoms of, 553 
Horseback riding, 1050 
astride, 1051 

during menstruation, 1282 
Housing, bad conditions of, 1120 
House, unsanitary conditions in, 1140 
Humidifier, 1203, 1206 

Humidity, and hot water radiators, 1210 
and radiators, 1204 
approximating, by hygrometers, 1208 
arrangement for, 1200 
electric spray device for attaining 

proper degree of, 1203 
good compromise in, 1204 
humidifier for attaining proper degree 

of, 1203 
ideal, 1200 

increasing of, 1203, 1206, 1207, 1210 
by pans, 1208 

in hot water heated room, 1207 
in steam heated room, 1203, 1206 
minimum register for, 1208 
need of, 1208 

relative, of high altitudes and of heated 
rooms, 1201 
Humidometer, 1208 
Hydrocele or rupture, 1311 
Hydrophobia, and dog bites, 302 

and milk, 302 
Hygrometer, 1208 

to make, 1208, 1209 
Hyponuclane tablets, for enriching blood, 

388 
Hysteria in young boy, advice on, 390 



1358 



INDEX TO QUESTIONS AND ANSWERS 



Ice, danger from, when taken from body 

of water receiving sewage, 221 
Ice box, stationary porcelain tub used for, 

1141 
Ice cream, poisoning from, 543 
Ichthyosis, questions on, 732 
Idiocy, distinguished from cretinism, 1017 
Impotency, partial, remedy for, 1313 
Indigestion, cure for, 647 

irregular pulse due to, 643 
Infantile paralysis, a germ disease, 255 

and cerebrospinal meningitis, 256 

and clothing, 255 

and meningitis, 255 

care of, 256 

cause of increasing frequency of, 256 

control of, 256 

duration of infectious period of, 255 

infectious nature of, 255 

nose secretion main factor in spread of, 
255 

preventive measures, 255 

quarantine for, 256 
Infantile uterus, cause and effect of, 787 

remedy for, 787 
Ingrowing nail, treatment for, 725 
Injuries, massage and exercise for, 1056 
Insanity and marriage, 414 
Insects in flour, 945 
Insomnia, and coffee, 359 

and mind, 387 

and nervous prostration, cure for, 387, 
388 

cause and remedy for, 410 

danger of taking sleeping powders for, 
336 

danger of taking veronal for, 336 

danger of using drugs for, 409 

distinguished from disease, 411 

due to nervousness, advice for, 391, 392 

training of mind as remedy for, 409, 410 

warning against taking of drugs for, 334 
Intermarriage, 1018, 1019, 1021, 1022 

and deafmutism, 1025 
Internal bath for constipation, 657 
Intestinal indigestion, 647, 650 

or intestinal fermentation, 645, 646 
Intestinal putrefaction, diet for, 649 
Itch, barber's, treatment for, 724 

bath, and relief for, 724 
cure for, 725 

Cuban, 724 

definition and manifestations of, 723 



Itch, due to steam heat and insufficient 
moisture in air, 1210 

winter, 723 
Itching, after bathing, 719 

and festering, between toes, 719 

cause of, 723 

palliative for, 723 

Jiggers, and butter, 948 

application for pain and irritation due 
to, 948 

Kernels in neck of children, 849 
Kidney disease and meat, 499 
Kidney medicines, 636 
Kidney trouble and diet, 162 
Kidneys, and continued sitting, 162 

and fruit and sugar, 162 

loss of one, and its effect, 633 

stone in, 634 

use of, 634 
Kitchen sinks, keeping clean, 1142 

Laceration due to childbirth, 790 
Lead poisoning, case of, in painter, 909, 
910 
cause of, 910 
Leprosy, prevention of, 300 

study and probable solution of, 300 
Leukorrhea, 1281 
cause of, 791 

and care of, 100 
cure for, 1282 
results of, 1282 
Lice, head, to get rid of, 947 
Lighting, poor, in hotels and rooming 

houses, 1142 
Lip reading, advantages of, for persons 
with approaching deafness, 139 
information regarding, from Volta Bu- 
reau, 139 
Liquor habit. See Alcohol habit. 
Listlessness, examination for cause of, 389, 

390 
Liver, sluggish, 648 
Liver spot, 727 
Lump on neck, 730 
Lumpy fingers, due to gout, 156 
Lungs, development of, in child with tu- 
bercular history, 19 
effect on, of removal of tonsils, 19 
fibroid, 106 
Lupus of nose, cure for, 102 



INDEX TO QUESTIONS AND ANSWEES 



1359 



Lymphatic glands, enlargement of, due to 
tonsils or tuberculosis, 553 
under chin, 554 
under jawbone, 554 
of neck, enlargement of, 554 
swollen, on neck, near ear, 554 

.Malaria, and stable odors, 284 

and substitute for sewers, 284 

and typhoid fever, 284 

and weeds, 283 

as a bar to progress, 283 

blood examination for germs of, 284, 
286 

control of, 284 

curability of, 284 

quinin for, daily allowance of, 286 
effects of, 286 

severe headache about same time each 
week, 284, 286 

symptoms of, in absence of chill, 284, 
286 
Marking, prenatal, 783, 832, 1016, 1017 
Marriage, and childbearing, at forty- 
eight, 787 
at forty-three, 786 

and disparity in ages, 789, 1283 

and goiter, 572 

and heart trouble, 599 

and insanity, 414 

and neurasthenia, 399, 400 

and paralysis agitans, 431 

and self -abuse, 1284 

for woman of forty-two, 1284 

of cousins, 1018, 1019, 1021, 1022 

of cousins doubly related, 1022 

of niece and uncle, 1022 

of second cousins, 1021 
Massage, and electric treatments, for weak 
muscles, 1054 

and exercise, for injuries, 1056 
Masturbation, in children, 1312 

See also Self-abuse 
Meals, liquids with, 501, 505 

number of, a day, 650, 651 

water with, 505 
Measles, and open windows, 242 

contagion of, from nurse, 242 

from room occupied by patient, 242 
time of, 242 

control of, 240, 241 

conveyance of, by third person, 241, 242 

duration of isolation for, 24a 



Measles, fumigation after, 242 

immunity and susceptibility to, 242 

not a universal disease, 240 

period of incubation of, 242 

quarantine rule for workers in same 
house with, 205 
Meat, and apoplexy, 615 

and kidney irritation, 499 

salt, 648 
Melancholia and operation, 414 
Memory, training of, 387 
Meniere's disease, curability of, 139 

explanation and symptoms of, 139 
Meningitis and infantile paralysis, 255 
Menorrhagia, case of, 1280 
Menstruation, absence of, or amenorrhea, 
1281, 1282 

and horseback riding, 1282 

after curettement for miscarriage, 791 

bathing during, 1280 

during pregnancy, 791, 792 

excessive, or menorrhagia, advice for, 
1280, 1281 

normal, 1281 

scanty, 1281 

and pregnancy, 1282 

six weeks after childbirth, 791 
Mental disorders, treatment for, 390, 

391 
Mentality, poor, and self-abuse, 1312 
Migraine, nature of, and cure for, 447, 448 
Milk, and flesh, 537 

and pimples, 537 

as food, 538 

boiled, 540, 542 

care of, in infant feeding, 538 
' eentrifuged, 539 

condensed, 543 

evaporated, 500, 543 

fresh, requirements for, 537 

grapefruit with, 539 

idiosyncrasy against, 538 

pasteurized, 543, 544 

proposal for safeguarding, 540 

raw, prohibited for dysentery, 540 

safe, 540 

sour, 544 

sterilized, 540 

sweet, and buttermilk, as articles of 
diet, 544 
relative nutritive value of, 545 

thermos-kept, 539 

to gain in weight, 542, 543 



1360 



INDEX TO QUESTIONS AND ANSWERS 



Milk bottles, washing of, including its 

cover, before opening, 203 
Milk diet, 538 

diseases recommended for, 537 

effects of, 538 
Milk leg, 794 
Mind, and insomnia, 387 

and nervous indigestion, 387 

influence of, on disease, 387 

relaxation of, 391 
Mitral lesion, length of life with, 598 
Mold germs, method of destroying, 203 
Mole on nose, removal of, 720 
Moles, cutting or burning of, 720 

removal of, 719, 720, 731 

sarcoma, or cancer, developing from, 720 
Moral degeneration, due to drug habit, 

337 
Morphin, warning against, for insomnia, 

334 
Morphin habit, advisability of going to in- 
stitution for cure of, 335 

cure of, in one seriously addicted, 335 
in one slightly addicted, 335 

legislation against, barring drug users, 
335 
Mosquitoes, and weeds, 283 

from cisterns, 286 

in Arctic regions, 286 

to get rid of, 944 
Moth millers, prevention of, 946 
Motorcycling, 1049 
Mouth, keeping clean, 752 
Mouth breathing, 852 

cause of, 14, 19 

dangers of, 14, 19 

overcoming of, 14, 19 
Mucus, clear, expectoration of, 163 

from urethra, 1311 

slimy, raising of, 43 

thick, dark, from nose, 13 
Muscles, exercise of, without moving 
joints, 1082 

of arm, exercises for, 1083 
Myocarditis, chronic, symptoms and treat- 
ment of, 597 
Mysophobia, definition and remedy for, 
414, 415 

Nails, brittle, causes and treatment of, 
725, 726 
diseases of, 725 
ingrowing, treatment for, 725 



Nails, splitting of, 726 

turning black, 582 
Nasal catarrh. See Catarrh, nasal. 
Nephritis, interstitial, and arteriosclerosis 
and high blood pressure, 631, 632 
definition of, 631, 632 
development of, 631, 632 
last stages of, 632 
Nerves, books on, 399 

of taste, 644 
Nervous, distinguished from neurotic, 403 
Nervous diseases, publication on, 339 
Nervous habits, biting of finger nails, 415 

drumming with hands, 415 
Nervous heart, 600 

causes of, 594, 595 

definition of, 594 

symptoms of, 594 

treatment for, and consequences of 
neglect, 594, 595 
Nervous indigestion, influence on, of mind, 

387 
Nervous prostration, and cure for, 387, 388 
Nervousness, 978 

advice for, 391, 392, 400 

and coffee, tea and tobacco, 361 

and exercise, 392 

and exercise in open air, 1050 

and milk and cream, 392 

and sleep, 410 

during sleep, in children, 857 

effect of, on one's child, 410, 411 

sign of, 415 
Neuralgia, cure of, by location and removal 
of cause, 386 

distinguished from neuritis, 385, 386 

due principally to self-neglect, 790 

possible causes of, 386 
Neurasthenia, advice for, 399 

and marriage, 399, 400 

and medicine, 399 

books on nerves valuable in, 399 

books recommended to sufferers from, 
400, 401, 403, 408 

excessive, sanitarium treatment for, 388, 
389 

mild, 400 

psychotherapy for, 402 

self -cure of, 401 

sexual, 1313 

signs of, in children, 1272 

treatment for, 400, 402, 407, 408 
Neurasthenics, advice for, 1313 



INDEX TO QUESTIONS AND ANSWERS 



1361 



Neuritis, and teeth, 386 

cure of, by location and removal of cause, 
386 

distinguished from neuralgia, 385, 386 

possible causes of, 386 
Neurotic, distinguished from nervous, 403 
Night losses, 1311 

Night sweats and loss of weight, 103 
Night terror in children, treatment for, 851 
Nightmare, and marriage, 1024 

cause and treatment of, 412 
Nitroglycerin for high blood pressure and 

hardening of arteries, 608 
"Nits," removal of, 947 
Nodding spasm, 857 
Nose, dull feeling on one side of, 13 

infection of, chronic, 13 

keeping clean, 752 

mu^as from, thick dark, 13 

Seller's or Dobell's solution for spray- 
ing of, 35 

spitting of blood from, 14 

stoppage of, 14 

toilet of, as cure for ozena, 32 
Nosebleed, due to overeating, 501 

treatment of, 611 
Nostrils, obstructed, 14 
Nux vomica, as stomach and nerve bracer, 
danger of, 336 

Obesity, overcoming, 690 
tendency to, 686 
to check, 689 

treatment of, Oertel diet, 685 
Obesity cures, short cut, 688 
Ointment of yellow oxid of mercury, for 

affections of eyelids, 128 
Olive oil, and flesh, 537 

and butter, relative food values of, 338 
and pimples, 537 
Onions, food value of, 648 
Operation, complete readjustment after to 

be expected with time, 1282 
Opium, codein and heroin derivatives of, 
336 
warning against, for insomnia, 334 
Oranges and smoking, 506 
Ovaries, removal of one, and childbirth, 
784 
and marriage, 784 
Overeating, danger of, 634 
Oxid of mercury, yellow, ointment of, for 
affections of eyelids, 128 



Oysters, fuel value of, 503 

temperature in cooking, required to kill 
germs in, 503 

taste and succulence of, 503 
Ozena, cause of, 32 

Palsy, telegrapher's, 909 
Paralysis, and blood pressure, 608 

due to apoplexy, cause of, 615 

survival of strokes of, 615 
Paralysis agitans, and heredity, 431 

and marriage, 431 

cause of, 431 

symptoms of, 431 
Patches, bright red, on scalp, 730 

on face and neck, brown, 728 
Peanut butter, food value of, 699 
Pellagra, cause of, 170 

diagnosed cases of, 171 

diet for prevention of, 170 

distribution of, 169 

' ' doctoring ' ' for, 170 

duration of life after first symptom, 170 

in cold climates, 170 

symptoms pointing toward, 170, 171 
Pests in flour, elimination of, 840 
Phantom tumors, 1283 
Phosphorus poisoning from matches, af- 
fecting worker in, not consumer, 
908 
Pickles, food value of, 650 
Pimples, and blackheads, treatment of, 734 

cause of, and treatment for, 733 

explanation of, 735 

prevention of, 734 

treatment of, 734, 735 
Pityriasis, nature and treatment of, 729 
Plague, bubonic, symptoms of, 299 
Play, systematic, need of, for growing 
children, 1270 

in open air, 1049 
Pneumonia, and air, 64 

mortality from, in high altitudes, 721, 
722 

tuberculosis following, 98 
Poison oak treatment, 891 
Poisoning from tyrotoxicon in ice cream, 

543 
Pork, necessity for cooking, 650 
Pregnancy, and age hazard, 784 

and dancing, 782 

and despondency, 784 

and determining sex of child, 785 



1362 



INDEX TO QUESTIONS AND ANSWEES 



Pregnancy, and exercise, 789 

and falls, 787 

and hernia, 791 

and hospital confinement for, 789 

and maternity corsets, 785 

and medicine called ' ' Mother 's Friend, ' ' 
789 

and menstruation, 782 

and seasickness, 664 

and sewing on machine, 1284 

and teeth, 752 

and traveling, 783 

books on, 781 

oare during, 785, 1284 

care of nipples during, 784 

corsets during, 1284 

diagnosis of, 784 

Abderhalden test for, 791 

dropsical conditions and convulsions with, 
recurrence of, 794 

earliest diagnosis of, 1283 

first signs of, 782 

first symptoms of, 791 

flowing during, 791, 792 

influencing of child's mind during, 781 

literature on, 789, 792 

" marking' ' of child during, 783 

missing of one period insufficient for 
diagnosis of, 1281 

morning sickness of, 793 

reading books on, during, 1284 

sick stomach of, treatment for, 792 

test for, 790 

time to consult physician in, 1285 

with urine showing trace of albumin and 
a few hyalin casts, 1282 
Privy vault, danger from one long time 

covered, 1222 
Proteid, meaning of, 647 
Psoriasis, and heredity, 729 

and marriage, 729 

and peroxid, 729 

care of patches in, 729 

definition, cause and symptoms of, 728 

treatment of, 728, 729 
Ptomain poisoning, protection from, 648 

treatment for, 649 
Pulse, irregular, due to indigestion, 643 
Pulse rate, lowered, 598 
Purging, as a habit, 34 
Pyorrhea, and fletcherizing, 751, 754 

and rheumatoid arthritis, 750 

curability of, 748 



Pyorrhea, cures for, 750 
early treatment of, 753 
manner of progression of, 
not contagious, 750 
treatment for, 754 



750 



Quacks, method of determining, 127 
Quinin, nature and effects of, 286 

Eadiators and dirt bands on ceiling, 1212 

Eaisins, California, 651 

Eash, due to dry air, 724 

Eaynaud 's disease, cause and cure of, 582 

nails turning black in, 582 

symptoms of, 582 

white finger ends from, 582 
Eefrigerator, cleansing of, 512 

insulation of, 512 

lining for, 512 

metal and wood, 512 

temperature of, 512 
Eelaxation of mind and body, 391 
Eetarded walking, due to rickets, 189 
Eetinal hemorrhage, explanation of, 129 
Eheumatism, and alcoholic beverages, 152 

and climate, 151, 152, 156, 157 

and diet, 152 
acid fruits, 152 
meat, 152, 153 

and gout, 156 

and medicated woolen underwear, 151, 
152, 153 

and mineral baths, 152 

and removal of tonsils, 151, 152 

and tuberculosis, 722 

causes and treatment of, 151 

gonorrheal, 1310 
Eheumatoid arthritis, and alcohol, 152 

and pyorrhea, 750 

and removal of tonsils, 750 

definition and symptoms of, 151 

symptoms and treatment of, 152 
Eickets, and childbearing, 190, 191 

causes of, 188, 189 

congenital, 190 

disposition to, 190 

prevention of, 188, 189 

sweating of head with, 190 

treatment of, 190 
Eings before eyes, 128 
Eingworm, cure of, 729, 730 

definition of, 729 
Eochelle salts, 33, 34 



INDEX TO QUESTION'S AND ANSWERS 



1363 



Bun-around, treatment for, 726 
Kupture or hydrocele, 1311 

Saccharin, 163, 164 

giving of, to babies, 834 
Salt, and Bright 's disease, 635 
Salt meat diet, 648 
Salts, Glauber, 36 

Eochelle, 33, 34 
Salvarsan, safety of, 1309 
Scalp, itching of, under sun, 759 
Scalp disease, 756 
Scarlatina and scarlet fever, 231 
Scarlet fever, aftermath of, 233 

animals as carriers of, 231 

contagion of, during first stages, 231 
from books, 211 
from scales, 233 

control of epidemic of, 203, 204, 232 

disinfection after, 232, 233 

length of quarantine for, 231 

no immunization against, 232 

period of incubation for, 231 

reporting of, 231 

resumption of exercise after, 233 

transmission of, 232 

not by houses, but by partly cured 

patients, 233 
peeling and throat condition, 231 
time of, 232 

treatment of, by hot baths, 232 
Scars, cause of, after operation, and sec- 
ond operation to remove, 720 

removal of, 731 
School inspection, barring of, from certain 
schools, 1273 

purpose of, 1270 
School rooms, bad ventilation in, 1202 

need of hygrometers in, 1203 
Schools, heating of, and changing air, 
1265 

length of sessions of, 1271 
Scurvy, cause and symptoms of, 189 

symptoms pointing to, 184 
Seasickness, and pregnancy, 664 

prevention of, 664 
Self-abuse, advice for, 1312 

and marriage, 1284 

and stupidity, 1312 

See also Masturbation 
" Sewer bug," 947 
Sexual neurasthenia, 1313 
Shingles, nature and cure of, 732 



Shoulders, round, correction of, 1067 
in children, correction of, 850 
stooping, braces for, 1067, 1068 
correction of, 1067, 1068 
danger of, 1068 
Sight, failing, causes of, 130 
Silver nitrate solution, directions for use 

of, in infant's eyes, 129 
Skating, exercise of, 1051 
Skin, bleaching of, 727 

discoloration of, by ammonia and per- 
oxid to remove superfluous hair, 
727 
dry, cause of, 718 

itching, cracking and festering between 

toes, cause and treatment of, 719 

sensitiveness of, after bathing, treatment 

of, 719 

Skin irritation, of bright red and itching 

spots, 722 
Sleep, a mental condition, 410 
adjustment of mind for, 386 
and bromid or sleeping potions for, 386 
and dreams, 386 
and frame of mind, 410, 411 
and nervousness, 410 
disturbed, and treatment for, 410 
for children, 856 

nervousness during, treatment for, 851 
Sleeping, and keeping warm, 1189, 1191 
cold quarters for, 1190 
fitful, in small boy, 851 
in draft, 1167 
out of doors, 1168 
Sleeping porch, 1166 
Sleeping room regulation, 1165 
Smallpox, and chickenpox, 221 

and Finsen method of nonactinic light, 

220 
contagion from, 221 
control of, by vaccination, 221 
danger from ice taken from body of 
water receiving sewage from city 
having a number of cases of 
smallpox, 221 
germ of, killed by sunshine and fresh 

air, 228 
immunity to, from vaccination, 227, 228 
transmission of, 228 
Snake bite, stimulant for, 891 
Snoring, causes of, 23 

effects of, 23 
Snuff, use of, 349, 350 



1364 



INDEX TO QUESTIONS AND ANSWERS 



Soda, for stomach distress, its danger, 337 
Sore throat, due to bacteria in crypts of 

tonsils, 38, 39 
Sour stomach, possible cause for, 652 
Spermatorrhea, 1311 
Spices, food value of, 650 
Spine, curvature of, 97 

tuberculosis of, 97 
Spots, on body, 727 

on face, 726, 727 
Sputum, black, 100 

Stammering, a nervous condition, and cure 
for, 440 

cure of, 439, 440 

a matter of training, 440 

Scripture's book on, recommended in 
overcoming of, 441 

self-cure of, 441 

suggestion for treatment of, 441 

See Stuttering 
Stature, increasing, 858 
Steam heat itch, due to low humidity, 1192, 

1210 
Sterility, advice for overcoming, 1285 

time to judge of, 1283 
Stomach, weak, diet for, 156 
Storm window problem, 1189, 1190 
Strychnin, danger of, as stomach and nerve 

bracer, 336 
Stuttering, and surgical operations, 440 

prevention of, in young child, 440 

See also Stammering 
Styes, cause and treatment of, 131 
Sugar, giving of, to children, 849 

use of, 646 
Sunlight, in bedrooms, 1141, 1142 
Sweating arm pits, 728 
Sweating of head in rickets, 190 
Swelling of legs, accompanied by ache and 

pain, 792 
Swelling on right side of throat, probable 

cause of, 553, 554 
Swimming, cramps in, 1083 
Swollen throat, possible cause of, 38 
Sycosis, definition and nature of, 719 
Syphilis, and safety of salvarsan for, 
1309 

contagiousness of, 1308 

curability of, 1309 

cure of, 1309 

inherited, 1308 

insufficiently treated, 1308 

relapse in, 1309 



Talking to one's self, 392 
Taste, nerves of, 644 
Tattooing, removal of, 726 
Tea, and nervousness, 361 

excessive use of, 361 

making of, 361 

over- stimulation of, 359 

with cream and sugar, 360, 361 
Teachers, help for nerves of, 1268 
Tear ducts, closure of, 130 
Teeth, and neuritis, 386 

and pregnancy, 752 

decaying, 751 

in diabetes, 164 

loose, 753 

soft and decaying, hardening of, 752 

wisdom, pulling of, 751 
Telegrapher's palsy, 909 
Temper in the morning, advice for, 402 
Tenements, space in, 1141 
Tennis, exercise of, 1051 
Testicles, undescended, 1311 
Tetter, 721 
Thermometers, care of, 1187 

inaccurate, 1186 
Throat, constant clearing of, 13 

daily washing of, 38 

swollen, possible cause of, 38 
Throat huskiness, 1271 
Thymus gland, definition and location of, 

575 
Thymus gland tablets, 575 
Thyroid gland, derangements of, 571 

enlargement of, causes and treatment of, 
569, 570 

functions of, 571 

location of, 571 
Thyroid intoxication, 571, 572 
Tick, spotted, bite of, 127 

wood, bite of, 127 
Tired feeling, exercise for, 1049, 1052 
Tobacco, action of, on nerves, 347 

and capacity, 344 

and coffee, 360 

and hearing, 348 

and inhaling, 347 

and nervousness, 361 

and neurasthenia, 346 

and sight, 347 

and stunted growth, 346 

and weak heart, 348 

cigarette cure, Dr. Kress 's, 349 

giving up of, 345, 347 



INDEX TO QUESTIONS AND ANSWERS 



1365 



Tobacco, persistence of craving for, 
349 
quitting use of, and effect on system, 

347 
transmission of disease through cigar 

ends, 349 
use of, by women, 345, 346 

by young boys, 346 
when to stop use of, 345, 346 
Tobacco blindness, 347 
Tobacco heart, 348 
Toilets, unclean, diseases contracted from, 

1309 
Tomatoes, as food, 506 
Tonsillar crypts, cleaning of, 18 
formation of particles in, 18 
sore throat due to bacteria in, 38, 39 
Tonsillitis, relation of frequent attacks of, 

to condition of tonsils, 19 
Tonsils, cleaning of, 18 

effect of removal of, on lungs, 19 
indication for removal of, 18 
infected, effect of, 18 
Toxemia, 892 
Trachoma, cause of, 127 

definition and nature of, 127 
infectiousness of, 127 
prevention of, 127 
symptoms of, 127 
Tubercular glands, 105 

of neck, consumption due to, 553 
Tubercular kidneys, and "dope," 633 

cause of, 633 
Tuberculin, for tuberculosis, 104, 105 

proper method of treatment with, 108 
Tuberculosis, and climate, 102 
advice on, 108 
Amarillo, Texas, 108 
Arizona, 110 

choice of, dependent on personal con- 
siderations, 109 
circumstances warranting change of, 

108 
Florida, 110 

reasons for going west, 106, 108 
Rocky Mountains, 109, 110 
sanitaria about Denver, 109 
and diabetes, 98 
and fistula, 98 
and night sweats, 103 
and pain, 100 
and rheumatism, 722 
and typhoid fever, 96 



Tuberculosis, coughs not due to, 100 
cures for, 100, 103, 104 

"Deoraden," 108 
danger from rooms vacated by person 

with, 204 
disinfection of articles used by patient 

with, 105 
disinfection of room occupied by person 

with, 205 
explanation of cough with, 99 
fibroid lungs due to, 106 
following pneumonia, 98 
in animals, cause of, 99 
in city and country, 96 
need of medical advice for, 101 
of knee, 102 
of skin, 102 
of spine, cause, symptoms and treatment 

of, 97 
curvature, 97 
preventive measures, 100 
relation of, to age, 96 
symptoms of, very early, early, and later, 

99 
symptoms suggestive of, 100 

in early stage, 108 
treatment of, 105 
when a menace to one's family and 

neighbors, 103 
Tumor, cystic, 986 
in cul-de-sac, 986 
of gums, 753 
Tumors, fibroid, nature of, 787 

phantom, 1283 
Twins, mentality of, 1024 
Typhoid fever, and cesspools, 317 
and malaria, 284 
and milk, 317 
and tuberculosis, 96 
and water filters, 319 
and winter cholera or winter diarrhea, 

319, 320 
developing, 319 
due to typhoid bacillus, 321 
prevention of, by vaccination, 319 

in epidemics, 317 
vaccination against, 317, 319 

Ulcers, of mouth, camphor for, 722 

cause of, 722 

treatment of, 722 
of uterus, local treatment for, 790 
Undescended testicles, 1311 



1366 



INDEX TO QUESTIONS AND ANSWERS 



Uremia, foods to be avoided in tendency 

to, 632 
Urethra, mucus from, 1311 
Urinating, smarting and aching after, not 

indicative of diabetes, 162 
Urine, excessive passing of, 161 
fetid odor in, 980 
gravel in, 634 
testing of, for sugar, 159, 163 

Vaccination, advisability of lay person vac- 
cinating self and family, in ab- 
sence of doctors, 226 

and amputation, 228 

blood test after, 226 

for colds, 608 

immunity to smallpox from, duration of, 
227 

method of, 226 

objections to, 228 

unreliability of any but present-day sta- 
tistics on, 226 
Vaccine, for acne, 734, 735 

for hay fever, 53 

for nasal catarrh, 36 
Varicocele, 1310, 1311 
Varnish, counteracting smell of, 1171 
Vasomotor disturbance, definition of, 608 
Ventilation, and colds, 1170 

and deflectors for open windows, 1164, 
1167 

and drafts and colds, 1168 

and kitchen air, 1169 

and open windows in winter, 1168 

and recirculation of air, 1171 

and sleeping in draft, 1167 

bad, overcoming effects of, 1171 

choice of closed windows or noises, 
1164 

fan system of, 1202 

of cars, 1169, 1171 

of churches, 1172 

of furnace-heated sleeping room, 1165 

of house, method of, 1170 

of office, by window, 1166 

of picture operators' booths, 1202 

of school rooms, 1202 

open windows in sleeping room of in- 
fant, 1166 

suggestion on, 1165 

unhealthy air not necessarily transporter 
of disease, 1168 

without current of air, 1167 



Veronal, for insomnia, 336 
nature of, 336 

Warts, removal of, 719, 730, 731 
Water, at meals, 505 

boiling of, 542 
Weight, and buttermilk, 692 
and worry, 699 
keeping down, 695 
reducing, 687, 692, 694 

and water, 690 

at fifty, 692 

by Epsom salts, 694 

by medicines, 687 

by reducing food, 691, 694 

diet for, 688 

drugs for, 690 

given result of treatment for, 692, 693 

intelligently, 689 

method of, 686 

peril in, 689 

too fast, 690 
to increase, 697, 698, 699 

bread, 699 

by exercise, 1052 

eggs for, 697 

exercise and food for, 697 

food and sleep, 698 

foods for, 696 

haphazardness in, 694 

milk for, 697 
Wen on head, removal of, 729 

olive oil for, 696, 698 
Whisky and alcohol, 342 
Whiteheads, removal of, 734 
Whole wheat flour and graham flour, 650 

and quarantine, 246 
Whooping cough, attendance of moving 
picture shows by children with, 
205 
contagion of, 244, 245 

its duration, 245, 246 

on trains, 245, 246 
control of, 243 

danger of, to infants, 243, 244 
duration of, 245, 246 
fumigation after, by city, 247 
germ of, 243 

its location, 244 
incubation period of, 245 
initial symptoms and course of, 244 
mortality from, 244 
prevention and treatment of, 247 



INDEX TO QUESTIONS AND ANSWERS 



1367 



(VTiooping cough, relief of whoop in, 246 

thick yellow mucus with, 245 
Winter cholera or diarrhea and typhoid 

fever, 319, 320 
Winter itch, 1210, 1212 

treatment of, 1213 
Workers, protecting of, from heat, 909 
Worms and epilepsy, 429 
Worriers, advice for, 1313 



Worry, ill-effects of, 391, 392 
Wounds, treatment of, 892 
Wrinkles, lotions for, 732 

reducing, 731 
Writer's cramp, 908 

X-ray and cancer, 979 

Yawning, frequent, more exercise for, 1057 
Yellow fever, transmission of, 264 



/ Vrf. 






